摘要
目的探讨2型糖尿病对乙肝疫苗接种免疫效果的影响及免疫对策。方法选择4个免疫预防接种中心的76例成人2型糖尿病患者(2型糖尿病组),并以70例同期接受预防接种、年龄及性别匹配的健康个体作为对照(对照组)。观察2组完成1个标准乙肝疫苗免疫接种程序后1、12、24个月的抗HBs阳转率和几何平均滴度(GMT),ELISA法检测血清γ干扰素(IFN-γ)、白介素(IL-)2、IL-4和IL-10水平。对低/无应答的2型糖尿病患者分别采用三角肌肌内注射和皮下+三角肌肌内注射两种方式,以20μg基因重组酵母疫苗进行再次免疫,观察抗HBs阳转率和GMT水平。结果 2型糖尿病组和对照组在完成1个标准乙肝疫苗接种程序后1个月,血清抗HBs阳转率分别为92.1%和98.6%(P<0.05),抗HBs GMT分别为106.78mU/ml和167.14mU/ml(P<0.01),低/无应答率分别为19.7%和7.1%。2型糖尿病组血清IFN-γ、IL-2和IL-4水平均显著低于对照组(P<0.05)。对低/无应答2型糖尿病患者于完成标准疫苗接种后第1个月采用20μg疫苗复种,皮下+三角肌肌内注射和单纯肌内注射抗HBs阳转率分别为73.3%和60.0%(P<0.05)。结论 2型糖尿病是影响成人乙肝疫苗接种免疫效果的因素之一,其机制可能与Th1/Th2细胞因子水平相对减低有关;采用皮下+三角肌肌内注射20μg重组酵母疫苗能够显著提高成人2型糖尿病患者乙肝疫苗接种成功率。
Objective To investigate the effects of type 2 diabetes mellitus on vaccination efficacy of hepatitis B vaccine,and explore the effective revaccination strategy.Methods Seventy-six adults with type 2 diabetes mellitus and 70 sex-and age-matched healthy individuals from 4 vaccination centers,who were vaccinated for one standard schedule（month 0,1,6） with gene recombinant yeast hepatitis B vaccine,were enrolled in present study.The serum anti-HBs and geometric mean titer（GMT） thereof were assayed before and month 1,12,24 after completion of one standard schedule of vaccination.The profiles of serum cytokines including interferon-γ（IFN-γ）,interleukin（IL）-2,-4 and-10 were determined before and after vaccination.To improve the vaccine efficacy of non-or lower-response patients with type 2 diabetes mellitus,a dose of 20μg gene recombinant yeast hepatitis B vaccine were used to revaccinate intramuscularly or subcutaneously plus intramuscularly.Results One month after completion of one standard schedule of vaccination,the positive conversion rates of anti-HBs in diabetes mellitus group and healthy group were 98.6 and 92.1%（P0.05）,the anti-HBs GMT were 106.78 mU/ml and 167.14 mU/ml（P0.01）,and the non-or lower-response rate were 19.7% and 7.1%,respectively（P0.05）.The mean levels of serum IFN-γ,IL-2 and IL-4 were lower in diabetes mellitus group（P0.05 or P0.01）,especially in non-or lower-response individuals,than in healthy group before and after a standard schedule of vaccination.Patients with non-or lower-response type 2 diabetes mellitus received revaccination with 20μg hepatitis B vaccine,the positive conversion rates of anti-HBs were 60.0% and 73.3%,respectively（P0.05）,when injected subcutaneously plus intramuscularly or only intramuscularly.Conclusions Type 2 diabetes mellitus could influence the vaccination efficacy of hepatitis B vaccine,probably through a mechanism of down-regulating Th1 and Th2 mediated immune response.Revaccination with 20μg gene recombinant yeast hepatitis B vaccine subcutaneously plus intramuscularly can successfully improve the vaccination efficacy.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2011年第10期1068-1070,共3页
Medical Journal of Chinese People's Liberation Army
基金
军队临床高新技术重大项目(2010gxjs099)
关键词
肝炎
乙型
慢性
糖尿病
2型
疫苗
免疫
hepatitis B
chronic
diabetes mellitus
type 2
immunotherapy
active
