乙型肝炎疫苗无/弱应答者复种远期效果

Long-term efficacy of hepatitis B revaccination in non and hypo-responders

目的 探讨乙肝疫苗无 /弱应答者复种远期效果。方法 严格筛选无 /弱应答者 40名 ,分肌肉和皮内接种 ,用 3针加倍剂量 (每次 1 0 μg或 2 μg) ,以 80名同期筛检人群正常应答者作对照 ,完成 30个月随访观察。 结果 无 /弱应答者复种后 39人产生抗体应答 ;第 30个月 ,肌肉与皮内组仍有 64 7%和 34 8%维持抗体阳性。但无 /弱应答者抗 -HBs阳性率和抗体阳性者GMT均明显低于正常应答对照 (P <0 0 1 )。无 /弱应答者HBV累积感染率 (单项抗 -HBc阳性 )为 2 5 0 % (肌肉组 1 7 6 % ,皮内组 30 4% ) ,显著高于正常应答对照 2 6 % (P <0 0 1 )。结论 肌肉接种好于皮内接种。无 /弱应答者复种确实能起到改善应答 ,并在一个相对较长时间维持抗体水平的作用 ,但效果不容乐观。

Objective To evaluate long-term efficacy of hepatitis B revaccination in non-and hypo-responders.Methods 40 non- and hypo-responders diagnosed with severe screening were given three 2-fold-dose boosters (10?μg or 2?μg per dose) randomly by intramuscular or intradermal route,and 80 normal responders diagnosed from the same screening were selected as the controls.A 30-month follow-up was finished after the first booster.Results 39 non-and hypo-responders produced protective level anti-HBs,and 64.7% of intramuscular vaccinees and 34.8% of intradermal vaccinees still kept anti-HBs positive at the 30th month.However,the anti-HBs positive rate and the GMT of the antibody positive subjects in non-and hypo-responders were significantly lower than those in normal responders (P<0.01),and the cumulative HBV infection rate (isolated anti-HBc positive-conversion as infection marker) in non-and hypo-responders was 25.0% (17.6% for intramuscular and 30.4% for intradermal),dramatically higher than 2.6% in normal responders (P<0.01).Conclusion Intramuscular route was more effective than intradermal route.It is undoubted that revaccination in non- and hypo-responders can improve response to the vaccine and keep protective anti-HBs within a relatively long time,but the efficacy was limited.The final conclusion needed further research with observation on immune memory.