论文部分内容阅读
目的 初步观察重组粒细胞 巨噬细胞集落刺激因子 (GM CSF)或乙型肝炎免疫球蛋白 (HBIG)联合酵母重组乙型肝炎疫苗 (rHBvac)对宫内感染呈慢性乙型肝炎病毒 (HBV)携带儿童的治疗作用。方法 母亲为慢性HBV携带者、出生时乙型肝炎表面抗原 (HBsAg)阳性、经乙型肝炎疫苗免疫仍发展为慢性HBV的无症状儿童 2 7名随机分为两组。Ⅰ组 (n =14)使用GM CSF 5 0 μg和rHBvac 10 μg同一部位肌肉注射 ,每月一次 ,共四次 ;Ⅱ组 (n =13)HBIG 2 0 0IU和rHBvac 10 μg不同部位肌肉注射 ,每月一次 ,共四次。治疗结束后一月定量复查HBV DNA及其他HBV标记。结果 两组各有 12名儿童完成研究。治疗前丙氨酸转氨酶 (ALT)异常Ⅰ组 3例 ,Ⅱ组 4例 ,治疗后各有两例恢复正常 ;治疗前乙型肝炎e抗原 (HBeAg)阳性Ⅰ组 9例 ,Ⅱ组 10例 ,治疗后各 1例发生HBeAg/抗 HBe血清转换HBV DNA定量 ,治疗后和治疗前相比 ,Ⅰ组有显著下降 (符号秩和检验P =0 0 2 3) ,Ⅱ组变化不明显。两组中均无HBsAg转阴病例。未出现严重副作用。结论 GM CSF联合乙肝疫苗对乙肝疫苗免疫失败的慢性HBV携带儿童有一定治疗作用 ,其作用可能通过增加 1型细胞因子分泌实现。
Objective To observe the effect of recombinant human granulocyte macrophage colony stimulating factor (GM CSF) or hepatitis B immunoglobulin (HBIG) combined with yeast recombinant hepatitis B vaccine (rHBvac) on chronic hepatitis B virus (HBV) Children’s therapeutic effect. Methods Twenty-seven asymptomatic children whose mothers were chronic HBV carriers and who were positive for hepatitis B surface antigen (HBsAg) at birth and were still immunized with hepatitis B vaccine were randomly divided into two groups. In group Ⅰ (n = 14), GM CSF 50 μg and rHBvac 10 μg were intramuscularly injected once a month for 4 times. In group Ⅱ (n = 13), HBIG 200 μl and rHBvac 10 μg were intramuscularly injected, Once a month, a total of four times. January after treatment, quantitative review of HBV DNA and other HBV markers. Results Twelve children in each group completed the study. Before treatment, alanine aminotransferase (ALT) abnormalities were found in 3 cases in group Ⅰ and 4 in group Ⅱ, and two cases returned to normal after treatment. Before treatment, 9 cases were positive for hepatitis B e antigen (HBeAg), 10 cases in group Ⅱ, After treatment, HBV DNA of HBeAg / anti-HBe seroconversion was detected in 1 case. After treatment, the level of HBV DNA was significantly decreased in group Ⅰ (sign rank sum test = 0 0 2 3), and the change in group Ⅱ was not obvious. No HBsAg negative cases in both groups. No serious side effects. CONCLUSION: GM CSF combined with hepatitis B vaccine may have a therapeutic effect on chronic HBV-carrying children who fail to achieve hepatitis B vaccine immunosuppression. The effect may be through increasing the secretion of type 1 cytokines.