Aziz A, Aziz S, Li D S, Murphy L, Leone N, Kennedy M, Dhillon S, Van Thiel D H
Division of Gastroenterology, Nutrition and Hepatology, Department of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA.
J Viral Hepat. 2006 Apr;13(4):217-21. doi: 10.1111/j.1365-2893.2005.00674.x.
Patients with chronic liver disease (CLD) respond poorly to standard hepatitis B (HBV) vaccine given as sequential 20 microg IM shots because of an overall impaired immune response. Many of these patients go on to liver transplantation and are at risk of acquiring recurrent or de novo HBV infection. To evaluate the efficacy and safety of high-dose (80 microg) IM HBV vaccination in patients with CLD who had previously failed to respond to a standard three-dose schedule of 40 microg IM vaccine given monthly. A retrospective review was undertaken at our institution of 79 patients with CLD who were treated with high-dose (80 microg) HBV vaccinations. All had previously failed a three-dose course of 40 microg HBV vaccine. An HBV vaccine response was defined as an anti-HBs titer greater than 100 mIU/ml. Liver enzymes, creatinine, age, prothrombin time, total vaccine dose, and MELD score were recorded. No adverse events were reported. Seventy-two per cent (57/79) of the subjects had an adequate response after receiving a mean total dose of 220 mug vaccine (range 80-800 microg). Twenty-eight per cent (22/79) of the subjects did not respond after receiving a mean total dose of 420 microg vaccine (range 240-720 microg). Non-responders had more severe hepatic disease defined as a higher mean total bilirubin level (p = 0.003) and a lower mean albumin level (p < 0.05). Age, prothrombin time, MELD score, and creatinine were not statistically significant between the responders and non-responders. Repeated high-dose (80 microg) HBV vaccination, in patients who do not respond to standard HBV vaccine doses, is safe and effective in the majority of patients with CLD.
慢性肝病（CLD）患者由于整体免疫反应受损，对按顺序给予20微克肌肉注射的标准乙型肝炎（HBV）疫苗反应不佳。这些患者中的许多人最终接受了肝移植，并有感染复发性或新发HBV感染的风险。为了评估高剂量（80微克）肌肉注射HBV疫苗对先前未对每月给予40微克肌肉注射的标准三剂疫苗接种方案产生反应的CLD患者的疗效和安全性。我们机构对79例接受高剂量（80微克）HBV疫苗接种的CLD患者进行了回顾性研究。所有患者先前均未通过40微克HBV疫苗的三剂疗程。HBV疫苗反应定义为抗-HBs滴度大于100 mIU/ml。记录肝酶、肌酐、年龄、凝血酶原时间、总疫苗剂量和终末期肝病模型（MELD）评分。未报告不良事件。72%（57/79）的受试者在接受平均总剂量为220微克疫苗（范围80 - 800微克）后有充分反应。28%（22/79）的受试者在接受平均总剂量为420微克疫苗（范围240 - 720微克）后无反应。无反应者患有更严重的肝病，表现为平均总胆红素水平较高（p = 0.003）和平均白蛋白水平较低（p < 0.05）。反应者和无反应者之间的年龄、凝血酶原时间、MELD评分和肌酐无统计学差异。对于对标准HBV疫苗剂量无反应的患者，重复高剂量（80微克）HBV疫苗接种在大多数CLD患者中是安全有效的。
