| ObjectiveTo observe the rate of Hepatitis B virus intrauterine infection through detection of HBV surface markers of newborns'cord blood, and evaluate the efficacy of injection of HBIG; To evaluate the efficacy of active-passive immunity effectiveness of HBVac combined HBIG, through detecting HBV serum makers of a year old infants; and to explore the mechanism of immunity failure by detecting Dendritic cell (DC) subgroups, T cell subgroups and cytokines of peripheral blood of infants with HBV intrauterine infection, to further enhance immunity effectiveness, and to provide theoretical basis for protecting high-risk infants.MethodsMothers (318)with positive Hepatitis B surface antigen (HBsAg)in the third trimester of pregnancy and their newborns (179)were selected in Jinan Maternal and Child Health Hospital, according to the results of the HBV surface marks of cord blood, observed the rate of intrauterine infection of different groups. 179 newborns during the first year after birth passive-active immunoprophylaxis with hepatitis B immune globulin and hepatitis B vaccine, 150 newborns of non- HBV carrier pregnant received hepatitis B vaccine at 0, 1 and 6 months of age, then followed up yearly, HBV serological marks were investigated by ELISA, to observe the immunity effectiveness,and in accordance with the results divided the infants of intrauterine infection into two groups, the immunity successful group and the immunity failure group, and infants were respectively carried on detection of cytokines of peripheral blood by ELISA and detection of DC subsets and T subsets of peripheral blood by flow cytometry, compared the difference between two groups and explored the mechanism of immunity failure.Results1. The rate of HBV intrauterine infection: the epidemiological investigation displayed the rate of HBV intrauterine infection of newborns was 17.59% (57/324). The rate of newborns of HBV carrier pregnant women with injection of HBIG was 9.76% (16/164); the rate of group of non-injection with HBIG was 25.63% (41/160), the difference is significant. The injection of HBIG in late pregnancy can effectively block the HBV intrauterine infection. The rate of HBV intrauterine infection of newborns from HBsAg and HBeAg double positive carrier pregnant women was highest than the control groups (χ2=9.52, P <0.05) , which was 25.19% (34/135).2. Result of Interactive analysis:There was positive interaction between non-injection of HBIG and HBeAg-positive,and I(AB) was 6.57,AP(AB) was 57.84%,AP*(AB) was 63.44%;There was also positive interaction between non-injection of HBIG and uterine-incision delivery, I(AB),AP(AB) and AP*(AB) respectively was 0.61,8.6% and 9.95%3. The effectiveness of Active-Passive Immunization: the epidemiological investigation showed that the immunization success rate and immunization failure rate of infants of non-HBV carrier Pregnant women respectively was 88.67% (133/150) and 11.33% (17/150); the immunization success rate and immunization failure rate of the infants with HBV intrauterine infection was 59.18% (29/49) and 40.82% (20/49); the immunization success rate and immunization failure rate of the infants with non-HBV intrauterine infection was 77.05% (94/122) and 22.95% (28/122), and chronic HBV infection incidence of different groups was 0.67% (1/150), 18.37% (9/49) and 1.64% (2/122) respectively.4. The result of DC cell subgroups and T cell subgroups of peripheral blood with FCM: The percentage and absolute number of MDC, PDC in immunity failure group (0.18%±0.08%), (12.94±5.97)×l06/L and (0.16%±0.09%), (11.75±7.36)×106/L were lower than those of immunity successful group (0.30%±0.12%), (20.28±6.82)×l06/L and (0.28%±0.12%), (18.01±5.58)×106/L. And the difference between two groups were significant (P <0.05); The percentage of CD4+ T and CD4+/CD8+ in immunity failure group (32.94%±7.58%) and (1.13±0.50) were lower than those of immunity successful group (39.55%±8.80%) and (1.66±0.51). The percentage of CD8+ T in immunity failure group (29.61%±7.08%) was higher than that of immunity successful group (24.62%±7.23%). And the difference between two groups was significant (P <0.05).5. The result of cytokines of peripheral blood by ELISA: The expressions of IL-12, IL-23 and IFN-γof immunity failure group were 31.38±5.44 pg/ml, 30.35±0.64 pg/ml and 30.45±7.38 pg/ml, which were significantly lower than immunity successful group (40.30±6.48 pg/ml, 32.68±2.08 pg/ml and 35.54± 7 .90 pg/ml) (P<0.05).6. The correlation between cytokines, T cell subgroups and DC cell subgroups: There was a positive correlation between IL-12 and DC1%, with lower lever DC1% and lower expression of IL-12. And there was a positive correlation between IFN-γand DC2%, with lower lever DC2% and lower expression of IFN-γ; and the same to IL-12 and IFN-γ. And there was a positive correlation between CD4+ T and DC cell subgroups.Conclusions1. The injection of HBIG in late pregnancy can effectively block HBV intrauterine infection; There was no relationship between uterine-incision delivery and vaginal delivery and HBV intrauterine infection; but injection of HBIG and uterine-incision delivery can more effective blocked HBV intrauterine infection, and there was positive interaction between them,and there was also positive interaction between non-injection of HBIG and HBeAg-positive.2. There was relationship between Infant's intrauterine infection and immunity effectiveness of hepatitis B vaccine (OR=2.315, P<0.05), which may be one reason of immunity failure.3. The lower level of DC subgroups depressed ability of antigen presentation, and induced the ability of Specific immune response was declined, which may be one of the important factors of immunity failure of HBV intrauterine infection.4. The lower level of CD4+% and CD4+/CD8+ and the higher level of CD8+% demonstrate the imbalance of T subsets in immunity failure group, cellular immune function was disordered, which induced immunity failure .5. The lower expression of IL-12, IL-23 and IFN-γin immunity failure group depressed cellular immunity and humoral immunity, cytokine response capacity were lower, which maybe one reason of immunity failure. |
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