常规和快速乙肝免疫接种效果比较  

A comparative study on standard and accelerated immunization schedules for rapid protection against hepatitis B

作　　者：陈仕珠[1] 张晋红[1] 张增平[1] 任菊香[1] 温风玲[1] 韩永战[1] 任雪莲[1] 陈鹰军[1] 

机构地区：[1]中国人民解放军451医院内五科,陕西省西安市710054

出　　处：《世界华人消化杂志》2006年第19期1884-1888,共5页World Chinese Journal of Digestology

摘　　要：目的：研究d 0,7,14接种程序的乙肝免疫效果方法：无HBV感染和无抗-HBs健康受试者分为组1：军校学员和教师485名,男432女53名；平均年龄27．1(16-58)岁．组2：实习医生和护士234名,男63女171名；平均年龄21．6(18-24)岁．组3：混合人群302名,男170女132；平均年龄29．8(3-69)岁．对照组：高校学生和其他人员383名,男205女178名；平均年龄25．8(2-59)岁．前3组按d 0,7,14程序,对照组按mo 0,1,6程序三角肌内接种乙肝疫苗20μg(＜12岁者10μg)．于首针接种后1,3,7,12,24和36 mo查HBV五项标志、抗-HBs滴度及肝功等．结果：全程接种完成率组1(97．7%)、组2(97．4%)、组3(95．0%)均明显高于对照组(66．3%)(P＜0．001)．对照组中非团体接种171名,43．3%未完成全程接种．首针接种后1,3 mo d 0,7,14程序组血清抗-HBs阳转率分别为66．9%,67．4%,58．2%和96．9%,97．3%,94．0%,明显高于对照组的21．1%和43．1%(P＜0．001)；7 mo时组2仍高于对照组(P＜0．05)．1,3 mo d 0,7,14程序组血清抗-HBs有效保护率分别为63．0%,65．2%,53．0%和94．5%,96．0%,93．6%,显著高于对照组的7．8%和30．9%(P＜0．001)；7和12 mo时对照组高于组3(P＜0．05),组2亦高于组3(P＜0．05)．1,3 mo时d 0,7,14程序组血清抗-HBs几何平均滴度(GMT)分别为122．7%,125．6%,118．8%和131．5%,132．1%,119．3%,显著高于对照组的21．3%和41．5%(P＜0．001)；但7,12,24和36 mo时对照组均高于其他3组(P＜0．05-0．01)．对mo 0,1,6程序无反应者予d 0,7,14(73．1%)方案接种后血清抗-HBs阳转率亦明显高于重复mo 0,1,6(11．0%)方案者(P＜0．001)．结论：d 0,7,14方案操作方便、全程接种完成率高、抗-HBs阳转率和GMT峰值出现早,适用于各类人群,尤需紧急免疫的高危或特殊人群；对0,1,6 mo程序无反应者亦有良好效果．AIM： To study the accelerated immunization schedule for rapid protection against hepatitis B. METHODS： Healthy subjects were consecutively collected and divided into four groups according to occupation risk of getting hepatitis B virus （HBV） infection. Group A contained students and teachers （432 male and 53 female） from military academy with a mean age of 27.1 （16-58） years old. Group B contained interns and nurses （171 female and 63 male） aged 21.6 （18-24） years old. Group C were mixed populations （170 male and 132 female） aged 29.8 （3-69） years old. 383 students and other subjects （205 male and 178 female） aged 25.8 （2-59） years old served as controls. Group A, B and C were vaccinated intradeltoideusly with 20 μg （10 μg for the individuals less than 12 years old） recombinant hepatitis B （rHB） vaccine by the accelerated schedule （immunized on day 0, 7 and 14）, and group D was immunized by the standard schedule （on mo 0, 1 and 6）. HBV markers and anti-HBs titers were tested 1, 3, 7, 12, 24 and 36 month after the first vaccination. RESULTS： The completion rate for the accelerated schedule （group A： 97.7%; group B： 97.4%; group C： 95.0%） was markedly higher than that for the standard schedule （66.3%, P 〈 0.001）. The individuals without completion of vaccination covered a percentage of 43.3%. The seroconversion rate （anti-HBs 〉 or = 2.1 IU/L） was significant higher I and 3 mo after the first vaccination in group A, B and C than in the controls （1 mo： 66.9%, 67.4%, 58.2% vs 21.1%, P 〈 0.001; 3 mo： 96.9%, 97.3%, 94.0% vs 41.1%, P 〈 0.001）. The seroconversion rate was still higher in group B than in control group （P 〈 0.05） at 7 mo. A higher protection rate （anti-HBs 〉 or = 10 IU/L） was found 1 and 3 month after the first dose in group A, B and C （63.0%, 65.2%, 53.0% and 94.5%, 96.0%, 93.6%, respectively） than that in the controls （1 too： 63.0%, 65.2%, 53.0% vs 7.8%; 3 mo： 94.5%, 96.0%, 93.6% vs 30.9

关 键 词：乙型肝炎 乙肝疫苗 免疫 高危人群 

分 类 号：R186[医药卫生—流行病学]