高剂量乙型肝炎疫苗在干扰素治疗后获得HBsAg清除患者中免疫效果研究

Study on the Immune Effect of High-Dose Hepatitis B Vaccine in Patients with HBsAg Clearance after Interferon Treatment

摘要: 目的：探讨聚乙二醇干扰素-α (Peg-IFN-α)治疗后获得乙肝表面抗原(HBsAg)清除的慢性乙型肝炎(CHB)患者，接种60 μg乙型肝炎疫苗(HBVac)免疫对HBsAb血清学转换率及乙型肝炎表面抗体(HBsAb)水平的影响，评估高剂量HBVac在该人群中的免疫保护效果。方法：回顾性收集2018~2024年中山大学附属第七医院及浙江大学附属第四医院经Peg-IFN-α治疗后实现HBsAg清除(间隔≥1周连续2次检测HBsAg < 0.05 IU/ml)的16~70岁CHB患者资料。患者在HBsAg转阴后接种至少1剂60 μg HBVac，并每3个月规律随访至少1次。通过门诊病历系统收集患者的人口学特征、治疗方案、血清学检查结果及60 μg HBVac接种情况，分析HBsAb血清学转换率、HBsAb ≥ 100 mIU/ml和≥300 mIU/ml比例，评价60 μg HBVac对经Peg-IFN-α治疗HBsAg清除患者的免疫保护效果。结果：共纳入96例患者，接种60 μg HBVac后，HBsAb血清学转换率为89.58% (86/96)，HBsAb水平与HBsAg复阳相关，HBsAb ≥ 100 mIU/ml组复阳率显著低于<100 mIU/ml组(12.5% vs 40%, P < 0.05)。结论：CHB患者经Peg-IFN-α治疗后获得HBsAg清除，接种高剂量HBVac可诱导较高的HBsAb血清学转换率，高水平的HBsAb滴度有助于降低HBsAg复阳率。

Abstract: Objective: To evaluate the immunogenic effect of 60 μg hepatitis B vaccine (HBVac) on seroconversion of hepatitis B surface antibody and the level of hepatitis B surface antibody (HBsAb) in chronic hepatitis B (CHB) patients who achieved HBsAg clearance after peginterferon-α (Peg-IFN-α) therapy. Methods: A retrospective study was conducted on CHB patients aged 16 to 70 years who achieved HBsAg clearance (HBsAg < 0.05 IU/ml in two consecutive tests ≥1 week apart) after Peg-IFN-α treatment at the Seventh Affiliated Hospital of Sun Yat-sen University and the Fourth Affiliated Hospital of Zhejiang University between 2018 and 2024. Patients received at least one dose of 60 μg HBVac after HBsAg clearance and were followed up every 3 months. The demographic data, treatment regimens, serological results and vaccination records were collected through outpatient medical record systems. Seroconversion rates and proportions of HBsAb ≥ 100 mIU/ml and ≥300 mIU/ml were analyzed. Results: Among 96 patients, the seroconversion rate of HBsAb was 89.58% (86/96). HBsAb level was associated with HBsAg re-positivity, with a significantly lower re-positivity rate in the HBsAb ≥ 100 mIU/ml compared to <100 mIU/ml group (12.5% vs 40%, P < 0.05). Conclusions: High-dose HBVac in CHB patients with HBsAg clearance after Peg-IFN-α therapy induces higher seroconversion rate, and higher HBsAb titers are associated with reduced HBsAg re-positivity.