Department of Pediatrics, Cardinal Tien Hospital, New Taipei City, Taiwan.
School of Medicine, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
Hepatology. 2016 Nov;64(5):1451-1461. doi: 10.1002/hep.28589. Epub 2016 May 20.
Despite immunoprophylaxis, hepatitis B virus (HBV) transmission in highly viremic mothers remains a global health issue. Using quantitative maternal surface antigen (HBsAg) to predict HBV infection in infants has not been investigated. We enrolled 526 mother-infant pairs with positive maternal HBsAg under current immunoprophylaxis. Maternal viral load and quantitative HBsAg were measured in the peripartum period. Infant HBsAg seropositivity for more than 6 months was defined as chronic infection. Rates of chronic infection in infants at various maternal HBsAg levels were estimated using a multivariate logistic regression model. Results showed that maternal HBsAg was positively correlated with maternal viral load (r = 0.69; P < 0.001) and accurately predicted maternal viral load above 6, 7, and 8 log IU/mL with an area under the receiver operating characteristic curve (AUC) of 0.97, 0.98, and 0.95. Nineteen infants were chronically infected. After adjustment for the other risk factor, maternal HBsAg level was significantly associated with risk of infection (adjusted odds ratio for each log IU/mL increase, 15.02; 95% confidence interval [CI], 3.89-57.94; P < 0.001). The AUC for predicting infection by quantitative maternal HBsAg was comparable to that by maternal viral load (0.89 vs. 0.87; P = 0.459). Estimated rates of infection at maternal HBsAg levels of 4, 4.5, and 5 log IU/mL were 2.4% (95% CI, 0.1-4.6; P = 0.04), 8.6% (95% CI, 4.5-12.7; P < 0.001), and 26.4% (95% CI, 12.6-40.2; P < 0.001).
Quantitative maternal HBsAg predicts infection in infants as well as maternal viral load does. Antiviral therapy may be considered in pregnant women with an HBsAg level above 4-4.5 log IU/mL to interrupt mother-to-infant transmission. (Hepatology 2016;64:1451-1461).
尽管有免疫预防措施，但高病毒载量的乙型肝炎病毒（HBV）母亲仍存在全球健康问题。使用定量的母体表面抗原（HBsAg）来预测婴儿的 HBV 感染尚未得到研究。我们招募了 526 对在当前免疫预防措施下 HBsAg 阳性的母婴。在围产期期间测量了母体病毒载量和定量 HBsAg。婴儿 HBsAg 持续 6 个月以上阳性定义为慢性感染。使用多变量逻辑回归模型估计了不同 HBsAg 水平的婴儿慢性感染率。结果显示，HBsAg 与母体病毒载量呈正相关（r = 0.69；P <0.001），并能准确预测 6、7 和 8 log IU/ml 以上的母体病毒载量，ROC 曲线下面积（AUC）为 0.97、0.98 和 0.95。19 例婴儿慢性感染。调整其他危险因素后，HBsAg 水平与感染风险显著相关（每增加 1 log IU/ml 的调整优势比，15.02；95%置信区间[CI]，3.89-57.94；P <0.001）。定量母体 HBsAg 预测感染的 AUC 与母体病毒载量相当（0.89 与 0.87；P = 0.459）。在 HBsAg 水平为 4、4.5 和 5 log IU/ml 时，感染率估计值分别为 2.4%（95%CI，0.1-4.6；P = 0.04）、8.6%（95%CI，4.5-12.7；P <0.001）和 26.4%（95%CI，12.6-40.2；P <0.001）。结论：定量的母体 HBsAg 预测婴儿感染的能力与母体病毒载量相当。对于 HBsAg 水平超过 4-4.5 log IU/ml 的孕妇，可能需要考虑抗病毒治疗以阻断母婴传播。（Hepatology 2016；64：1451-1461）
