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目的评价乙肝疫苗低应答/无应答儿童重新接种或加大剂量接种后的免疫效果。方法用酶联免疫法(ELISA)筛选出1岁以内已全程接种乙肝疫苗的4~6岁儿童血清HBsAg、抗-HBs、抗-HBc 3项指标全为阴性者,再用固相放射免疫法(RIA)复核并对抗-HBs小于10mIU/ml者,使用重组(CHO细胞)乙肝疫苗,按10μg剂量/1针次和20μg剂量/1针次分2组接种,均为0、1、6程序接种3针,完成接种后1~2月时采血,检测抗-HBs水平。结果2019例筛选儿童血清HBsAg、抗-HBs、抗-HBc 3项指标全为阴性者672例,占33.28%。抗-HBs<2.1mIU/ml的无应答儿童占27.44%,2.1~9.9mIU/ml的低应答儿童占5.05%。10μg剂量接种组采集到158例血清,抗-HBs≥10mIU/ml者155例,占98.10%,GMT为364.36mIU/ml。20μg剂量接种组采集到173例血清,抗-HBs≥10mIU/ml者172例,占99.42%,GMT为392.86mIU/ml。2组疫苗再免疫后抗-HBs的GMT增幅为53.61~721.87倍。结论乙肝疫苗无(低)应答儿童重新接种乙肝疫苗3针后免疫效果良好,10μg剂量组与20μg剂量组的抗体达到保护水平率差异无统计学意义,无应答儿童再免疫后产生的抗体GMT水平2组差异无统计学意义,低应答儿童的抗体GMT水平则表现为20μg剂量组高于10μg剂量组。
Objective To evaluate the immunological effects of low-response / no-response hepatitis B vaccination or increased dose inoculation of hepatitis B vaccine. Methods Serum HBsAg, anti-HBs, and anti-HBc in children aged 4 to 6 years who had been vaccinated with hepatitis B vaccine within 1 year of age were all screened by enzyme-linked immunosorbent assay (ELISA), and all of them were negative by solid phase radioimmunoassay (RIA) and against-HBs less than 10 mIU / ml were vaccinated with recombinant (CHO cell) hepatitis B vaccine at 10 μg dose / 1 dose and 20 μg dose / 1 dose sub-divided in 2 groups Inoculation 3-needle, after completion of 1 to 2 months after inoculation blood collection, detection of anti-HBs levels. Results 2019 cases of screening children with serum HBsAg, anti-HBs, anti-HBc indicators were all negative 672 cases, accounting for 33.28%. Responding children with anti-HBs <2.1 mIU / ml accounted for 27.44%, and those with low responders 2.1-9.9 mIU / ml accounted for 5.05%. In the 10μg dose group, 158 serum samples were collected, 155 cases were anti-HBs≥10mIU / ml, accounting for 98.10%, GMT was 364.36mIU / ml. In the 20μg dose group, 173 cases of serum were collected and 172 cases of anti-HBs≥10mIU / ml, accounting for 99.42%. The GMT was 392.86mIU / ml. The GMT increase of anti-HBs after re-immunization was 53.61-721.87 times. Conclusion There was no significant difference in the level of protection between the 10μg dose group and the 20μg dose group in the children with no (low) response to hepatitis B vaccine re-vaccination with 3 doses of hepatitis B vaccine. The GMT level There was no significant difference between the two groups. The antibody GMT level in children with low response was higher than that in 10μg dose group.