人类免疫缺陷病毒-1感染者对重组乙型肝炎疫苗的免疫应答

Immune responses in patients with human immunodeficiency virus-1 infection after vaccinated with recombinant hepatitis B virus vaccine

目的比较HIV-1感染者与健康者接种乙型肝炎（乙肝）疫苗后免疫应答的差异。方法健康对照者19例和H1V-1感染者20例分别在0、1、6个月肌内注射重组乙肝疫苗20μg，并在第1、3次疫苗注射后1个月检测抗-HBs水平，高于10mIU／mL即为阳性。抗HBs水平比较采用几何均数进行单因素方差分析，两两比较用Scheffe法，率的比较用Fisher’s精确概率检验。结果健康对照组第1、3次疫苗注射后1个月，抗-HBs阳性血清转换者分别为10例和18例，而HIV-1感染组分别为3例和11例，两组比较差异有统计学意义（P=0．015、0．005）。CD4^＋T淋巴细胞≥200×10^6／L的H1V—1感染者在第1、3次疫苗注射后1个月，抗-HBs阳性血清转换者分别为2例和6例，而CD4^＋T淋巴细胞〈200×10^6／L的分别为1例和4例，两组比较在第1次疫苗注射后1个月差异无统计学意义（P=0．202），在第3次疫苗注射后1个月差异有统计学意义（P=0．005）。CD4^＋T淋巴细胞〈200×10^6／L组（A组）、CD4^＋≥200×10^6／L组（B组）和健康对照组（C组）完成3次疫苗接种后1个月抗HBs水平分别为（101±210）、（529±704）、（5989±10704）mIU／mL，三组比较差异有统计学意义（F=18．53，P〈0．001），A组分别与C、B组比较，差异有统计学意义（P〈0．001、〈0．05），B组与C组比较，差异无统计学意义（P=0．353）。所有入组者对乙肝疫苗均有良好耐受。结论HIV-1感染者接种乙肝疫苗后与HIV-1阴性者相比，血清转换率和抗-HBs水平降低。尤其是CD4^＋T淋巴细胞〈200×10^6／L组。

vaccine between Objective To observe the difference of immune response to hepatitis B virus （HBV） human immunodeficiency virus （HIV） infec and nineteen healthy individuals were on month0.1,6. The serumanti-HBsleve tions, and the level 〉10 mlU/ml, was co ted and healthy individuals. Methods injected intramuscularly with 20 μg of 1 was measured on the 30th day after the nsidered positive. The data of anti-HBs geometric mean and compared by one factor analysis of variance, and ne by Scheffe test. positive in healthy group were respectively 10 analyzed by Fisher＇ s exact and 18 one month after the fir paired test. st and but they were 3 and 11 in HIV infected group. The differences between the two groups were significant （P=0. 015 and P=0. 005, respectively）. In HIV infected group, anti-HBs positive in patients with CD4^＋ ≥200×10^6/L were respectively 2 and 6, but they were only 1 and 4 in patients with CD4^＋ 〈200 ×10^6/L. The difference between the two groups was significant after the third injection （P=0. 005）, but not significant after the first injection （P=0. 202）. The sermn anti-HBs levels measured 1 month after the third injection were （ 101 ± 210 ）, （529 ± 704 ）, （5989 ± 10 704 ） mIU/mL, respectively, in CD4^＋〈200×10^6/L. group （A）, CD4^＋ ≥200 ×10^6/L. group （B） and healthy control group （C）. The difference of three groups was significant（F= 18.53, P〈0. 001 ）. The differences between A and C, A and B were significant （P〈0. 001, P〈0. 05, respectively）. The difference between B and C was not significant （P= 0. 353）. All recruited individuals tolerate well to HBV vaccine. Conclusions Compared with HIV-1 negative individuals, the anti-HBs seroeonversion rate and serum anti-HBs level are decreased in HIV infected patients, specially in patients with CD4^＋ 200 ×10^6/L.