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目的 探讨对乙型肝炎表面抗原 (HBsAg)阳性母亲分娩新生儿实施母婴阻断的最佳方案 ,探索免疫失败的原因及对策。方法 通过总结东南大学医学院附属南京第二医院 1985～ 2 0 0 3年 32 0 0例HBsAg阳性母亲分娩新生儿实施母婴阻断后的血清乙型肝炎病毒 (HBV)标志物资料 ,根据不同阻断方案分成 5组 :血源疫苗组(第 1组 )、血源联合组 (第 2组 )、基因疫苗组 (第 3组 )、基因联合组 (第 4组 )和宫内阻断组 (第 5组 )。其中共 977例婴儿随访至 12个月龄。观察、比较各组婴儿出生时及 1、6、12个月龄时的HBsAg、乙型肝炎表面抗体 (HBsAb)的阳性率。结果 第 5组 12个月龄时HBsAg阳性率仅为 4 0 % ,保护率达 96 0 % ,与前 4组比较差异有显著性意义 (P <0 0 5或P <0 0 1)。第 4、5组比较 ,出生时HBsAb检出率分别为 8 3%、81 0 % ,差异有显著性意义(P <0 0 1) ;宫内感染率分别为 5 1 7%、32 0 % ,差异有显著性意义 (P <0 0 5 ) ;免疫失败率为 19 4 %、12 5 % ,差异有显著性意义 (P <0 0 5 )。第 2、4组 12个月龄时HBsAg的阳性率分别低于第 1、3组 ,HBsAb阳性率高于第 1、3组 ,差异有显著性意义 (P <0 0 5 )。双阳组、单阳组母亲分娩新生儿 12个月龄时HBsAg的阳性率分别为2 0 1%、7 8% ,差异有显著性意
Objective To explore the best way to block the newborn infants born to hepatitis B surface antigen (HBsAg) positive mothers and explore the reasons and countermeasures of immune failure. Methods The data of serum hepatitis B virus (HBV) markers after maternal and infant blockage were analyzed in neonates delivered from 320 HBsAg positive mothers in Nanjing Second Hospital Affiliated to Medical College of Southeast University from 1985 to 2003, The blocking protocol was divided into five groups: the blood-borne vaccine group (group 1), the blood group (group 2), the gene vaccine group (group 3), the gene combination group (group 4) (Group 5). A total of 977 infants were followed up to 12 months of age. The positive rates of HBsAg and HBsAb at the time of birth and 1, 6 and 12 months of age in each group were observed and compared. Results The positive rate of HBsAg in group 5 at 12 months of age was only 40% and the protection rate was 96 0%. There was significant difference between the 4 groups (P <0.05 or P <0.01). In group 4 and group 5, the detection rates of HBsAb at birth were 83% and 81 0%, respectively, with significant difference (P <0.01). The intrauterine infection rates were 51.7% and 32.0% (P <0.05). The rates of immune failure were 19.4% and 125%, respectively, with significant difference (P <0.05). The positive rates of HBsAg in groups 12 and 12 were lower than those in groups 1 and 3 respectively (P <0.05). The positive rates of HBsAb in groups 2 and 4 were higher than those in groups 1 and 3 (P <0.05). The positive rates of HBsAg in Shuangyang group and single Yang group mothers at delivery of 12 months old were 20% and 78% respectively, the difference was significant