乙型肝炎疫苗不同接种方案对肝移植受者接种成功率及Th2细胞变化的影响  

Impact of different hepatitis B vaccine immunization schedules on immune seroconversion and Th2 cell changes among liver transplantation recipients

作　　者：王维伟 王麟[2] 朱雄伟[3] 肖桦[3] 窦古枫 郭静[3] 陕海丽[3] 林美雄[3] 李向农 牛玉坚[1,3] 

机构地区：[1]徐州医科大学研究生学院,江苏徐州221004 [2]首都医科大学附属北京友谊医院肝病研究中心,北京100050 [3]武警总医院器官移植研究所,北京100039

出　　处：《中国疫苗和免疫》2017年第2期144-147,137,共5页Chinese Journal of Vaccines and Immunization

基　　金：国家自然科学基金(乙肝疫苗快速接种法在乙肝相关性肝病肝移植患者发挥治疗作用的免疫学机制研究;81450066)

摘　　要：目的研究乙型肝炎(乙肝)疫苗(Hepatitis B vaccine,HepB)不同接种方案对乙肝相关性肝病肝移植受者疫苗接种成功率及外周血Th2细胞变化的影响,探索提高接种成功率的新方法和相关免疫机制。方法选择124名肝移植受者,随机分为4组:传统组在第0、1、6个月各接种1剂20μg HepB;传统加强组在第0、1、6个月各接种1剂60μg HepB;快速组在第0、1、2、3个月各接种1剂40μg HepB,第4、5、6个月各接种1剂20μg HepB;胸腺肽组在快速组基础上从第0天接种开始,每10天皮下注射1.6mg胸腺肽1次,连续6个月。比较分析HepB接种成功率、接种前后乙肝表面抗体(抗-HBs)浓度变化及Th2细胞占CD4+T细胞比例的变化,并观察各组病例排斥反应。结果4组病例HepB接种成功率分别为3.23%(1/31)、6.45%(2/31)、23.33%(7/30)和30.00%(9/30)(x^2=9.35,P<0.05)。传统组抗-HBs浓度在实验前后无显著变化,其余3组抗-HBs浓度和全部4组的Th2细胞比例实验后均较实验前显著升高。接种成功者的Th2细胞比例增幅显著高于非成功者。抗-HBs浓度增幅与Th2比例增幅呈正相关(r=0.55,P=0.000)。研究期间无移植排斥反应发生。结论对乙肝相关性肝病肝移植受者,合理增加疫苗接种剂量、调整接种时间间隔或在接种过程中加用胸腺肽均可不同程度提高HepB免疫成功率,其可能的机制是这些措施促进了机体Th2细胞表达从而助推了抗-HBs的生成。Objective To study the impact of ules on seroconversion and Th2 cell changes different hepatitis B vaccine （HepB） immunization sched- among hepatitis B-related liver transplantation recipients, and to explore a new protocol for improving seroconversion and a related immune mechanisms. Methods A total of 124 liver transplantation recipients were randomized into 4 groups： the traditional group received 3-doses of 20μg HepB at 0, 1 and 6 months;the intensified traditional group received 3-doses of 60p, g HepB at 0, 1 and 6 months; the rapid group received 3-doses of 40p, g HepB at 0, 1, 2 and 3 months, followed by 3-doses of 20μg HepB at 4, 5 and 6 months ; and the thymosin group received the same regimen of HepB as the rapid group, but also received 1.6mg thymosin by injection every 10 days for 6 months. We compared seroconversion rates for HepB, concentrations of hepatitis B surface antibody （anti-HBs） , and proportions of Th2 cells in CD4 ＋ T cells in peripheral blood before and after the regi-mens. Liver transplant rejection was monitored during the study. Results The respective seroconversion rates ofanti-HBs in the 4 groups were 3.23% （1/31）, 6.45% （2/31）, 23.33% （7/30）, and 30. 00% （9/30） （x^2 =9.35, P〈0.05）. No significant differences in the anti-HBs concentration were seen before and after completing the regimen in the traditional group, while both the anti-HBs concentration and the Th2 cell proportion after the completing the regimens were significantly higher than before in each of the other groups. Increases of Th2 cell proportions were signifi- cantly higher among subjects who seroconverted than among subjects who did not seroconvert. There was a positive correlation between the increase of anti-HBs concentrations and the increase of the Th2 cell proportion after completing the regimens （ r=0. 550, P = 0. 000）. No transplant rejections occurred in any subjects during the study period. Conclusions The seroconversion rate of HepB immunization for hepatitis B-related

关 键 词：肝移植 乙型肝炎疫苗 免疫成功率 TH2细胞 

分 类 号：R617[医药卫生—外科学]