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目的了解儿童异基因造血干细胞移植(allo-HSCT)前后乙型肝炎病毒(HBV)免疫标记的变化情况,探讨供受者allo-HSCT前不同HBV免疫状态与allo-HSCT后受者HBV免疫标记变化的关系。方法回顾性分析2010年1月-2012年6月在我院接受allo-HSCT治疗的130例儿童血液病患儿移植前后HBV免疫标记物(HBsAg、HBsAb、HBeAg、HBeAb及HBcAb)、HBV-DNA等临床资料,移植后随访中位时间18(6～36)个月。结果 (1)allo-HSCT前:HBsAg阴性患儿126例,阳性4例;HBsAb阳性患儿92例;HBsAg阳性供者6例,余均为HBsAg阴性供者。(2)allo-HSCT后:16例移植前HBsAb阴性受者移植后转为HBsAb阳性;66例移植前HBsAb阳性受者接受HBsAb阳性供者移植后,47例仍为HBsAb阳性,18例为HBsAb阴性,1例发生HBV再激活;21例移植前HBsAb阳性受者接受HBsAb阴性供者移植后,13例转为HBsAb阴性。(3)移植前供者HBsAb阳性,输注CD34+细胞>7.24×106/kg、移植前受者HBsAb滴度高低对移植后受者HBsAb转为阴性有显著影响,P值分别为0.005、0.040和0.000。(4)2例移植前合并HBV感染患儿移植后发生HBV再激活,2例移植前无HBV感染患儿接受大三阳供者移植后继发HBV感染。结论 HBsAb阴性患儿接受HBsAb阳性供者allo-HSCT后,在造血和免疫功能重建的同时,其体内可产生针对HBV的保护性抗体;移植后受者HBsAb随时间逐渐丢失,丢失的比例与移植前受者HBsAb滴度高低、输注CD34+细胞数高低、供者HBsAb阳性与否明显相关。因此,移植前对供受者进行针对HBV的免疫接种及移植后免疫重建后对受者再次免疫接种有利于预防移植后HBV激活及感染。
Objective To investigate the changes of hepatitis B virus (HBV) immunological markers before and after allo-HSCT in children and to explore the changes of HBV immune markers in HBV recipients with allo-HSCT before and after allo-HSCT Relationship. Methods The changes of HBV immune markers (HBsAg, HBsAb, HBeAg, HBeAb and HBcAb) and HBV-DNA in 130 children with hematologic diseases who underwent allo-HSCT in our hospital from January 2010 to June 2012 were retrospectively analyzed. And other clinical data, the median follow-up after transplantation 18 (6 to 36) months. Results (1) Before ano-HSCT, 126 cases of HBsAg-negative children were positive, 4 cases were positive, 92 cases were HBsAb-positive children, 6 cases were HBsAg-positive donors, all of whom were HBsAg-negative donors. (2) After allo-HSCT, 16 cases of HBsAb-negative recipients were transplanted to HBsAb-positive after transplants; 47 cases of HBsAb-positive HBsAb-positive donors were transplanted after 66 cases of transplanted HBsAb-positive recipients and 18 cases of HBsAb Negative, one case of HBV reactivation; 21 cases of HBsAb-positive recipients before transplantation after HBsAb negative donor transplantation, 13 cases turned to HBsAb negative. (3) HBsAb positive before transplantation and CD34 + cells infused> 7.24 × 106 / kg. The HBsAb titer before transplantation had a significant effect on HBsAb negative after transplantation, with P values of 0.005, 0.040 and 0.000. (4) HBV reactivation occurred in 2 children with HBV infection prior to transplantation, and 2 children without HBV infection before transplantation after secondary Sanyang donor transplantation after secondary HBV infection. Conclusion HBsAb-negative children receiving HBsAb-positive donor allo-HSCT, in the hematopoietic and immune function reconstruction at the same time, its body can produce antibodies against HBV; recipients HBsAb gradually lost over time, the proportion of loss and transplantation Before the recipient HBsAb titers, the number of CD34 + cells transfusions, HBsAb positive or not significantly correlated. Therefore, pre-transplant immunization against HBV for recipients and post-transplant immunosurveillance after recipient immunization is beneficial to prevent post-transplant HBV activation and infection.