成年人乙型肝炎疫苗无或弱应答者三种方案再免疫的效果分析

目的 探讨成年人乙型肝炎(简称乙肝)疫苗接种后无或弱免疫应答者三种不同方案再免疫的效果.方法 采用随机(数字表法)、开放性的研究方法 ,对2年内至少完成1个标准乙肝疫苗免疫接种程序、复查乙肝病毒标志物均阴性者,随机(数字表法)地接受3种再免疫方案,A组:34例,先予粒细胞-巨噬细胞集落刺激因子(GM-CSF)300μg皮下注射,次日开始按常规程序予乙肝疫苗接种,10μg/次;B组:33例,单纯乙肝疫苗接种,20μg/次;C组:33例,单纯乙肝疫苗复种,10μg/次.接种首针前及首针后第1、2,8个月(T1、T2、T8)检测乙肝病毒表面抗体(抗-HBs).结果 T1时,联合GM-CSF组、20 μg组和10μg组抗-HBs阳性率分别为26.47%,48.48%和18.18%(X2=7.20,P=0.027);T8时,20μg组抗-HBs阳性率达75.76%,联合GM-CSF组达64.71%,均高于10μg组的39.39%(X2=9.07,P=0.011).20μg 峭组在T1 时抗-HBs滴度(417.00±69.36)高于联合GMCSF组(203.74±79.56),在,T2时抗-HBs滴度(458.17±64.09)高于复种组(257.86±76.60),T8时20μg组(532.73±68.82)和联合GM-CSF组(501.48±70.00)抗-HBs滴度均高于10μg组(256.12±75.39)(t=4.27,P=0.0173).结论 对乙肝疫苗无(弱)应答者增加疫苗剂量和联合GM-CSF方案进行加强免疫是有效的措施,免疫效果均优于单纯复种.

Immune effects of three different programs for revaccination among adults of non-and hypo-responders to Hepatitis B vaccine

Objective To investigate the immune effects of three different programs for revaccination among adults of non- and hypo-responders to recombinant Hepatitis B vaccine.Methods Those who were once immunized with recombinant Hepatitis B vaccine more than one standard schedule(0.1.and 6 months)in two years and negative for Hepatitis B markers were randomly given three different projects for revaceination.34 adults of A group were given GM-CSF 300 μg by subcutaneous injection for the first day,then 10 μg each time by intramuscular route for routine immune method.33 adulm of B group were given Hepatitis B vaccine 20μg each time.33 adults of C group were given Hepatitis B vaccine 10 μg each time.The blood samples were collected before the first injection and in 1.2 and 8 months following the first injection to test Anti-HBs.Results At T1,the anti-HBs positive conversion rate of group A,B and C was 26.47%,48.48% and 18.18% respectively (X2=7.20,P=0.027).At T8,the anti-HBs positive conversion rate of group A(64.71%) and group B(75.76%)were higher than group C (39.39%),and there was significant difference (X2=9.07,P=0.011).At T1,the anti-HBs level of group B(417.00±69.36) was higher than that of group A(203.74±79.56).At T2,the anti-HBs level of group B(458.17±64.09) was higher than that of group C (257.86±76.60).At T8,the anti-HBs level of group A(501.48±70.00) and group B (532.73±68.82) were higher than those of group C (256.12±75.39)(t=4.27,P=0.0173).Conclusion Schemes of augmentation doses of Hepatitis B vaccine and being combined with GM-CSF should be in effect for non-and hypo-responders to Hepatitis B vaccine.