不同剂量乙型肝炎疫苗对慢性乙型肝炎患者特异性T淋巴细胞应答反应的影响

目的研究接受不同剂量重组酵母乙型肝炎疫苗治疗的慢乙肝患者外周血淋巴细胞对疫苗的特异性细胞免疫反应。方法选择72例6个月内无使用抗病毒治疗的慢性乙型肝炎患者按1：1：1的比例随机分为90tLg组、60tLg组、安慰剂组（0μg）。患者同时联合使用干扰素alb5MIU每周3次共24周。所有患者均停药后观察24周。在不同的时间点检测患者HBVDNA、HBeAg及肝功能，酶联免疫斑点试验（ELISPOT）法检测产生IFN-7的细胞数。结果治疗前三组患者的ELISPOT阳性率的差异无统计学意义。治疗24周时高剂量、低剂量和安慰剂组ELISPOT试验阳性的患者分别有12例、12例和7例。重组酵母乙型肝炎疫苗组（高剂量、低剂量）ELISPOT阳性率比安慰剂组明显升高，差异有统计学意义（P=0．0446）。24例ELISPOT阳性的重组酵母乙型肝炎疫苗组（高剂量、低剂量）患者中有6例产生HBVDNA转阴、7例发生HBeAg消失或转换，而7例ELISPOT阳性的安慰剂组患者均无HBVDNA转阴及HBeAg消失或转换。停药后24周，ELISPOT阳性者中。重组酵母乙型肝炎疫苗组（高剂量、低剂量）共有4例产生HBVDNA转阴、9例发生HBeAg消失或转换，而接受安慰剂治疗组均无HBVDNA转阴、仅有1例发生HBeAg转换。结论重组酵母乙型肝炎疫苗对慢性乙型肝炎患者有提高特异性T淋巴细胞功能的作用。高剂量组和低剂量组ELISPOT阳性率差异无统计学意义。

Specific T cell immune response in chronic hepatitis B patients treated with different doses of recombinant hepatitis B vaccine

OBJECTIVE: To study the specific cellular immunoresponse of peripheral blood lymphocytes in the chronic hepatitis B patients treated with different doses of recombinant hepatitis B vaccine. METHODS: Seventy-two chronic hepatitis B patients who did not use any anti-HBV drugs within 6 months were randomized into 3 groups (90 micrograms, 60 micrograms, and placebo) in a ratio of 1:1:1. The patients in different groups were treated with different doses of recombinant hepatitis B vaccine in combination with IFN alpha 1b 50 micrograms with 3 times a week for 24 weeks. All patients were followed up for 24 weeks (W24). HBV DNA, HBeAg and liver functions were detected at different time points, and the number of cells that secrete IFN-gamma were detected by ELISPOT. RESULTS: There were no significant difference in ELISPOT positive ratio among the 3 groups on baseline detection. At W24, 12 cases, 12 cases, and 7 cases showed ELISPOT positive in the group of 90 micrograms, 60 micrograms, and placebo. The proportion of patients who were ELISPOT positive was higher in the groups treated with recombinant hepatitis B vaccine (including the dose of 90 micrograms and 60 micrograms) than that in the placebo group (P=0.0446). HBV DNA turned negative in 6/24 of the patients treated with recombinant hepatitis B vaccine (at both the doses of 90 micrograms and 60 micrograms), and HBeAg/Anti-HBe seroconversion or HBeAg became negative in 7/24 of them. In the placebo group, none of the patients showed undetectable HBV DNA, HBeAg/Anti-HBe seroconversion or HBeAg disappearance. At the 24W of follow up, in the patients who were ELISPOT positive, HBV DNA became undetectable in 4 of the patients treated with recombinant hepatitis B vaccine (at doses of 90 micrograms and 60 micrograms), and HBeAg/Anti-HBe seroconversion or HBeAg disappearance were found in 9 of the cases. In the placebo group, none of the cases showed undetectable HBV DNA, and only 1 case had HBeAg/Anti-HBe seroconversion. CONCLUSION: The recombinant hepatitis B vaccine may increase the function of specific T lymphocytes in patients with chronic hepatitis B. There were no significant differences between the patients treated with the dose of 90 micrograms and 60 micrograms hepatitis B vaccine.