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目的了解乙肝疫苗的婴幼儿乙型肝炎阻断和隐匿性感染保护效果及影响因素,为有效预防婴幼儿乙型肝炎感染提供实验室依据。方法选择甘肃省武威市7月龄~3岁以内、完成10μg重组乙肝疫苗(汉逊酵母)0-1-6免疫接种程序的婴幼儿,采用分组队列对比法,采集健康组婴幼儿、免疫组(乙型肝炎母亲)婴幼儿及其母亲外周血标本进行HBV血清学和分子生物学检测。结果婴幼儿乙型肝炎感染率健康组0.47%(1/215),免疫组7.87%(17/216),母婴阻断率92.13%(199/216),两队列HBs Ag阳性检出率差异有统计学意义(c2=14.765,P<0.05);抗-HBs阳性率健康组94.42%(203/215)、免疫组88.89%(192/216),HBV-DNA阴性率健康组99.53%(214/215)、免疫组95.37%(206/216);413名HBs Ag阴性婴幼儿中,未检测出HBV-DNA阳性者,婴幼儿乙型肝炎隐匿性(OBI)感染率为0.00(0/413);婴幼儿HBV-DNA阳性者均发生在母亲HBV-DNA阳性者中,占8.93%(10/112);免疫组不同年龄组婴幼儿HBs Ag结果差异有统计学意义(c2=14.259,P<0.05)。结论新生儿出生后按0-1-6程序接种乙肝疫苗和乙型肝炎母亲所生婴幼儿乙肝疫苗联合HBIG并按计划完成疫苗免疫,可以有效阻断婴幼儿感染OBI;7~12月龄乙型肝炎阻断效果较其他年龄组好;母亲HBV-DNA载量影响乙型肝炎母婴阻断效果。
Objective To understand the protective effect and influencing factors of hepatitis B block and occult infection in infants and young children with hepatitis B vaccine and provide a laboratory basis for effective prevention of hepatitis B infection in infants and children. Methods Wuwei City, Gansu Province, from 7 months of age to 3 years old, complete 10μg of recombinant hepatitis B vaccine (Hansenula) 0-1-6 immunization programs of infants and young children, the use of group cohort comparison method, healthy children infants, immune group (Hepatitis B mothers) and their mothers peripheral blood samples for HBV serology and molecular biology tests. Results Hepatitis B infection rate in infants and young children was 0.47% (1/215) in healthy group, 7.87% (17/216) in immunized group, and 92.13% (199/216) in maternal and infant group. The positive rate of HBsAg The positive rate of anti-HBs was 94.42% (203/215) in healthy group, 88.89% (192/216) in immune group and 99.53% (214) in HBV-DNA negative rate healthy group (c2 = 14.765, / 215), and 95.37% (206/216) in the immunized group. The positive rate of OBI in infants with positive HBV-DNA was 0.00 (0/413 ). The positive rate of HBV-DNA in infants and young children was 8.93% (10/112) in mothers with HBV-DNA positive. The results of HBsAg in infants and young children in different age groups were statistically different (c2 = 14.259, P <0.05). Conclusions Newborn babies born with hepatitis B vaccine and HBsAg-HBIG combined with HBIG vaccinated according to the schedule of 0-1-6 and immunized according to plan can effectively block the infantile infection of OBI; 7-12 months of age B Hepatitis B block better than other age groups; mother HBV-DNA load affect hepatitis B maternal and child block effect.