乙肝疫苗无（低）应答加大剂量再免疫效果分析

目的探讨乙肝疫苗接种后无（低）应答者加大剂量再免疫的效果，以提高乙肝疫苗预防接种的保护率。方法对近3年已完成标准乙肝疫苗免疫接种程序至少一年、复查乙肝病毒标志物均为阴性的健康人群，随机地接受3种再免疫方案，按常规程序（0、1、6个月）予肌肉注射。A组40例：进口重组乙肝疫苗（安在时），每次剂量40μg；B组40例：安在时，每次剂量20μg；C组40例：国产重组乙肝疫苗，每次剂量20μg。在首针乙肝疫苗接种前及接种后第1、2、7个月（T1、T2、T7）采血检测抗-HBs。结果T1时，进口40μg组、进口20μg组和国产20μg组复种后应答率分别为45．0％（18／40）、37．5％（15／40）和30．0％（12／40），3组应答率差异无统计学意义（χ^2=1．920，P=0．383）；T2和T7时，3组复种后应答率分别为67．5％（27／40）、47．5％（19／40）、40．0％（16／40）和77．5％（31／40）、55．0％（22／40）、50．0％（20／40），进口40μg组应答率高于其余两组（χ^2为4．014～6．545之间，P均〈0．05）。T2和T7时，进口40μg组应答率差异无统计学意义（χ^2=1．003，P=0.317）。各组患者复种后均未出现严重副反应。结论对乙肝疫苗无（低）应答者增加疫苗剂量加强免疫是有效的措施，抗-HBs应答率随疫苗剂量增加而提高。进口40μg组加强2针即可，加强3针未能较加强2针明显提高抗-HBs应答率。

Effectiveness of Hepatitis B Vaccine Booster Dose in Low Responder

Objective To evaluate the effectiveness of booster dose of yeast recombinant hepatitis B vaccine in the low-responding adult subjects. Methods Individuals with a history of immunization with recombinant hepatitis B vaccine according to the standard scheme in the past three years and negative for hepatitis B markers （HBsAg, anti-HBs, HBeAg, anti-HBe and anti-HBe） were randomly divided into various groups for 3 booster immunization, namely 0, 1st and 6th month.40 adults in group A were given with Engerix 40 txg each time by intramuscular route. 40 adults in group B were given with Engerix 20 μg and 40 adults of group C were given with hepatitis B vaccine （made in China） 20 μg. The level of serum anti-HBs was determined before the 1st injection and at the 1st （T1）, 2nd （T2） and 7th （T3） month after the first injection. Results In T1, the positive anti-HBs sero-conversion rate of group A, B and C was 45.0% （18/40）, 37.5% （15/40） and 30.0% （12/40）, respectively. The difference was not statistical significant （χ^2=1.920,P=0.383）. The positive anti-HBs sero-conversion rate for these three groups in T2 was 67.5% （27/40）, 47.5% （19/40） and 40.0% （16/40）; and was 77.5% （31/40）, 55.0% （22/40） and 50.0% （20/40） in T7. The positive anti-HBs sew-conversion rate in group A was higher than those in group B and group C （χ^2=4.014-6.545, P〈0.05）. In group A, there were no statistical significance （χ^2=1.003, P=0.317） of the anti-HBs positive conversion rate between T2 and T7.There was no severe side-effect in all these groups after revaccination. Conclusions Booster dose of yeast recombinant hepatitis B vaccine is effective for the low responders. The anti-HBs sero-eonversion rate is associate with the increase in the vaccine dose.Two booster doses of 40 μg Engefix are enough for the low-responders and the third dose could not further increase the rate of anti-HBs seroconversion.