摘要
目的 检测新生儿外周血干扰素-γ（IFN-γ）和白介素-10（IL-10）含量，探讨HBsAg阳性母亲妊娠中晚期服用替比夫定对婴儿乙型肝炎（乙肝）疫苗无/弱应答的影响。方法 采用双向性队列研究方法，选择2011年7月至2013年1月在太原市第三人民医院产科分娩的321对HBsAg阳性孕妇及新生儿，根据HBsAg阳性孕妇妊娠中晚期替比夫定服用情况将其分为服药组和未服药组，对新生儿全程接种乙肝疫苗并随访至12月龄。采用电化学发光法（ECLIA）和荧光定量聚合酶链反应（FQ-PCR）分别检测母亲、新生儿及婴儿外周血HBV血清学标志物与HBV DNA，ELISA检测新生儿外周血IFN-γ、IL-10含量。结果 乙肝疫苗无/弱应答率为17.99%。非条件logistic回归显示，HBsAg阳性母亲妊娠中晚期服用替比夫定是婴儿乙肝疫苗无/弱应答的保护因素（aRR=0.119，95%CI：0.014~0.974）；以新生儿血清IFN-γ、IL-10含量中位数为界分为高含量组与低含量组，研究发现服药组发生新生儿血清IFN-γ、IL-10高含量的可能性较大（aRR=8.684，95%CI：1.977~38.140；aRR=5.330，95%CI：1.278~22.236），新生儿血清IFN-γ、IL-10高含量组发生乙肝疫苗免疫无/弱应答的可能性较小（aRR=0.300，95%CI：0.105~0.857；aRR=0.104，95%CI：0.030~0.354）。结论 HBsAg阳性母亲妊娠中晚期服用替比夫定发生婴儿乙肝疫苗无/弱应答的可能性较小，其可能通过促进新生儿IFN-γ和IL-10分泌来降低婴儿乙肝疫苗无/弱应答发生风险。
Objective To explore the effect of telbivudine treatment in a prevention program on infants born to HBsAg-positive mothers with non-/hypo-responsiveness to hepatitis B vaccine. Methods A retrospective cohort study with a total of 321 HBsAg-positive pregnant women and their infants enrolled, was conducted. The mothers were recruited from the Third People＇s Hospital of Taiyuan, from July 2011 to January 2013. According to the situation of telbivudine intake in second and third trimesters of pregnancy, the participants were divided into two groups：with telbivudine-treated or as control. The neonates were followed up till the age of 12 months. Maternal, neonatal and infantile HBV-M together with HBV DNA in serum were measured using the electro-chemiluminescence immuno-assay （ECLIA） kits and fluorescence quantitative polymerase chain reaction （FQ-PCR） assay, respectively. Results The rate of non-/hypo-response was 17.99%. After adjusting the potential confounding factors, the telbivudine treatment on HBsAg-positive mothers in the second and third trimesters of pregnancy seemed as the protective factor for non-/hypo-response to hepatitis B vaccine in infants （aRR=0.119, 95%CI：0.014-0.974）. Levels of IFN-γ and IL-10 in telbivudine-treated group were higher than those in the controls （aRR=8.684, 95%CI：1.977-38.140; aRR=5.330, 95%CI：1.278-22.236）. When the serum levels of IFN-γ and IL-10 in neonatal peripheral blood were higher than 228.47 pg/ml and 174.05 pg/ml respectively, the infants were less likely to be non-/hypo-responsive to the hepatitis B vaccine （aRR=0.300, 95%CI：0.105-0.857） （aRR=0.104, 95%CI：0.030-0.354）. Conclusion Telbivudine treatment provided for the HBsAg-positive mothers in second and third trimesters of pregnancy were less likely to develop non-/low-responsive to hepatitis B vaccine in infants since IFN-γ and IL-10 might have played a vital role in this process.
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2017年第2期168-172,共5页
Chinese Journal of Epidemiology
基金
国家自然科学基金（81072341,81573212）
