乙型肝炎疫苗预防血液病患者输血后乙型肝炎病毒感染调查

Post-transfusion Hepatitis B in Patients with Hematological Disease Prevented by Hepatitis B Vaccine

目的 了解血液病患者肝炎病毒感染情况 ,寻求血液病患者输血后乙型肝炎病毒感染的预防策略。方法应用 EL ISA及酶法检测 2 6 8名血液病患者各型肝炎病毒抗体及肝功能 ,并对符合乙肝疫苗接种条件的患者分组进行人重组乙肝疫苗接种 ,所有患者按血液病需要进行治疗、输血。结果 血液病患者存在较高的乙型肝炎病毒感染率 (2 6 .4 9% ) ,且在不同的血液病病种间存在差异 (χ2 检验 ,P =0 .0 13) ;血液病患者输血后乙型肝炎病毒的感染率为 3.77% ,据多因素方差分析结果 ,肝炎病毒的感染在输血组与非输血组、接种组与对照组差异均具有显著性 ,(P =0 .0 0 4、 P =0 .0 12 ) ;血液病患者接种乙肝疫苗后乙肝表面抗体总的阳转率为 6 6 .3% ,并且 70 .5 %的患者是在接种后 1个月即产生抗体 ,多因素方差分析结果显示 ,乙肝表面抗体的产生受接种方式、不同病种、是否输血等多因素影响。结论 血液病患者对乙肝疫苗接种能产生良好的免疫应答 ,乙肝疫苗接种尤其是加强接种方案可作为预防血液病患者发生输血后乙型肝炎的有效措施。

OBJECTIVE To investigate the status of hepatitis virus infection in hemopathic patients, and look for a way to prevent hepatitis B virus infection in these patients after blood transfusion. METHODS Antibodies of various hepatitis virus and liver function in 268 hemopathic patients were examined with enzyme-linked immunosorbent assay (ELISA) and enzyme assay. Human recombinant hepatitis B vaccine was given to qualified patients in different groups. All patients were treated and blood-transfused according to their hemopathic status. RESULTS There was relatively high incidence of hepatitis B virus infection in hemopathic patients (26.49%), and there were differences in different hemopathies (chi-square test, P=0.013). The incidence of hepatitis B in hemopathic patients after blood transfusion was 3.77%. In terms of the results of general factorial ANOVA, the incidence of hepatitis B infection between groups with blood transfusion and without tranfusion, between vaccination group and controls all differed significantly (P=0.004, P=0.012). In addition, there was interaction between vaccination group and blood transfusion one (P=0.004). The total positive rate of hepatitis B surface antibody in hemopathic patients after inoculating hepatitis B vaccine was 66.3%. In 70.5% patients, antibodies were detected one month after vaccination. The results of general factorial analysis of variance suggest that the generation of hepatitis B surface antibody be associated with many factors, such as the manner of vaccination, different diseases, blood transfusion. CONCLUSIONS The hemopathic patients have good immune response to hepatitis B vaccine. The hepatitis B vaccination, especially intensified vaccinated projection could be the available method to prevent hepatitis B infection in hemopathic patients after blood tansfusion.