婴儿出生时 HBsAg(+)母亲的乙肝疫苗无应答与 HBsAg 的胎盘转移有关。
No response to hepatitis B vaccine in infants born to HBsAg(+) mothers is associated to the transplacental transfer of HBsAg.
机构信息
a The Department of Infectious Disease , First Affiliated Hospital of Medicine College, Xi'an Jiaotong University , Xi'an , Shaanxi , China.
b The Department of Rheumatism , First Affiliated Hospital of Medicine College, Xi'an Jiaotong University , Xi'an , Shaanxi , China.
出版信息
Infect Dis (Lond). 2017 Aug;49(8):576-583. doi: 10.1080/23744235.2017.1292541. Epub 2017 Feb 19.
BACKGROUND
No or low hepatitis B (HB) vaccine response is more frequent in infants from HBsAg(+) mothers than those from HBsAg(-). Our previous study found temporary positivity of HBsAg in infants from HBsAg(+) mothers. In this study, we hypothesized that HBsAg in infant blunt immune response to standard hepatitis B vaccination.
METHODS
A total of 328 consecutive HBsAg(+) mothers and their offspring were enrolled. Blood samples were taken from mothers and their infants and quantified for HBsAg, anti-HBs titer and HBV DNA load concentration; Placenta samples were collected to stain for HBsAg.
RESULTS
First, 6.7% infants (22/328) showed anti-HBs titer lower than 10 mIU/mL after HB vaccination (non-response to HB vaccine). HBsAg(+) newborns showed higher risk of non-response than HBsAg(-) infants (13.0% versus 5.0%, p = 0.016). Infants from high HBsAg titer mothers displayed higher risk of HBsAg positivity at birth than those from low titer mothers (45.3% versus 2.8%, p < 0.001). HBsAg titer in mothers of HBsAg(+) newborns was much higher than mothers of HBsAg(-) newborns (p < 0.001). All those data supported HBsAg can be transferred through placenta. Our hypothesis was further reinforced by immunostaining with specific antibody against HBsAg, a substantial higher prevalence (87.5% versus 30.8%, p = 0.024) and stronger immunostaining (p = 0.008) was demonstrated in HBsAg(+) group comparing with placenta of the HBsAg(-) group.
CONCLUSION
No response to HB vaccine in infants of HBsAg(+) mothers was associated to the transplacental transfer of HBsAg.
背景
与 HBsAg（-）母亲的婴儿相比，来自 HBsAg（+）母亲的婴儿更常出现乙型肝炎（HB）疫苗无应答或低应答。我们之前的研究发现 HBsAg（+）母亲的婴儿中 HBsAg 呈暂时阳性。在这项研究中，我们假设 HBsAg 阻断了婴儿对标准乙型肝炎疫苗接种的免疫反应。
方法
共纳入 328 例连续的 HBsAg（+）母亲及其后代。从母亲及其婴儿采集血样，检测 HBsAg、抗-HBs 滴度和 HBV DNA 载量浓度；收集胎盘样本进行 HBsAg 染色。
结果
首先，328 例婴儿中有 6.7%（22/328）在乙型肝炎疫苗接种后抗-HBs 滴度低于 10 mIU/mL（对乙型肝炎疫苗无应答）。HBsAg（+）新生儿对乙型肝炎疫苗无应答的风险高于 HBsAg（-）婴儿（13.0%比 5.0%，p=0.016）。来自高 HBsAg 滴度母亲的婴儿出生时 HBsAg 阳性的风险高于来自低滴度母亲的婴儿（45.3%比 2.8%，p<0.001）。HBsAg（+）新生儿母亲的 HBsAg 滴度明显高于 HBsAg（-）新生儿母亲（p<0.001）。所有这些数据均支持 HBsAg 可通过胎盘转移。我们的假设进一步通过针对 HBsAg 的特异性抗体免疫染色得到加强，与 HBsAg（-）组相比，HBsAg（+）组的阳性率（87.5%比 30.8%，p=0.024）和免疫染色强度（p=0.008）均显著升高。
结论
HBsAg（+）母亲的婴儿对乙型肝炎疫苗无应答与 HBsAg 的胎盘转移有关。
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