摘要目的 观察乙型肝炎相关性肝病肝移植受体术后对乙型肝炎疫苗免疫的反应,初步探讨影响疫苗接种成功的相关因素,为提高疫苗接种成功率寻求进一步的解决方案. 方法 前瞻性观察了13例乙型肝炎相关肝病肝移植术后患者,术后应用拉米夫定和乙型肝炎免疫球蛋白联合方案预防乙型肝炎复发平均达38个月(27～77个月),接种方案为分别在第0、1、2、6个月肌内注射接种乙型肝炎基因重组疫苗,每次40μg,分别在接种1、2、3、6、7个月时检测血清抗-HBs的滴度水平.结果 13例患者均按计划完成4次乙型肝炎疫苗接种,有7例(53.8%)出现抗体阳性反应,抗-HBs滴度有2例(15.4%)增幅＞100 U/L,4例(30.8%)超过基础值1倍以上;第四次疫苗接种后随访8个月,有6例抗-HBs滴度水平仍高于接种前10 U/L以上,仅有1例下降到接种前水平.结论 乙型肝炎相关性肝病肝移植受体术后接种乙型肝炎疫苗重建针对乙型肝炎的主动免疫是可行的,但如何提高疫苗的免疫反应率和反应水平值得我们更进一步研究.

abstractsObjectives To study the active immunity response of liver transplant patients for HBV-related diseases after hepatitis B vires(HBV)vaccine immunization and to investigate the factors that influence the effectiveness of the vaccination in order to find measures to increase its success.Methods Thirteen patients who had liver transplants because of HBV-related end-stage liver diseases received hepatitis B virus immunoglobulin and lamivudine for an average of 38 months(range 27-77 months).They received double intramuscular doses(40μg)of a recombinant vaccine at months 0,1,2 and 6.The anti-HBs titers were tested regularly at months 1,2,3,6 and 7.Results Seven of the 13 patients(53.8%)developed higher serum titers of anti-HBs compared with their titers prior to the vaccinations,2 patients of the 13(15.4%)developed an increase by 100 U/L and in 4 patients(30.8%)their base levels were doubled.Those responding patients were followed-up for another 8 months after the fourth vaccination,and only 1 patient among them had a decrease of the anti-HBs titers below the level prior to the vaccination.Conclusion Hepatitis B vaccine immunization can be used to enhance the active immunity against HBV in patients who had liver transplants for HBV-related diseases.