癌症患儿抗肿瘤治疗后乙肝免疫接种状况评估
Assessment of hepatitis B immunization status after antineoplastic therapy in children with cancer.
作者信息
Karaman Serap, Vural Sema, Yildirmak Yildiz, Urganci Nafiye, Usta Merve
机构信息
Department of Pediatric Hematology, Sisli Etfal Education and Research Hospital Clinic of Pediatrics, Istanbul, Turkey.
出版信息
Ann Saudi Med. 2011 Nov-Dec;31(6):573-6. doi: 10.4103/0256-4947.87091.
BACKGROUND AND OBJECTIVES
Hepatitis B is a disease that is preventable with vaccination. Antibody levels after vaccination may be affected by suppression of the immune system due to cancer therapy. Children with cancer have a high risk of hepatitis B virus (HBV) infection. We aimed to assess the pretreatment immunization status against HBV infection and the rate of continuity of immunization after therapy in children with cancer.
DESIGN AND SETTING
Retrospective case review of patients treated from 2004 to 2008.
PATIENTS AND METHODS
We reviewed the medical records of patients treated in the departments of pediatric hematology and oncology and collected data on immunization history and hepatitis B serology. Anti-HBs antibody titers were compared before and after treatment.
RESULTS
This study included 159 (99 males, 60 females) children who had a serologic examination. Antineoplastic therapy had been given for acute leukemia (n=66), non-Hodgkin lymphoma (n=27), Hodgkin lymphoma (n=20), and solid tumors (n=46). Fifty-one patients had not been immunized against HBV prior to the therapy; HBV serology was negative in 49 of these patients and HBsAg was positive in 2 patients. Anti-HBs antibody positivity was present in 99 of 108 patients with an immunization history, whereas no vaccination response was present in 9 patients. The titer of anti-HBs antibody was decreased below the protection level in 33 (33%) patients with positive anti-HBs antibody, whereas the protection level was found to be maintained in 66 (67%) patients. The most significant decrease (63.6%) was observed in leukemia patients. Posttreatment HBsAg and HBV DNA positivity was detected in two of the patients with negative pretreatment serology, whereas no HBV infection developed in the group with positive anti-HBs antibody.
CONCLUSIONS
This study demonstrated the importance of routine childhood vaccination in reducing the risk of HBV infection in patients with cancer.
背景与目的
乙型肝炎是一种可通过疫苗预防的疾病。癌症治疗导致的免疫系统抑制可能会影响疫苗接种后的抗体水平。癌症患儿感染乙型肝炎病毒（HBV）的风险很高。我们旨在评估癌症患儿治疗前针对HBV感染的免疫状态以及治疗后免疫接种的持续率。
设计与背景
对2004年至2008年接受治疗的患者进行回顾性病例审查。
患者与方法
我们查阅了儿科血液学和肿瘤学部门治疗的患者的病历，并收集了免疫史和乙型肝炎血清学数据。比较治疗前后的抗-HBs抗体滴度。
结果
本研究纳入了159名（99名男性，60名女性）接受血清学检查的儿童。抗肿瘤治疗用于急性白血病（n = 66）、非霍奇金淋巴瘤（n = 27）、霍奇金淋巴瘤（n = 20）和实体瘤（n = 46）。51名患者在治疗前未接种HBV疫苗；其中49名患者的HBV血清学检测为阴性，2名患者的HBsAg呈阳性。108名有免疫史的患者中有99名抗-HBs抗体呈阳性，而9名患者无疫苗接种反应。抗-HBs抗体呈阳性的33名（33%）患者的抗体滴度降至保护水平以下，而66名（67%）患者的保护水平得以维持。白血病患者中观察到最显著的下降（63.6%）。两名治疗前血清学检测为阴性的患者治疗后检测到HBsAg和HBV DNA阳性，而抗-HBs抗体呈阳性的组中未发生HBV感染。
结论
本研究证明了儿童常规疫苗接种对于降低癌症患者HBV感染风险的重要性。
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