作　　者： (聂黎）; (庞星火）; (张政）; (马建新）; (刘秀颖）; (邱倩）; (梁妍）; (李倩）; (张卫）;

机构地区： 北京市疾病预防控制中心北京市预防医学研究中心科研教学管理办公室,100013

出　　处： 《中华流行病学杂志》 2017年第9期1151-1155,共5页

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 μg HepB-SCY vaccine, 20 μg HepB-SCY vaccine, 20 μg HepB-CHO vaccine and 10 μg 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 χ2 test, Mantel-Haensel χ2 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 μg 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.

关 键 词： 乙型肝炎疫苗 免疫效果 快速免疫方案