婴儿HBV血清学标志物HBsAb、HBeAb、HBcAb阳性模式影响因素分析

发布时间：2019-01-27 10:07

【摘要】：目的:本研究旨在探讨婴儿HBV血清标志物HBs Ab、HBe Ab、HBc Ab阳性影响因素,随访了解HBs Ab、HBe Ab、HBc Ab变化情况,为临床工作提供参考,同时让临床医生进一步了解OBI,使隐匿性HBV感染者得到早期干预。方法:收集2014.1.1-2016.11.30于我院行HBV血清学标志物检测(HBVM)HBs Ab、HBe Ab、HBc Ab阳性且年龄小于6月的5968例婴儿及78例HBV DNA检测结果,从收集的5968例婴儿中筛选出母亲为HBV感染的婴儿,并收集其乙肝疫苗接种、HBIG、母孕期乙肝病毒携带状态、分娩方式、喂养方式等资料。随访部分婴儿HBV血清学标志物检测结果,并对所有资料进行回顾性分析。结果:1.5968例HBs Ab、HBe Ab、HBc Ab阳性婴儿中,新生儿所占比例为69.1%(4121/5968),母亲为HBV阳性者占13.4%(796/5968),HBV感染母亲的婴儿与非HBV感染母亲的婴儿HBs Ab、HBe Ab、HBc Ab测定值差异均具有统计学差异(P=0.0000.05)。2.721例HBV感染母亲的婴儿HBs Ab、HBe Ab、HBc Ab阳性影响因素多重回归分析结果显示:母亲乙肝病毒感染携带状态对婴儿HBs Ab测定值存在显著性负相关,以母亲乙肝大三阳者为参照,母亲HBs Ag(+)者与HBs Ab的回归系数β为-0.249(P=0.0010.05),母亲乙肝小三阳者与HBs Ab的回归系数β为-0.406(P0.001),说明与母亲乙肝大三阳者比,母亲乙肝小三阳、HBs Ag(+)者的HBs Ab测定值更低。其他变量对HBs Ab的测定值影响均没有统计学意义。婴儿年龄对HBe Ab测定值存在显著性正相关(β=0.195,P0.001),年龄越大,HBe Ab测定值越高。另外,母亲乙肝病毒感染携带状态对HBe Ab测定值存在显著性负相关,以母亲乙肝大三阳者为参照,母亲HBs Ag(+)者与HBe Ab的回归系数β为-0.377(P0.001),母亲乙肝小三阳者与HBe Ab的回归系数β为-0.448(P0.001),说明与母亲乙肝大三阳者比,母亲乙肝小三阳、HBs Ag(+)者的HBe Ab测定值更低。其他变量对HBe Ab的影响均没有统计学意义。婴儿年龄对HBc Ab测定值存在显著性负相关(β=-0.377,P0.001),婴儿年龄越大,HBc Ab测定值越低。母亲年龄与HBc Ab测定值存在显著性正相关(β=0.098,P=0.0110.05),母亲年龄越大,HBc Ab测定值越高。另外,以母亲乙肝大三阳者为参照,母亲HBs Ag(+)者与HBc Ab存在显著负相关(β=-0.204,P=0.0040.05),母亲乙肝小三阳对HBc Ab的影响没有统计学意义,说明与母亲乙肝大三阳者相比,母亲HBs Ag(+)者的HBc Ab测定值更低。其他变量对HBc Ab的影响均没有统计学意义。3.78例HBs Ab、HBe Ab、HBc Ab阳性婴儿行HBV DNA检测,有2例母亲为乙肝病毒感染婴儿HBV DNA检测阳性(2/78),其中1例婴儿随访至1岁4月时HBV DNA检测已为阴性。4.52例随访婴儿,男性31例,女性21例,平均随访年龄为2.4岁,所有随访者中,除1例HBc Ab仍为阳性外,其余随访者HBe Ab、HBc Ab均转阴。按随访时间间隔不同分为4组,分别为6月组、6月-1年组、1-2年组、2年组,各随访组中均存在儿童随访后HBs Ab浓度较随访前降低,及HBs Ab无应答或低应答表现,在随访儿童中,母亲是否为HBV感染对其免疫应答失败率无统计学意义(P=0.510.05)。结论:1.所有受检婴儿中,以新生儿出现HBs Ab、HBe Ab、HBc Ab阳性最为常见,HBV感染母亲所生婴儿血清HBe Ab、HBc Ab浓度较非HBV感染母亲所生婴儿高,HBs Ab浓度较非HBV感染母亲所生婴儿低。2.母孕期乙肝病毒感染携带状态可影响婴儿HBs Ab、HBe Ab、HBc Ab浓度,且随着年龄的增长,HBe Ab、HBc Ab浓度逐渐下降。3.部分HBV感染母亲所生婴儿母婴阻断后虽然HBs Ag阴性且HBs Ab阳性,伴或不伴HBc Ab阳性,但血清HBV DNA检测阳性,提示免疫阻断后仍可能存在隐匿性乙肝病毒感染,建议对HBV感染母亲所生婴儿免疫阻断后除完善HBV血清学检查外,若有条件者,还应行HBV DNA检查,对HBs Ag阴性但HBV DNA阳性婴儿,应定期随访.4.随访过程中,大部分婴儿HBe Ab、HBc Ab有转阴趋势,在不同随访年龄阶段均有50%以上的儿童出现随访后HBs Ab浓度较随访前降低,且伴有免疫应答失败或低应答。
[Abstract]:Objective: The purpose of this study was to study the positive factors of HBsAg, HBe Ab and HBc Ab in the infants with HBV serum markers. Follow-up to understand the changes of HBs Ab, HBe Ab and HBc Ab and provide reference for clinical work. Methods: A total of 5968 infants with HBV infection and 78 cases of HBV DNA were collected from the collected 5968 infants, and the hepatitis B vaccine was collected and HBIG was collected from the collected 5968 infants. The status of the hepatitis B virus in the mother's pregnancy, the mode of delivery, the feeding mode and so on. The results of the detection of the serum markers of HBV in the infants were followed up, and all the data were analyzed retrospectively. Results: 1. 5968 of the positive infants with HBs Ab, HBe Ab and HBc Ab, the proportion of the newborn was 61.9% (4121/ 5968), the mother was 13. 4% (796/ 5968) of the HBV-positive, and the infant and non-HBV-infected mother of the HBV-infected mother and the non-HBV-infected mother were the anti-HBs Ab and the HBe Ab. The results of the multiple regression analysis of the positive influence factors of HBc Ab and HBc Ab in the infants with HBV infection showed that the status of HBV infection in the mother had a significant negative correlation with the measured value of the infant's HBs Ab. The regression coefficient of the mother's HBs Ag (+) and the HBs Ab was-0.249 (P = 0. 0010. 05), and the regression coefficient of the mother's B-3-positive and the HBs Ab was-0.406 (P0.001), indicating that the mother's B. The HBs antigen of the HBsAg (+) was lower than that of the HBsAg (+). The effect of other variables on the determination of HBs Ab was not statistically significant. There was a significant positive correlation between the age of the baby and the measured value of the HBe Ab (P = 0.195, P 0.001). The higher the age, the higher the value of the HBe Ab. In addition, there was a significant negative correlation between the status of HBV infection of mother and the value of HBe Ab, and the regression coefficient of the mother's HBs Ag (+) and HBe Ab was-0.377 (P0.01), and the regression coefficient of the mother's hepatitis B and the HBe Ab was-0.448 (P0.001). The results showed that the measured value of HBe Ab for HBsAg (+) was lower than that of the mother's hepatitis B. The effects of other variables on the HBe Ab were not statistically significant. There was a significant negative correlation between the infant age and the measured value of HBc Ab (P =-0.377, P 0.001), the higher the age of the baby, and the lower the value of HBc Ab. There was a significant positive correlation between the age of the mother and the measured value of HBc Ab (P = 0.098, P = 0.0110. 05), the higher the age of the mother, and the higher the measured value of HBc Ab. In addition, there was a significant negative correlation between the mother's HBs Ag (+) and the HBc Ab (P =-0.204, P = 0. 0040. 05), and the effect of the mother hepatitis B triyang on the HBc Ab was not statistically significant. The serum HBc Ab of the mother's HBs Ag (+) was lower. There was no significant difference in the effect of other variables on the HBc Ab. Of these, 1 case was followed up to the age of 1, and the detection of HBV DNA was negative. 4. 52 follow-up infants, 31 males and 21 females. The average follow-up age was 2. 4 years. All the follow-up patients, except 1 case of HBc Ab, were still positive, and all the remaining follow-up HBc Ab and HBc Ab were negative. The follow-up time interval was divided into 4 groups, 6 months, 6 months to 1 year group, 1 to 2 year group and 2 year group. In the follow-up group, the concentration of the HBs Ab was lower than that before the follow-up, and the HBs Ab was no response or low response, and in the follow-up children, The failure rate of the immune response of the mother was not statistically significant for HBV infection (P = 0.510. 05). Conclusion: 1. The HBc Ab and HBc Ab were the most common among all the infants tested, and the serum HBe Ab and HBc Ab in the mother of HBV infection were higher than that of the non-HBV-infected mothers, and the concentration of the HBs Ab was lower than that of the non-HBV-infected mothers. The status of HBV infection in mother pregnant women could affect the concentration of HBc Ab, HBc Ab and HBc Ab, and with the increase of age, the concentration of HBe Ab and HBc Ab decreased gradually. The serum HBV DNA was positive with or without the positive of the HBc Ab, but the HBV DNA in the serum was positive. In addition to improving the serological test of HBV, it is suggested that, in addition to improving the serological test of HBV, if there are conditions, HBV DNA should be checked, and the positive infants with HBsAg negative but HBV DNA should be followed up regularly. 4. During the follow-up, the majority of the infants with the HBe Ab and HBc Ab had a tendency to change the negative. In the different follow-up age, more than 50% of the children had a decrease in the concentration of the HBs Ab after follow-up and accompanied by a failure of an immune response or a low response.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R725.1

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