抗-HBs衰减青少年乙肝疫苗加强免疫效果研究

目的研究乙肝疫苗(Hepatitis B Vaccine,HepB)基础免疫后12～15年乙肝病毒表面抗原抗体(抗-HBs)衰减者加强免疫前后抗体水平间的关系,比较不同剂次的加强免疫效果。方法选择婴儿期完成HepB基础免疫的1993—1997年出生的儿童,采集静脉血,使用化学发光法检测后,HBsAg及抗-HBc阴性而抗-HBs降至保护性水平(10mIU/ml)以下作为研究对象。按抗-HBs滴度水平分为3组:Ⅰ组(﹤0.1 mIU/ml)、Ⅱ组(0.1～1 mIU/ml)和Ⅲ组(﹥1 mIU/ml);按0、1、6免疫程序加强免疫3剂10μg的重组乙肝疫苗(汉逊酵母)(HepB-HPY),分别于免疫1剂和3剂后1个月采集静脉血,检测抗-HBs。结果 453名研究对象加强免疫1剂后各组抗-HBs阳转率分别为67.96%、85.61%和97.60%,抗体滴度分布差异有统计学意义(χ2=132.88,P﹤0.05),几何平均浓度(GMC)分别为37.31、152.77和1310.27 mIU/ml(F=86.11,P﹤0.05);加强免疫3剂后各组抗-HBs阳转率分别为99.00%、99.21%和99.49%(Fisher确切概率法,P﹤0.05),GMC分别为1714.67、1502.32和3383.68 mIU/ml(F=16.59,P﹤0.05)。全程采血的425名儿童在免疫1剂和3剂后抗体阳转率分别为87.76%和99.29%(χ2=46.68,P﹤0.05)。结论对于完成HepB基础免疫后抗体衰减至10 mIU/ml以下的12～15岁儿童有必要进行加强免疫,加强免疫前抗体滴度较高者加强免疫效果较好;加强免疫3剂比1剂效果好。

A Study on the Effect of Booster Vaccinations in Anti-HBs Declined Adolescents

Objective To investigate the changes in Antibodies to hepatitis B virus surface antigen（Anti-HBs）levels after booster vaccinations and to compare the immunological effects of different doses in adolescents with Anti-HBs Decline who received primary immunization 12-15 years ago.Methods Adolescents who have received fundamental immunity of hepatitis B vaccine in infancy were detected for HBsAg,Anti-HBs and Anti-HBc by chemiluminescence detection.HBsAg and Anti-HBc negative children with Anti-HBs﹤10 mIU/ml were divided into three groups according to their Anti-HBs titer levels：GroupⅠ（﹤0.1 mIU/ml）,GroupⅡ（0.1-1 mIU/ml）and GroupⅢ（1 mIU/ml）,and then immunized 10 ug Hepatitis B Vaccine made by recombinant deoxyribonucleic Acid（DNA）techniques in Hansenula Polymorpha Yeast（HepB-HPY）on a 0-1-6 month schedule and Anti-HBs antibody levels were tested one month after the first and third dose,respectively.Results Among 453 adolescents,the Anti-HBs positive rates after using first dose in different groups were 67.96%,85.61%,and 97.60%,respectively.There were statistically significant differences in antibody titer（χ~（2）=132.88,P﹤0.05）,and the Geometric Mean Concentrations（GMCs）were 37.31 mIU/ml,152.77 mIU/ml,and 1310.27 mIU/ml,respectively（F=86.11,P﹤0.05）.Anti-HBs positive rates after using third dose in different groups were 99.00%,99.21% and 99.49%,respectively,and statistically significant differences were found among three groups（Fisher exact probabilities,P﹤0.05）.The GMCs were 1714.67 mIU/ml,1502.32 mIU/ml,and 3383.68 mIU/ml,respectively（F=16.59,P﹤0.05）.The positive rates of antibody of the 425 adolescents were 87.76% and 99.29% after first and third doses o of immune booster.Conclusion 12-15 years old adolescents with Anti-HBs﹤10 mIU/ml after fundamental immunity of hepatitis B vaccine need booster immunization.The effect is better for adolescents with a relatively higher Anti-HBs titer before booster,and the effect of three doses booster is better than only one dose.