5岁以下儿童肝移植术后注射乙肝疫苗免疫效果的多因素分析  

Multivariate analysis of immune effect of hepatitis B vaccination in post-liver transplantation children aged under 5 years old

作　　者：周翠云[1] 孙丽莹[2] 宋伟[3] 王冬梅[4] Zhou Cuiyun;Sun Liying;Song Wei;Wang Dongmei(Department of Disease Prevention and Control and Infection Management,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Intensive Care Unit,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of International Medical Center,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院疾病预防控制与感染管理处,100050 [2]首都医科大学附属北京友谊医院重症医学科,100050 [3]首都医科大学附属北京友谊医院普外科,100050 [4]首都医科大学附属北京友谊医院国际医疗中心,100050

出　　处：《国际外科学杂志》2020年第2期98-102,共5页International Journal of Surgery

摘　　要：目的探讨5岁以下儿童肝移植术后接种乙肝疫苗免疫应答的效果及多针次接种必要性的评估。方法回顾性分析2014年2月—2018年12月于首都医科大学附属北京友谊医院普外科同一肝移植组进行肝移植手术,术后遵医嘱注射乙肝疫苗完成4针次以上的5岁以下170例患儿的临床资料,其中男性75例,女性95例,年龄4个月至5岁,患儿每针次接种疫苗后随来院肝移植门诊复诊时抽血检测乙肝五项,观察HBsAb应答效果及其相关影响因素。计数资料数据用例数和百分数(%)表示,组间比较用χ^2检验。结果5岁以下患儿肝移植术后完成第1个疗程乙肝疫苗注射后免疫应答成功121例(HBsAb≥100 IU/L),应答失败49例(HBsAb<100 IU/L),接种第2个疗程后应答成功29例,最终只有20例患儿接种8针次即2个疗程后HBsAb<10 IU/L。影响乙肝疫苗接种免疫效果的相关因素与性别、原发病、供肝方式、术后接种疫苗时间无关,与年龄、居住地、术前HBsAb滴度高低有关(抗-HBs以100 IU/L为标准)。平均年龄2岁以上患儿明显比1岁以下患儿术后接种第1个疗程后免疫应答率高,术前儿童接种过乙肝疫苗且抗-HBs滴度>100 IU/L患儿其术后接种第1疗程后免疫应答率更高(84.72%),术前抗-HBs滴度<100 IU/L患儿术后接种乙肝疫苗第1疗程后免疫应答稍低(60.71%)。结论大部分肝移植患儿可通过接种乙肝疫苗主动免疫获得保护性抗体来预防乙肝病毒再感染,坚持多针次接种能有效地诱导机体产生乙肝抗体,提高免疫应答水平,具有保护效果,且经济有效,肝移植术后接种乙肝疫苗存在必要性,是目前肝移植术后推广应用方法之一。Objective To investigate the effect of hepatitis B vaccine immune response after liver transplantation in children under 5 years old and assess the necessity of multiple vaccination.Methods A retrospective collection of children who had liver transplantation from February 2014 to December 2018 in the same liver transplantation group in the Department of General Surgery,Beijing Friendship Hospital,Capital Medical University were analyzed.In accordance with the requirements of the doctor,170 children under 5 years old injected with over 4 doses were enrolled,including 75 males and 95 females,aged from 4 months to 5 years old.After every dose of vaccination,the blood were collected to detect hepatitis B following regular review in liver transplantation clinic,observe the effect of HBsAb(hepatitis B surface antibody)after postoperative hepatitis B vaccination.Count data were represented by cases and percentage(%),and comparison between groups were analyzed by chi-square test.Results After the first course of treatment,in total children under 5 years old who completed the first course of treatment,121 cases got successful immune responses(HBsAb≥100 IU/L)and 49 cases got the responses failure(HBsAb<100 IU/L).After the second course of treatment,29 cases got successful immune responses,and only 20 cases finally failed to response(HBsAb<10 IU/L)to 8 injections namely two courses.The factors affecting the immune effect of hepatitis B vaccination were not related to gender,primary disease,liver feeding mode,and postoperative vaccination time,and were related to age,place of residence,and preoperative level of HBsAb titer(100 IU/L).The immune responses rate of children averagly aged over 2 years old was significantly higher than that of children under 1 year old after the first course of postoperative vaccination.Children with preoperative hepatitis B vaccination and>100 IU/L anti-HBs titer had a higher immune response rate after the first course of postoperative vaccination(84.72%),and the immune response rate of childre

关 键 词：肝移植 肝炎疫苗 乙型 儿童 学龄前 免疫 

分 类 号：R726[医药卫生—儿科]