乙肝表面抗原阳性母亲所生婴儿乙肝血清学标志物的转变
Transformation of hepatitis B serologic markers in babies born to hepatitis B surface antigen positive mothers.
作者信息
Wang Jian-She, Chen Hui, Zhu Qi-Rong
机构信息
Laboratory of Infectious Diseases, Children's Hospital of Fudan University, 183 Fenglin Road, Shanghai 200032, China.
出版信息
World J Gastroenterol. 2005 Jun 21;11(23):3582-5. doi: 10.3748/wjg.v11.i23.3582.
AIM
To better understand the clinical significance of hepatitis B serologic markers in babies born to hepatitis B surface antigen (HBsAg) positive mothers, the incidence of maternal serologic markers of hepatitis B via placenta and its transformation in these babies were investigated.
METHODS
Mothers with positive HBsAg were selected in the third trimester of pregnancy. Their babies received immunoprophylaxis with hepatitis B immunoglobulin and hepatitis B vaccine after birth, and were consecutively followed up for hepatitis B serologic markers and HBV DNA at birth, mo 1, 4, 7, 12, and 24.
RESULTS
Forty-two babies entered the study, including 16 born to hepatitis B e antigen (HBeAg)-positive HBsAg carrier mothers and 26 to HBeAg-negative HBsAg carrier mothers. Apart from four babies born to HBeAg-positive carrier mothers and demonstrated persistent positive HBeAg eventually became HBV carriers, all other babies developed anti-HBs before 12 mo of age. Among the other 12 babies born to HBeAg-positive carrier mothers, HBeAg was detected in 7 at birth, in 4 at mo 1, and in none of them thereafter. No antibody response to the transplacental HBeAg was detected. Among the babies born to HBeAg-negative carrier mothers, anti-HBe was detected 100% at birth and mo 1, in 88.5% at mo 4, in 46.2% at mo 7, in 4.2% at mo 12 and none in mo 24. Among all the immunoprophylaxis-protected babies born to either HBeAg-positive or HBeAg-negative carrier mothers, anti-HBc was detected in 100% at birth, mo 1 and mo 4, in 78.9% at mo 7, in 36.1% at mo 12 and in none at mo 24.
CONCLUSION
HBeAg can pass through human placenta from mother to fetus and become undetectable before 4 mo of age, but no antibodies response to the transplacental HBeAg can be detected till mo 24 in the immunoprophylaxis-protected babies. The sole existence of anti-HBe before 1 year of age or anti-HBc before 2 years of age in babies born to HBsAg carrier mothers may simply represent the transplacental maternal antibodies, instead of indicators of HBV infection status.
目的
为了更好地理解乙肝表面抗原（HBsAg）阳性母亲所生婴儿乙肝血清学标志物的临床意义，研究乙肝母亲血清学标志物经胎盘的发生率及其在这些婴儿中的转化情况。
方法
在妊娠晚期选择HBsAg阳性的母亲。她们的婴儿在出生后接受乙肝免疫球蛋白和乙肝疫苗免疫预防，并在出生时、1个月、4个月、7个月、12个月和24个月连续随访乙肝血清学标志物和HBV DNA。
结果
42名婴儿进入研究，其中16名婴儿的母亲为乙肝e抗原（HBeAg）阳性的HBsAg携带者，26名婴儿的母亲为HBeAg阴性的HBsAg携带者。除了4名母亲为HBeAg阳性携带者的婴儿最终持续HBeAg阳性并成为HBV携带者外，所有其他婴儿在12个月龄前均产生了抗-HBs。在其他12名母亲为HBeAg阳性携带者的婴儿中，7名出生时检测到HBeAg，4名在1个月时检测到，此后均未检测到。未检测到对经胎盘HBeAg的抗体反应。在母亲为HBeAg阴性携带者的婴儿中，100%在出生时和1个月时检测到抗-HBe，4个月时为88.5%，7个月时为46.2%，12个月时为4.2%，24个月时均未检测到。在母亲为HBeAg阳性或HBeAg阴性携带者的所有接受免疫预防的婴儿中，100%在出生时、1个月和4个月时检测到抗-HBc，7个月时为78.9%，12个月时为36.1%，24个月时均未检测到。
结论
HBeAg可经胎盘从母亲传给胎儿，并在4个月龄前无法检测到，但在接受免疫预防的婴儿中，直到24个月时才检测到对经胎盘HBeAg的抗体反应。HBsAg携带者母亲所生婴儿在1岁前单独存在抗-HBe或2岁前单独存在抗-HBc可能仅代表经胎盘的母体抗体，而非HBV感染状态的指标。
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