不同种类和剂量乙型肝炎疫苗成年人快速免疫效果观察

摘要

目的 探讨不同种类和剂量乙型肝炎(乙肝)疫苗(HepB)在成年人中的快速免疫效果.方法 在北京市朝阳区筛选≥20周岁、乙肝5项指标检测为阴性或单独核心抗体阳性者为接种对象,以社区为单位分成4组,按“0-1-2”免疫方案分别接种10、20 μg酒酿酵母乙肝疫苗(HepB-SCY)、20 μg中国仓鼠卵巢乙肝疫苗(HepB-CHO)、10 μg汉逊酵母乙肝疫苗(HepB-HPY).全程接种1～2个月后采用化学发光法定量检测抗-HBs水平.结果 共有1 772名符合条件的研究对象完成疫苗接种和效果观察.平均年龄48.50岁,女性占62.75％.10、20 μg HepB-SCY组,20 μg HepB-CHO组和10 μg HepB-HPY组的抗-HBs阳转率和几何平均滴度(GMT)分别为79.49％、84.34％、82.50％、74.15％(P=0.005)和39.53、62.37、48.18、33.64 mIU/ml(P=0.025);总体抗-HBs阳转率和GMT分别为79.01％和41.18 mIU/ml.4组研究对象抗-HBs水平均随年龄增长均呈下降趋势,组间抗-HBs的GMT的差异随年龄增大而缩小.logistic回归分析显示,控制了“是否单独核心抗体阳性”和“乙肝疫苗接种史”2个变量后,“接种疫苗种类和剂量”、“年龄”、“是否吸烟”均与抗-HBs有统计学关联.结论 “0-1-2”快速免疫方案中采用20 μg剂量仍能在中高年龄组人群中获得80％以上的阳转率,可作为“0-1-6”乙肝疫苗常规免疫程序的补充.%Objective To evaluate the effectiveness of rapid hepatitis B vaccination with different vaccine dosages and types in adults.Methods Adults who were aged ≥20 years,negative in the detections of 5 HBV serum markers or only anti-HBc positive were selected from Chaoyang district of Beijing.They were divided into 4 community-based specific groups and given three doses of 10 μ g HepB-SCY vaccine,20 μ g HepB-SCY vaccine,20 μ g HepB-CHO vaccine and 10 μ g HepB-HPY vaccine respectively at month 0,1,and 2.Their blood samples were collected within 1-2 months after completing the three dose vaccination to test anti-HBs level by using chemiluminesent microparticle immunoassay.A face to face questionnaire survey was conducted,and x2 test,Mantel-Haensel x2 test,Kruskal-Wallis rank test and multiple logistic regression analysis were performed.Results A total of 1 772 participants completed vaccination and observation.Their average age was 48.5 years,and 62.75％ of them were females.The anti-HBs positive rates in the groups of 10 μg HepB-SCY,20 μg HepB-SCY,20 μg HepB-CHO and 10 μg HepB-HPY vaccines were 79.49％,84.34％,82.50％ and 74.15％,respectively (P=0.005),and the geometric mean titers (GMT) were 39.53 mIU/ml,62.37 mIU/ml,48.18 mIU/ml and 33.64 mIU/ml respectively (P=0.025).The overall anti-HBs positive rate and GMT were 79.01％ and 41.18 mIU/ml.The anti-HBs GMT of 4 groups declined with age.The differences in anti-HBs GMT among 4 groups minimized with age.The result of logistic modeling indicated that vaccine type and dosage,age and smoking were associated with anti-HBs statistically after controlling the variables of "only anti-HBc positive or not" and "history of hepatitis B vaccination".Conclusion Hepatitis B vaccination at dosage of 20 tg based on 0-1-2 month rapid schedule could achieved anti-HBs positive rates ＞80％ in middle aged and old people,which can be used as supplement of 0-1-6 month routine schedule.