淋巴瘤患者接种不同剂量乙肝疫苗的免疫效果及影响因素分析

Analysis of the Immune Efficacy and Influencing Factors of Different Dose of Hepatitis B Vaccine in Patients with Lymphoma

目的:了解淋巴瘤患者接种不同剂量乙肝疫苗后HBsAb阳转率,评价不同剂量乙肝疫苗的免疫效果并分析其影响因素。方法:选择经酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)检测确认乙肝5项指标(HBsAg、HBsAb、HBeAg、HBeAb、HBcAb)全阴性的淋巴瘤患者236人,于化疗前1-2周开始按0、1、6个月免疫程序接种乙肝疫苗,完成全程免疫接种1个月后检测HBsAb水平,比较HBsAb+和HBsAb-者各项指标间的差异。结果:淋巴瘤患者总HBsAb阳转率为75%,高剂量(20μg)组HBsAb阳转率为81.4%,明显高于低剂量(10μg)组的68.6%(χ^2=5.09,P<0.05)。HBsAb阳转率在年轻患者、女性患者、B细胞型(除外DLBCL亚型)、分期早、未使用激素、利妥昔单抗治疗患者中均较高(P<0.05),而在有无全身症状、是否应用来那度胺治疗方面差异均无统计学意义(P>0.05)。2种剂量的乙肝疫苗接种后均未发生明显不良反应。结论:淋巴瘤患者接种高剂量乙肝疫苗可以取得更好的免疫效果。

Objective:To investigate the conversion rate from negative to positive(positive rate)of HB sAb in lymphoma patients inoculated with different dose of hepatitis B vaccine,to evaluate the immune efficacy of different dose of hepatitis B vaccine,and to analyze the influencing factors.Methods:Two hundred thirty six patients with lymphoma were selected,whose 5 indexes of hepatitis B(HBsAg,HBsAb,HBeAg,HBeAb and HBcAb)were all negative confirmed by ELISA.The hepatitis B vaccine was inoculated according to 0,1 and 6 months immune procedures at 1-2 weeks before chemotherapy.The HBsAb level was detected at 1 month after the immunization,the differences in each indexes between HBeAb+and HBeAb-patients were compared.Results:The positive rate of HB sAb was 75%in all patients with lymphoma.The positive rate of high dose(20μg)group was 81.4%,which was significantly higher than that of the low dose(10μg)group with68.6%(χ^2=5.09,P<0.05).The positive conversion rate of HBsAb significantly higher in the patients of young,female,B-cell(except DLBCL subtype),early Ann Arbor stage,and the treatment regimens without glucocorticoid and rituximab.There were no statistical significances in systemic symptoms or no and treatment regimens with or without lenalidomide.Two doses of hepatitis B vaccine not displayed obvious adverse reactions.Conclusion:The high dose of hepatitis B vaccine can achieve better immune efficacy than that of the low dose in the patients with lymphoma.