【摘要】 目的客观地评价北京市现行不同乙型肝炎(乙肝)疫苗的免疫效果。方法选择既往无乙肝疫苗接种史的大学生及出生时全程免疫过的儿童,检测血清HBsAg、抗-HBs及抗-HBc,全阴性者作为观察对象。入选人学生280人,按照0、1、6个月程序进行3针基础免疫,其中接种重组酿酒酵母乙肝疫苗(10μg、5μg、5μg)140人,重组汉逊酵母乙肝疫苗(10μg、10μg、10μg)140人。入选儿童98人进行1针加强免疫,其中酿酒酵母疫苗49人(5μg),汉逊酵母疫苗49人(10μg)。免疫后1个月采血检测抗-HBs。结果大学生3针免疫后,抗-HBs有效阳转率(≥10 mIU／ml)酿酒酵母疫苗低于汉逊酵母疫苗(93．5％,99．3%,P<0 05),几何平均滴度(GMT)二者差异无统计学意义(81．2 mIU／ml,94 6 mIU／ml,P>0．05)。从男性看,接种酿酒酵母疫苗的抗体有效阳转率及GMT均低于汉逊酵母疫苗(85．7％,100.0％,P<0.01)(56．6 mIU／ml,98.6 mIU／ml,P<0.01),而对于女性,差异均无统计学意义(98.8％,98．5％,P>0．05)(103.4 mIU／ml,90．3 mIU／ml,P>0.05)。从同种疫苗不同性别看,接种酿酒酵母疫苗抗体有效阳转率及GMT男性均低于女性(85．7％,98．8％, P<0．01)(56．6 mIU／ml,103.4 mIU／ml,P<0．01),而汉逊酵母疫苗男女性差异均无统计学意义(100．0％,98．5％,P>0.05)(98．6 mIU／ml,90．3 mIU/ml,P>0．05)。出生时按程序免疫的儿童,其抗-HBs阳性率随年龄增长呈下降趋势(P<0．01)。70例阴转者经1针加强免疫后,98．6％出现阳转, GMT显著提高到免疫前的15倍。阳转率及GMT 2种疫苗差异无统计学意义(100．0％,97．4％, P>0．05)(80．5 mIU／ml,68.5 mIU／ml,P>0．05)。结论乙肝疫苗的接种效果与疫苗种类及受种者性别均有关系。成人基础免疫,按目前常规使用剂量,男性接种汉逊酵母疫苗效果优于酿酒酵母疫苗,女性2种疫苗效果均好。儿童加强免疫,2种疫苗效果均较理想。重组疫苗初免后抗体阴转者的免疫记忆良好,新生儿完成重组乙肝疫苗全程免疫后至少6年之内无需加强。更多还原

【Abstract】 Objective To evaluate the immunity status on different hepatitis B vaccines currently being used in Beijing. Methods College students who had not received hepatitis B vaccine and children who had received whole-course immunization at birth, were tested HBsAg, anti-HBs and anti-HBc. All the test-negative cases were served as research subjects. 3 doses recombinant hepatitis B vaccines were given to the college students, following the 0, 1, 6 months schedule. Among which, 140 cases received recombinant beer yeast hepatitis B vaccine (BY vaccine, 10μg, 5μg, 5μg), and 140 cases with recombinant hansenula polymorpha hepatitis B vaccine (HP vaccine, 10μg, 10μg, 10μg). 1 dose was given for boosting immunization to 98 children, in which 49 cases with BY vaccine (5μg) and 49 cases with HP vaccine ( 10μg). Anti-HBs was tested 1 month after. Results The total positive (≥10 mIU/ ml) rate was lower among BY vaccine group than HP vaccine group for the college students (93.5% , 99. 3 % , P < 0. 05) , but no statistical difference on GMT (81. 2 mIU/ml, 94. 6 mIU/ml, P > 0.05 ) was found. For males, the positive rate and GMT were lower in BY vaccine group than in HP vaccine group (85.7%,100.0%,P<0.01)(56.6 mIU/ml,98.6 mIU/ml, P< 0.01), but with no statistical difference for females ( 98. 8 % , 98. 5 % , P > 0. 05 ) ( 103.4 mIU/ml, 90. 3 mIU/ml, P > 0. 05 ). For the same vaccine, the positive rate and GMT were lower in males than in females when using BY vaccine(85. 7% , 98.8%,P<0.01)(56.6 mIU/ml, 103.4 mIU/ml, P< 0. 01) , but no statistical difference was found on HP vaccine( 100.0% ,98. 5% , P >0.05) (98. 6 mIU/ml,90.3 mIU/ml, P> 0.05). The positive rate of anti-HBs was decreasing along with age among the children who had received a whole-course immunization at birth(P<0.01). 98. 6% of the 70 negative cases appeared positive conversion after receiving 1 dose and the GMT raised significantly by 15 times. No statistical difference was found between the two kinds of vaccines( 100.0 % , 97. 4 % , P > 0.05) (80. 5 mIU/ml, 68. 5 mIU/ml, P > 0. 05). Conclusions The type of vaccine and sex were related to the effects, better with HP vaccine than BY vaccine in males but was the same for females in adults receiving basic immunization according to the conventional doses. Both kinds of vaccines were ideal when children receiving boosting immunization. The immune memory was good for persons who had received primary immunization with recombinant vaccine but antibody appeared negative conversion. It was not necessary to boost immunization within 6 years after a whole-course immunization with recombinant hepatitis B vaccine in infancy.更多还原