摘要
目的探讨慢性酒精性肝病对乙肝疫苗接种效果的影响及应对策略。方法选取来自两个免疫接种中心的65例慢性酒精性肝病患者和40例同期接受预防接种、年龄及性别匹配的健康个体,均按照标准的免疫程序(0、1、6个月)注射重组乙肝疫苗。采用化学发光法检测抗HBs滴度,流式细胞术检测外周血中CD4+ CD25+调节性T细胞的百分含量。对低应答和无应答的慢性酒精性肝病患者分别以20μg和40μg重组酵母疫苗进行再免疫接种,检测复种后抗HBs滴度。结果慢性酒精性肝病患者和健康对照组在完成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92.3%和97.5%(P<0.05),低/无应答率分别为21.55%和7.5%(P<0.05)。低/无应答的14例慢性酒精性肝病患者中,各有7例分别接受40μg和20μg重组酵母疫苗再接种,前者再接种后抗HBs的阳转率(85.71%)显著高于后者(71.43%,P<0.05)。乙肝疫苗接种前1周及完成接种后1个月时慢性酒精性肝病患者外周血CD4+CD25+调节性T细胞的百分含量(分别为6.41%±2.34%、7.02%±2.83%)均明显低于健康对照(分别为10.02%±1.83%、10.04%±2.14%,P<0.05)。结论慢性酒精性肝病可能是影响乙肝疫苗接种效果的因素之一,其机制可能与下调CD4+CD25+调节性T细胞百分含量有关。应用40μg重组酵母疫苗可提高慢性酒精性肝病患者乙肝疫苗接种的成功率。
Objective To investigate the influence of chronic alcoholic liver disease （CALD） on the efficacy of hepatitis B vaccines and the strategy of prevention. Methods A total of 65 patients with CALD and 40 sex- and age-matched healthy individuals from two immunization centers were vaccinated according to the standard schedule （months 0, 1, and 6） with recombinant yeast hepatitis B vaccine were enrolled in this study. Their anti-HBs titers were determined using the chemiluminescence method. The percentage of CD4＋ CD25＋ regulatory T cells in the peripheral blood were detected by flow cytometry.Revaccination was performed using 20μg and 40μg of recombinant yeast hepatitis B vaccines to improve its efficacy among nonresponsive and poor responsive individuals.The anti-HBs titers after revaccination were also determined.Results After completion of the standard schedule hepatitis B vaccination for one month,the anti-HBs positive rate of the subjects with CALD was significantly lower than that of the healthy individuals（P0.05）,which was 92.3% and 97.5%,respectively.The nonresponsive and less responsive rate was 21.55% and 7.5%, respectively （P0.05）. Out of the 14 nonresponsive and less responsive patients with CALD,7 were given 40μg of recombinant yeast vaccine and the other 7 were given 20μg of recombinant yeast vaccine.The anti-HBs positive rate in the 40μg group （85.71%） was significantly higher than that in the 20μg group （71.43%, P0.05） after revaccination.The percentages of CD4＋ CD25＋ regulatory T cells in the peripheral blood of the CALD patients（6.41%±2.34% and 7.02%±2.83%） one week before hepatitis B vaccination and one month after vaccination were lower than those of the healthy individuals（10.02%±1.83% and 10.04%±2.14%,P0.05）.Conclusions CALD affects the efficacy of hepatitis B vaccine.The underlying mechanism might be attributed to a decrease in CD4＋ CD25＋ regulatory T cells.Revaccination with 40μg of recombinant yeast hepatitis B vaccine successfully improves vaccination efficacy.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2012年第5期493-495,共3页
Medical Journal of Chinese People's Liberation Army
基金
国家“十二五”科技重大专项课题(2012ZX10002-003)~~
关键词
肝炎
酒精性
肝炎疫苗
乙型
免疫接种
hepatitis
alcoholic
hepatitis B vaccines
immunization
