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目的探讨IL-2水平与乙肝疫苗接种后免疫应答发生的关系以及复种卡介菌素和重组酵母乙肝疫苗对免疫失败人群的免疫效果。方法对1 071位5~7岁儿童进行乙肝标志物筛选,对乙肝疫苗接种无应答者首先接种免疫佐剂卡介菌素15次,再接种重组酵母乙肝疫苗,按0、1、3月方案进行免疫;随机选取抗-HBs阴性者21人和抗HBs≥10mIU/ml强应答组22人,抽取静脉血,分离外周血单个核细胞(PBMC),用特异性抗原HBsAg和非特异性抗原植物血凝素(PHA)刺激培养,测定培养上清中的白细胞介素-2(IL-2)水平。结果1 071位儿童中HBsAg、抗-HBc和抗-HBs等全阴者127例,经复种免疫后,抗HBs阳性119例,阳转率93.70%(119/127),平均几何滴度(GMT)为312.63 mIU/ml;在HBsAg或PHA刺激下,强应答组PBMC产生的IL-2水平均高于无、弱应答组(t=8.80和2.23,P均<0.05);PHA刺激的无、弱应答组和强应答组PBMC上清IL-2水平均高于HBsAg刺激组(t=5.70和4.38,P均<0.05)。结论乙肝疫苗初免后抗-HBs为阴性者按0、1、3月3针复种,可获得较好的免疫效果。乙肝疫苗无、弱应答者的PBMC可能存在着细胞免疫功能缺陷,由T细胞介导的细胞免疫功能低下可能是乙肝疫苗接种后无、弱应答发生的原因。
Objective To investigate the relationship between the level of IL-2 and the immune response after vaccination with hepatitis B vaccine and the immune effects of multiple vaccinia and recombinant yeast hepatitis B vaccine on immune failure population. Methods A total of 1071 children aged 5 to 7 years were screened for hepatitis B virus (HBV), and those who did not respond to hepatitis B vaccination were vaccinated with 15 doses of vaccinia adjuvant and then inoculated with recombinant hepatitis B vaccine according to the 0, 1 and 3 months plan 21 were randomly selected anti-HBs and anti-HBs ≥ 10mIU / ml strong response group of 22 patients were drawn venous blood, isolated from peripheral blood mononuclear cells (PBMC), with specific antigen HBsAg and non-specific antigen plant blood (PHA), and the level of interleukin-2 (IL-2) in the culture supernatant was measured. Results Among 1 071 children, 127 cases of HBsAg, anti-HBc and anti-HBs were found in all patients. After anti-HBs immunization, 119 anti-HBs were positive, the positive rate was 93.70% (119/127), the average geometric titers ) Was 312.63 mIU / ml. The levels of IL-2 produced by PBMC in the strong response group were significantly higher than those in the non-weak and weak response groups (t = 8.80 and 2.23, both P <0.05) stimulated by HBsAg or PHA; The levels of IL-2 in the supernatant of PBMC in both weak-response group and strong-response group were higher than those in HBsAg-stimulated group (t = 5.70 and 4.38, P <0.05). Conclusion Hepatitis B vaccine immunized with 3 anti-HBs after 0, 1, and 3 months of vaccination could achieve a better immune response. Hepatitis B vaccine, weak responders PBMC may have cellular immune function defects, T cell mediated cellular immune dysfunction may be hepatitis B vaccination after no, weak response to the reasons.