慢性肝病的患者一旦重叠感染急性或慢性乙肝有更严重的发病率和死亡率。这篇文章显示了乙肝疫苗对慢性肝病的病人是安全有效的，但是这方面的数据是缺乏的。我们评估了乙肝疫苗对肝硬化的安全性及免疫原性。试验包括肝功能Child A级及B级的乙肝表面抗原及乙肝核心抗体阴性的患者，在相隔0、30、60天接受了20微克乙肝疫苗的肌肉注射，并在120天之后检测乙肝表面抗体。我们研究了平均年龄为47.48 ±9.37的52个患者，反应率在Child A级及B级的患者中分别为88%、33.3%。我们观察到慢性酒精肝病（44%）比其他原因如隐源性肝硬化（69%）及HCV（75%）的反应率低。肝硬化患者乙肝抗体滴度要比正常群众低。随着年龄及肝硬化程度的增长，对乙肝疫苗的反应率更弱。这些结果表明如果我们在更早的年龄（<50岁）并且在肝硬化早期（Child A）接种疫苗与超过50岁并且肝硬化B级相比，乙肝疫苗的免疫原性更好。
Introduction. Patients with chronic liver disease (CLD) are more likely to have severe morbidity and fatality rate due to superimposed acute or chronichepatitis B (HBV) infection. The literature has shown that hepatitis B vaccines are safe and effective in patients with CLD, but the data in cirrhosis liveris lacking. We assessed the safety and immunogenicity of HBV vaccine in patients with cirrhosis liver. Methods. CTP classes A and B CLD patients negative for hepatitis B surface antigen and antibody to hepatitis B core antigen were included. All patients received three doses of hepatitis B vaccine 20 mcg intramuscularly at 0, 30, and 60 days. Anti-HBs antibody was measured after 120 days. Results. 52 patients with mean age 47.48 ± 9.37 years were studied. Response rates in CTP classes A and B were 88% and 33.3%. We observed that the alcoholic chronic liver disease had less antibody response (44%) than other causes of chronic liver disease such as cryptogenic 69% and HCV 75%. Conclusions. Patients with cirrhosisliver will have low antibody hepatitis B titers compared to general population. As the age and liver disease progress, the response rate for hepatitis Bvaccination will still remain to be weaker.
吉林大学第一医院肝病科 李雅君 摘译
本文首次发表于[Adv Virol. 2013;2013:196704]
本文首次发表于[Adv Virol. 2013;2013:196704]
Safety and efficacy of hepatitis B vaccination in cirrhosis of liver
AbstractIntroduction. Patients with chronic liver disease (CLD) are more likely to have severe morbidity and fatality rate due to superimposed acute or chronichepatitis B (HBV) infection. The literature has shown that hepatitis B vaccines are safe and effective in patients with CLD, but the data in cirrhosis liveris lacking. We assessed the safety and immunogenicity of HBV vaccine in patients with cirrhosis liver. Methods. CTP classes A and B CLD patients negative for hepatitis B surface antigen and antibody to hepatitis B core antigen were included. All patients received three doses of hepatitis B vaccine 20 mcg intramuscularly at 0, 30, and 60 days. Anti-HBs antibody was measured after 120 days. Results. 52 patients with mean age 47.48 ± 9.37 years were studied. Response rates in CTP classes A and B were 88% and 33.3%. We observed that the alcoholic chronic liver disease had less antibody response (44%) than other causes of chronic liver disease such as cryptogenic 69% and HCV 75%. Conclusions. Patients with cirrhosisliver will have low antibody hepatitis B titers compared to general population. As the age and liver disease progress, the response rate for hepatitis Bvaccination will still remain to be weaker.
