Tang J R, Hsu H Y, Lin H H, Ni Y H, Chang M H
Department of Pediatrics, College of Medicine, National Taiwan University, Taipei.
J Pediatr. 1998 Sep;133(3):374-7. doi: 10.1016/s0022-3476(98)70272-0.
To investigate the prevalence and outcome of hepatitis B surface antigenemia in newborns of hepatitis B e antigen (HBeAg)-positive hepatitis B surface antigen (HBsAg) carrier mothers under the current immunoprophylaxis program.
From 1984 to 1993, 665 high-risk newborns born to HBeAg-positive HBsAg carrier mothers were prospectively recruited. The newborns were tested for HBsAg soon after birth, before hepatitis B immune globulin administration. All newborns received hepatitis B immune globulin within 24 hours after birth plus subsequent hepatitis B vaccination. Those who were seropositive for HBsAg at birth were regularly followed up for their hepatitis B virus (HBV) markers, liver function profiles, and alpha-fetoprotein levels from 1984 to 1996.
Sixteen (2.4%) of the 665 subjects were found to be seropositive for HBsAg at birth, and all remained HBsAg-positive at 6 months of age. Twelve of the 16 received long-term follow-up care, and all were confirmed to have chronic HBV infection. Of the 12, 2 had HBeAg seroconversion, and 1 had alanine aminotransferase flares without HBeAg seroconversion. Delayed appearance of hepatitis B core antibody (anti-HBc) occurred in 2 without alanine aminotransferase elevation.
Current immunoprophylaxis strategy does not protect newborns with surface antigenemia, apparently acquired in utero, from becoming HBV carriers. Immunologic attempts to eliminate HBV may occur in carrier children infected in utero, despite their profound immune tolerance to HBV.
在当前免疫预防方案下，调查乙肝e抗原（HBeAg）阳性的乙肝表面抗原（HBsAg）携带者母亲所生新生儿中乙肝表面抗原血症的患病率及转归情况。
1984年至1993年，前瞻性招募了665名由HBeAg阳性的HBsAg携带者母亲所生的高危新生儿。新生儿在出生后、注射乙肝免疫球蛋白之前立即检测HBsAg。所有新生儿在出生后24小时内接受乙肝免疫球蛋白注射，并随后接种乙肝疫苗。对出生时HBsAg血清学阳性的新生儿，在1984年至1996年期间定期随访其乙肝病毒（HBV）标志物、肝功能指标及甲胎蛋白水平。
665名研究对象中，16名（2.4%）在出生时HBsAg血清学阳性，且在6月龄时均仍为HBsAg阳性。16名中的12名接受了长期随访，均被确诊为慢性HBV感染。这12名中，2名发生HBeAg血清学转换，1名出现谷丙转氨酶升高但无HBeAg血清学转换。2名出现乙肝核心抗体（抗-HBc）延迟出现且谷丙转氨酶无升高。
当前的免疫预防策略不能保护那些显然在子宫内获得表面抗原血症的新生儿不成为HBV携带者。对于子宫内感染的携带者儿童，尽管他们对HBV具有深度免疫耐受，但仍可能出现免疫清除HBV的尝试。
