中国4省(区市)早产儿和足月儿乙型肝炎疫苗免疫应答多中心比较研究

目的 分析早产儿和足月儿乙型肝炎(乙肝)疫苗(HepB)抗体免疫应答。方法 按照多中心研究方法, 以北京、山东、江苏、广西4省(区市)为研究现场, 选取按照0-1-6程序、使用5ng重组HepB(酿酒酵母)(HepB-SC)或10ng重组HepB(汉逊酵母)(HepB-HP)完成HepB初免的7~12月龄婴儿;以其中全部早产儿作为早产儿组, 按照I:1随机选择其中Hq>B种类、月龄、性别和居住地相同的足月儿作为足月儿组。对所有研究对象进行问卷调查, HepB免疫史根据接种卡确定;同时采集静脉血2ml, 使用化学发光微粒子免疫分析法检测血清HBV表面抗体(抗-HBs);比较两组婴儿抗体应答率和抗体水平。结果 4省(区市)共调査648对婴儿。早产儿组初免无应答率、低应答率、正常应答率和髙应答率分别为1.39%, 8.64%、45.83%和44.14%, 足月儿组分别为1.08%、9.26%、44.91%和44.75%, 两组4项指标差异均无统计学意义(口>0.05);两组初免后抗-HBs几何平均浓度(GMT)分别为755.14和799.47mlU/ml, 差异无统计学意义(P>0.05)。多因素条件logistic回归分析显示, 排除出生体重、分娩方式、胎次、产程损伤和父母乙肝病毒表面抗原状态后, 是否早产与HepB抗体应答率无关(P>0.05)。结论 早产儿和足月儿HepB免后抗体应答无明显差异.可以按照相同的HepB免疫策略进行接种。     

健康人群乙型肝炎疫苗再免疫抗体应答

目的探讨不同年龄组健康人群接种不同类型、不同剂量乙型肝炎（乙肝）疫苗（Hepatitis B Vaccine,HepB）的再免疫抗体应答。方法采用分层随机抽样方法,按地域分布选取东莞市5个镇2～4、6～8、13～15、16～40岁4个年龄组健康人群,用酶联免疫吸附试验筛查乙肝病毒核心抗体、乙肝病毒表面抗原和乙肝病毒表面抗体均为阴性,且有3剂HepB免疫史的人作为再免疫研究对象。采用5μg重组HepB（酵母）（HepB Made by Recombinant DNA Techniques in Yeast,HepB-Y）、10μg HepB-Y、10μg重组HepB（中国仓鼠卵巢细胞）（HepB Made by Recombinant DNA Techniques in CHO Cell,HepB-CHO）、10μg重组HepB（汉逊酵母）（HepB Made by Recombinant DNA Techniques in Hansenula Yeast,HepB-HY）、20μg HepB-CHO和20μg HepB-Y,均按0、1、6个月程序再免疫3剂。结果不同类型不同剂量HepB在人群中的再免疫成功率和抗体水平中位数[毫国际单位/毫升（mIU/ml）]分别为：5μg HepB-Y94.34%和226.53,10μg HepB-Y86.46%和175.36,10μg HepB-CHO97.39%和331.44,10μg HepB-HY91.30%和439.01,20μg HepB-CHO99.20%和386.66,20μg HepB-Y89.04%和372.97。各年龄组的再免疫成功率和抗体水平中位数（mIU/ml）分别是：2～4岁98.25%和353.42,6～8岁96.80%和320.31,13～15岁94.67%和282.12,16～40岁87.76%和305.24。结论年龄、疫苗种类和剂量是影响再免疫抗体应答的主要因素,随年龄的增长再免疫抗体应答下降,更换疫苗种类可提高再免疫抗体应答。     

乙型肝炎疫苗加强接种的免疫应答反应

本文对87例HBsAg阳性无症状携带者母亲所生之新生儿应用HBIG和?或乙肝疫苗阻断.在1～5岁期间,每年随访一次.当这些儿童的抗-HBs下降到S/N值(RIA)<10时,随即给予乙肝疫苗加强接种,这样共有166例次接受了加强注射.经加强接种后1年复查共有65例次(36.2%)的儿童重新获得有效水平保护性抗-HBs,平均滴度达30.8.本文还观察到初免的应答效果对加强接种的免疫应答有显著相关性,大多数初免反应良好者,加强接种后抗-HBs滴度高;所需接受的加强接种次数少;有效水平保护性抗-HBs维持时间长.结果显示机体的免疫机制状态不仅决定了初免反应的强弱,也决定了加强接种后的免疫应答状况.初免方法及加强接种的剂量与加强接种的免疫应答强弱间在本组未见有明显相关性.     

新生儿乙型肝炎疫苗免疫持久性和加强免疫应答研究

为了观察新生儿乙型肝炎(乙肝)疫苗免疫后长期的预防保护效果及加强免疫后的免疫应答状况和特点,在乙肝疫苗试点区,每隔1～2年,采取整群随机抽样方法对1985～1988年出生的新生儿接种乙肝疫苗后的效果随访1次,随访15年,共观察5006人.将血源乙肝疫苗免疫后9～11年的170名儿童分为3组,用重组(酵母)乙肝疫苗分别进行1～3剂次的加强免疫,每剂次5μg,然后采血用固相放射免疫法检测乙肝病毒表面抗原(HBsAg)和抗体(抗-HBs).结果显示新生儿血源乙肝疫苗全程免疫后抗-HBs阳性率为92.83%,几何平均滴度(GMT)为200.91;而至14～15岁时分别下降为45.31%和27.95%,说明15年后约有55%的儿童抗-HBs在保护性水平以下(＜10mIU/ml),而HBsAg阳性率为1.38%,与全程免疫后1年相比差异无显著的统计学意义.加强免疫后1年,3个不同剂次加强免疫组的抗-HBs GMT迅速升高,为原来的6～18倍;抗-HBs阳性率也由免疫前的62.5%～66.7%上升至100.0%.但随着加强免疫时间的延长,抗-HBs的GMT和阳性率逐渐下降,至免疫后3年,1针加强免疫组抗-HBs阳性率降至71.2%,2针组降至79.2%,而3针组仅降至92.5%.表明国产血源乙肝疫苗具有持久的预防保护效果,以及良好的免疫回忆反应;加强免疫的效果与加强免疫针次和加强免疫前的免疫状况有密切的关系.因此,在开展新生儿乙肝疫苗普种的地区,如果需要,可以进行重组(酵母)乙肝疫苗5μg 3针加强免疫,初免后抗体水平较低者尤应如此.     

北京市海淀区新生儿乙型肝炎疫苗免疫效果分析

目的评价北京市海淀区新生儿12月龄内全程接种10μg酵母乙型肝炎疫苗(Hepatitis B vaccine,HepB)免疫效果。方法于2009年8~9月对在京居住时间≥6个月、12月龄内完成全程HepB接种的儿童家长进行调查,获得儿童一般情况、居住地区性质、HepB接种情况、体重、身长、出生时体重、是否早产、母亲分娩方式、喂养方式、母亲乙肝表面抗原(Hepatitis B surface antigen,HBsAg)和乙肝e抗原(Hepatitis B e antigen,HBeAg)、父亲HBsAg情况等数据,采集被调查儿童静脉血标本2 ml,定量检测乙肝表面抗体(抗-HBs)和HBsAg。结果共调查7~15月龄儿童691名,纳入分析666名,儿童无HBsAg阳性出现,抗-HBs阳性(≥10 IU/L)率达99.8%(665/666),抗-HBs浓度最小的6.99 IU/L,最大的超过15 000 IU/L,平均几何浓度(geometric mean concentration,GMC)为1 527.0 IU/L,中位数为1 337.2 IU/L;男童抗-HBs GMC(1 719.1 IU/L)和女童(1 342.2 IU/L)、采血时间距HepB3间隔≥60 d的儿童GMC(1 342.2 IU/L)和60 d的儿童GMC(1 342.2 IU/L)比较,差异有统计学意义(F=7.222,P=0.007;F=36.487,P0.001);抗-HBs阳性的儿童中,低应答率(抗-HBs≥10 IU/L且100 IU/L)1.2%,中应答率(抗-HBs≥100 IU/L且1 000 IU/L)34.0%,高应答率64.8%。结论北京市海淀区新生儿12月龄内全程接种HepB后,产生的抗-HBs阳性率高。抗-HBs阳性的儿童中,抗-HBs GMC随着采血时间和HepB3间隔的延长而降低,男童抗-HBs GMC高于女童。     

成人重组酿酒酵母和汉逊酵母乙型肝炎疫苗免疫应答及相关因素研究

乙型肝炎(乙肝)疫苗(HepB)是乙肝防治的有效手段。我国自1992年在新生儿中普种HepB、儿童HBsAg携带率显著下降,但成人HBsAg携带率仍较高。     

重组乙型肝炎疫苗(啤酒酵母)和重组乙型肝炎疫苗(汉逊酵母)在成人中的抗体应答

目的观察重组乙型肝炎(乙肝)疫苗(啤酒酵母)和重组乙肝疫苗(汉逊酵母)在成人中的乙肝病毒表面抗体(抗-HBs)应答。方法对乙肝病毒表面抗原(HBsAg)阴性、且未接种过乙肝疫苗的新入学大学生,全程接种重组乙肝疫苗(啤酒酵母)和重组乙肝疫苗(汉逊酵母),观察抗-HBs应答。结果接种10μg、5μg、5μg重组乙肝疫苗(啤酒酵母)的136人,抗-HBs阳转率94.1%,几何平均浓度(GMC)105.42毫国际单位/毫升(mIU/ml);接种10μg×3重组乙肝疫苗(汉逊酵母)的136人,抗-HBs阳转率99.3%,GMC 111.49mIU/ml。接种两种疫苗均未观察到明显的不良反应。结论采取10μg×3的免疫程序接种重组乙肝疫苗(汉逊酵母)的抗-HBs阳转率和GMC均高于采用10μg、5μg、5μg免疫程序接种重组乙肝疫苗(啤酒酵母)。     

TLR基因多态性对广西汉族儿童乙型肝炎疫苗初次免疫应答水平的影响

  目的  探讨Toll样受体(toll-like receptors,TLR)基因多态性与广西汉族儿童乙型肝炎(以下简称乙肝)疫苗初次免疫应答水平的关联。  方法  收集2014-2016年到广西自治区妇幼保健院、南宁市妇幼保健院儿科就诊的8~9月龄汉族儿童513例为研究对象。采集外周血标本,采用微粒子酶免疫法检测乙肝血清标志物"两对半",用套式聚合酶链式反应法检测乙肝病毒DNA,应用SNPscanTM多重SNP分型技术检测TLR基因10个位点的基因多态性。采用非条件Logistic回归分析TLR等位基因、基因型与儿童乙肝疫苗免疫后应答的关联。  结果  TLR3基因rs13126816的基因多态性与广西汉族儿童初次乙肝疫苗免疫后应答情况有关(OR=1.79,95% CI:1.11~2.89,P=0.018);A/A基因型[238.04(519.75) mIU/L]和G/A基因型[347.96(619.68) mIU/L]儿童的乙肝病毒表面抗体(hepatitis B surface antibody,抗-HBs)水平明显低于G/G基因型[489.08(854.76) mIU/L]的儿童,差异均有统计学意义(均有P < 0.05);携带等位基因A[317.20(608.72) mIU/L]儿童的抗-HBs水平也明显低于携带等位基因G[457.01(852.66) mIU/L]的儿童,差异有统计学意义(Z=-3.055,P < 0.05)。TLR基因其余位点均与乙肝疫苗免疫应答无关(均有P>0.05)。  结论  TLR3基因rs13126816位点等位基因A可能是汉族儿童产生初次乙肝疫苗免疫低应答的影响因素。     

乙型肝炎疫苗初次免疫正常应答和高应答新生儿在幼儿期加强免疫对免疫保护持久性影响的配对病例对照研究

目的 探讨乙型肝炎(乙肝)疫苗加强免疫对初次免疫(初免)正常应答和高应答新生儿免疫持久性的影响。方法 选择乙肝疫苗初免正常应答和高应答新生儿,在其幼儿期(2~3岁)时加强免疫3剂次者作为加强免疫组,按照1:1匹配原则随机选择性别、居住乡镇相同的未加强免疫者作为未加强免疫组;于初免5年后采血检测抗-HBs和抗-HBc。结果 加强免疫组和未加强免疫组初免5年后抗-HBs阳性率分别为97.39%(224/230,95%CI:94.41%~99.04%)和53.91%(124/230,95%CI:47.24%~60.48%),几何平均抗体浓度(GMC)分别为1140.02(95%CI:887.46~1464.46) mIU/ml和11.53(95%CI:8.73~15.23) mIU/ml;两组5年随访抗体阳性率和GMC值的差异均有统计学意义(P<0.05)。两组HBV突破性感染率分别为0.87%(2/230)和2.17%(5/230),差异无统计学意义(P>0.05)。多因素分析表明,初免5年后抗-HBs阳性率与是否加强免疫和初免时抗-HBs水平独立相关,OR值分别为38.75(95%CI:16.23~92.54)和3.06(95%CI:1.51~6.17)(P值均<0.05)。结论 乙肝疫苗初免正常应答或高应答儿童在幼儿期加强免疫可有效提高抗体持久性,但对预防HBV感染可能无明显作用。     

乙型肝炎疫苗免疫应答影响因素非条件logistic回归分析

目的探讨多种因素与乙型肝炎(乙肝)疫苗免疫应答的关系。方法对隆安县1151名3—4岁儿童采血检测乙肝抗体、乙肝表面抗原和乙肝核心抗体,并进行多因素非条件logistic回归分析。结果山区4岁年龄组、母亲HBsAg阳性和疫苗保存对儿童乙肝疫苗免疫应答可能有一定的影响,但母亲携带HBsAg对其儿童乙肝疫苗免疫成功后有加强免疫作用。结论为今后乙肝免疫预防工作提供参考。     

乙型肝炎病毒核心抗体单项阳性及健康的成年人乙肝疫苗免疫效果配对比较研究

目的：探讨单项乙型肝炎（乙肝）病毒核心抗体（抗-HBc）阳性成年人接种乙肝疫苗（HepB）的免疫效果。方法筛选出HBsAg、抗-HBs阴性及抗-HBc阳性,既往无HepB免疫史的18～49岁者组成抗-HBc单项阳性组（单阳组）,并按1∶1匹配原则选择对照组。依照“0-1-6”免疫程序对单阳组和对照组接种HepB,对两组无应答者再次按该免疫程序接种HepB,比较两组人群抗-HBs阳转率及其滴度。结果两组人群共调查228对。对照组和单阳组初次免疫抗体阳转率分别为91.23%和91.67%,差异无统计学意义（χ2＝0.00,P＞0.05）。对照组无应答率、低应答率、正常应答率和高应答率分别为8.77%、11.84%、31.14%和48.25%,单阳组分别为8.33%、30.70%、35.96%和25.00%,对照组低应答率低于单阳组（χ2＝22.28,P＜0.01）,高应答率高于单阳组（χ2＝24.43,P＜0.01）。初次免疫后对照组抗-HBs几何平均浓度（534.07 mIU/ml）高于单阳组（183.99 mIU/ml）,差异有统计学意义（u＝4.42,P＜0.01）;再次免疫1针后,对照组应答率（82.35%）高于单阳组（41.18%）（P＜0.05）,再免疫3针后两组应答率分别达到90.00%和82.35%（P＝1.00）。结论抗-HBc单阳者HepB初次免疫可获得较好的免疫应答,但低于一般人群;初次免疫无应答的抗-HBc单阳者3剂次再免疫可获得较高阳转率。     

Antibody response to hepatitis B vaccine is independently associated with hepatitis B breakthrough infection among adults: Results from a three-year follow-up study in China

Hepatitis B breakthrough infection (HBBI) and its risk factors are rarely reported among adults in China. In 2009–2010 in three townships of China, hepatitis B vaccine (HepB) administration and anti-HBs detection after HepB were conducted among the residents aged 18–59 years. HBsAg, anti-HBs and anti-HBc were detected for these vaccinees in 2013. A total of 252 out of 4701 vaccinees turned to be positive for anti-HBc in 2013, but nobody was positive for HBsAg. The HBBI rate was 5.36% (95% CI 4.73, 6.04). The highest rate was found in age-group of 18–29 years (7.33%, 95% CI: 5.31, 9.82). The rate was significantly different by the residential townships (P < 0.001) and by the antibody response to HepB (P = 0.003). Multivariate analysis showed that anti-HBs response to HepB was the independent risk factor of HBBI. The study documents the association between hyporesponse to HepB and HBBI among adults. It also suggests more attention should be given to new HBV infection among young adults.     

宁波市1085名新生儿接种重组酵母乙型肝炎疫苗后低无应答率及影响因素分析

接种乙型肝炎(乙肝)疫苗是预防乙肝最有效的手段。然而研究发现．正常人接种乙肝疫苗后仍有5％~10％出现低无免疫应答。为了解宁波市新生儿接种乙肝疫苗后的免疫效果,对该市按0、1、6程序接种3针5 μg重组酵母乙肝疫苗的新生儿进行乙肝血清学检测。     

蒙阴县实施补种乙型肝炎疫苗项目前后学生乙型肝炎抗体水平的研究

目的观察实施补种乙型肝炎(以下简称乙肝)疫苗项目前后疫苗应答效果,为后续学生乙肝预防方案提供依据。方法对随机抽取的甲、乙2所学校的1 364名学生,在补种乙肝疫苗项目前后,分别采用胶体金法检测指血中乙肝抗体(抗-HBs),对质控区和测试区同时出现红带判定为阳性。统计方法采用χ2检验。结果①通过实施乙肝补种项目,1 364名学生抗-HBs检出率由补种前的71.0%上升为86.6%,补种前后差异有统计学意义(χ2=99.47,P0.01)。②学校甲在补种前抗-HBs检出率为68.6%,学校乙为76.1%,差异有统计学意义(χ2=7.65,P0.01);补种后抗-HBs检出率基本相近,差异无统计学意义(χ2=1.71,P0.05)。③补种前,五年级的学生抗-HBs的检出率高于七年级,分别为76.2%和63.4%,差异有统计学意义(χ2=25.97,P0.01);补种后,五年级学生抗-HBs的检出率为89.5%,也高于七年级的82.4%,差异有统计学意义(χ2=13.98,P0.01)。④男女学生在补种前抗-HBs检出率分别为72.8%和68.6%,差异无统计学意义(χ2=2.92,P0.05)。补种后,男女学生的抗-HBs检出率分别87.7%和85.2%,差异无统计学意义(χ2=1.74,P0.05)。结论①补种前后人群抗-HBs检出率对比,免疫效果非常明显,但结果偏低。②乙肝疫苗的补种应与抗-HBs的检测相结合,才能进一步提高免疫效果。建议将抗-HBs纳入中小学生健康检查项目。     

Hepatitis B vaccine response among infants born to hepatitis B surface antigen-positive women

Purpose

Annually, an estimated 25,000 infants are born to hepatitis B surface antigen (HBsAg)-positive women in the United States. Hepatitis B (HepB) vaccine and hepatitis B immune globulin (HBIG) are recommended at birth, followed by completion of vaccine series and post-vaccination serologic testing (PVST). In a large cohort of infants born to HBsAg-positive women, factors influencing vaccine response were evaluated.

Methods

Data were from HBsAg-negative infants born to HBsAg-positive women in the Enhanced Perinatal Hepatitis B Prevention Program (EPHBPP) from 2008 to 2013. Vaccine non-responders were defined as infants with antibody to hepatitis B surface antigen (anti-HBs) <10 mIU/mL at PVST after receiving ≥3 vaccine doses. Multivariable analyses modeled statistically significant predictor variables associated with non-response.

Results

A total of 17,951 maternal-infant pairs were enrolled; 8654 HBsAg-negative infants born to HBsAg-positive mothers received ≥3 doses of vaccine with anti-HBs results. 8199 (94.7%) infants responded to a primary HepB series; 199 (94.8%) to a second series. Factors associated with anti-HBs <10 mIU/mL included gestational age <37 weeks, vaccine birth dose >12 h after birth, timing of final vaccine dose <6 months after birth, receipt of 3 vs. 4 vaccine doses, and PVST interval >6 months from final vaccine dose in bivariate analysis. PVST interval >6 months from final vaccine dose (OR = 2.7, CI = 2.0, 3.6) was significantly associated with anti-HBs <10 mIU/mL; the proportion increased from 2% at 1–2 months to 21.6% at 15–16 months after the final dose. Receipt of a 4th dose improved the response rate (OR = 0.5, CI = 0.3, 0.8).

Conclusions

Ninety-five percent of a large cohort of uninfected infants born to HBsAg-positive mothers in the United States responded to primary HepB vaccine series. The proportion of infants with anti-HBs <10 mIU/mL increased with longer interval between the final vaccine dose and PVST. Optimal timing of PVST is within 1–2 months of final vaccine dose to avoid unnecessary revaccination.     

Prevalence of protective level of hepatitis B antibody 3 years after revaccination in HIV-infected children on antiretroviral therapy

After responding to highly active antiretroviral therapy (HAART), HIV-infected children had a good response to hepatitis B immunization. However, there are limited data on the durability of antibody to hepatitis B surface antigen (anti-HBs) in these children. The primary objective of this study is to determine the prevalence of protective anti-HBs level 3 years after a 3-dose HBV revaccination among HIV-infected children with immune recovery (CD4 cell ≥15%) while on HAART. The secondary objective is to assess immunologic memory among children who had waning of anti-HBs. An anti-HBs level of ≥10 mIU/mL was defined as a protective antibody level. Sixty-nine HIV-infected children who had history of a 3-dose HBV revaccination while receiving HAART were enrolled. The mean (SD) of CD4 cell and duration of HAART at time of revaccination was 27.2% (6.7) and 5.9 years (0.4), respectively. The proportion of children with protective anti-HBs level 3 years after the revaccination was 71.0% [95% CI, 58.8-81.3]. The geometric mean titer was 114(SD 5) IU/mL. By multivariate logistic analysis, the predictors for protective anti-HBs level 3 years after revaccination were CD4 cell count ≥500 cells/mm³ at the time of vaccination (p = 0.04) and anti-HBs level ≥ 100 IU/mL at 1 month after completion of the 3-dose vaccination (p < 0.001). Anamnestic response after one booster dose was demonstrated among 14 of 17 children who had waning protective anti-HBs level (82.4% [95% CI, 62.2-102.6]). Our findings support the recommendation of giving a 3-dose HBV vaccination to HIV-infected children with immune recovery while receiving HAART.     

Immune response in infants after universal high-dose hepatitis B vaccination: A community-based study in Beijing,China

BackgroundVaccination of infants beginning at birth is recommended to prevent Hepatitis B virus (HBV) infection in China. Compared to 5 μg/dose vaccine administered in other regions in China, a three-dose HB recombinant yeast vaccine at 10 μg/dose has been administered for infants within 24 h after birth, 1 month and 6 months of age in Beijing since 2006. In a community-based retrospective cohort study, factors influencing immunologic vaccine response were evaluated.MethodsA total of 3670 infants who completed a 3-dose 10 μg recombinant HB vaccine regimen and born to hepatitis B antigen negative mothers were included. The effect on anti-HBs titers of maternal nutrient status, infants’ birth condition, growth factors, timeliness of vaccination, dosing interval and the interval until post-vaccination serologic testing (PVST) were evaluated.ResultsA total of 3666 infants with no markers of HBV infection were included in analysis. The mean anti-HB titers were 1767.17 mIU/ml. Only 16.9% of the infants completed their PVST within 30–59 days after the final dose of vaccination. Multivariate linear regression analysis showed that delay in PVST (β = −0.097, p < 0.0001) and maternal folic acid supplementation (β = 0.067, p = 0.002) were associated with log-transformed anti-HB titers. Also a trend toward significant association was observed between the calcium supplementation of infants and log-transformed anti-HBs titers (β = 0.062, p = 0.057). Longer interval between dose 2 and dose 3 was not observed to increase the anti-HB titers after cofactors adjustment.ConclusionsOur findings illustrate the importance of timing of PVST to avoid unnecessary revaccination. Multi-center large cohort studies should verify the effect and magnitude of folate and calcium supplementation on HB vaccine response.     

乙型肝炎疫苗初次免疫正常应答和高应答婴儿初次免疫5年后免疫记忆持久性随访观察

目的 探讨乙型肝炎(乙肝)疫苗初次免疫(初免)正常应答和高应答新生儿在初免后5年免疫记忆情况及其影响因素。方法 对初免正常应答和高应答新生儿于初免后5年检测其抗-HBs,其中低于保护水平(10 mIU/ml)者接种1剂次乙肝疫苗(激发剂次)并于接种后14 d采集血标本,再次检测抗-HBs,并计算激发剂次后抗-HBs阳转率(≥10 mIU/ml)和GMT。将检测的初免抗体、随访抗体和激发剂次后抗体均从低到高分成不同等级,分析激发剂次后抗体的影响因素。结果 37.98%(980/2 580)初免正常应答和高应答新生儿在初免后5年抗-HBs已降至保护水平以下,其中激发剂次后98.95%(757/765)出现抗体阳转,GMT为2 811.69(95%CI:2 513.55～3 145.19) mIU/ml。激发剂次后抗体滴度随初免抗体水平和随访抗体水平的升高而升高(F值分别为5.46、10.23,均P<0.000 1)。多因素分析显示,激发剂次后抗体滴度与性别、出生体重、早产等无关(P>0.05),而与初免抗体和随访抗体水平独立相关(OR=1.001,95%CI:1.000～1.002,P<0.001;OR=1.28,95%CI:1.81～1.39,P<0.001)。结论 新生儿乙肝疫苗初免后5年存在较强的免疫记忆;免疫记忆的强度与初免抗体及激发剂次前抗体水平有关。     

HBsAg阳性孕产妇其幼儿乙型肝炎疫苗免疫应答情况及其影响因素

目的  获取HBsAg阳性孕产妇其幼儿乙型肝炎(乙肝)疫苗无/弱应答的概率,分析其影响因素。 方法  对2016年1月至2017年4月在陕西省西北妇女儿童医院分娩的284对HBsAg阳性孕产妇及其幼儿进行研究,随访幼儿乙肝疫苗接种情况及血清学标志物产生情况。 结果  高危幼儿无/弱应答率为10.57%(28/237)。表面抗原(HBsAg)、e抗原(HBeAg)和核心抗体(HBcAb)均阳性的孕产妇其幼儿发生乙肝疫苗免疫无/弱应答率为19.64%,高于HBsAg、e抗体(HBeAb)和HBcAb均阳性的孕产妇的幼儿,其乙肝免疫无/弱应答率为9.89%(RR=1.99,95% CI：1.01~3.92,P＜0.001)。孕期有穿刺史者其幼儿发生无/弱应答的风险是无穿刺史者的6.72倍(RR=6.72,95% CI：2.79~16.19,P=0.049),幼儿发生乙肝疫苗无/弱应答的孕产妇白蛋白(ALB)低于强应答组(t=2.518,P=0.013),白球比(A/G)高于强应答组(t=-5.559,P＜0.001)。 结论  HBsAg阳性孕产妇幼儿是乙肝疫苗无/弱应答的重点人群,其又处于母亲为传染源的高危环境中,应重点进行抗体监测。其孕期有创检查可能会增加幼儿发生乙肝疫苗无/弱应答的概率。HBsAg、HBeAg和HBcAb均表现为阳性的孕产妇幼儿有较高的乙肝疫苗免疫无/弱应答率。