Watts Abhishek, Bennett William E, Molleston Jean P, Gupta Sandeep K, Croffie Joseph M, Waseem Shamaila, McFerron Brian A, Steiner Steven J, Kumar Sanjay, Vanderpool Charles P, Hon Emily C, Bozic Molly A, Subbarao Girish C, Pfefferkorn Marian D
*Section of Pediatric Gastroenterology, Hepatology and Nutrition †Section of Pediatric and Adolescent Comparative Effectiveness Research, Riley Hospital for Children at Indiana University Health, Indiana University School of Medicine, Indianapolis, IN.
J Pediatr Gastroenterol Nutr. 2017 Nov;65(5):551-554. doi: 10.1097/MPG.0000000000001580.
Patients with inflammatory bowel disease (IBD) often receive immunosuppressive therapy, which may make them vulnerable to infections such as hepatitis B. We hypothesized that hepatitis B virus titers are low in the vaccinated pediatric population with IBD. The aims of our study were to identify the incidence of lower titers of hepatitis B surface antibody (HBsAb) and determine which patient factors may be associated with lower HBsAb titers.
Patients with diagnosis of IBD, ages 5 to 18 years, were prospectively enrolled. Patients were confirmed to have had a full series of hepatitis B vaccination. Quantitative serum HBsAb titers were measured and logistic regression analysis with independent variables of age, sex, race, disease phenotype, surgery, medications and a dependent variable of adequate HBsAb titers (> 10 mIU/mL) was performed.
Of the 116 patients enrolled, 57 were boys and 59 were girls. 75 patients had a diagnosis of Crohn disease; 32 had a diagnosis of ulcerative colitis; and 9 patients had been diagnosed as having indeterminate colitis. At the time of the study, 15 patients were taking corticosteroid, 66 on an immunomodulator, and 53 on a biologic. Sixty percent of patients in the 5- to 10-year age group had protective titers versus 22% to 27% in the older groups, P = 0.04. Only 28% of the 116 patients had HBsAb titers of >10m IU/mL. Twenty percent of the patients taking corticosteroids, 27% taking immunomodulators, and 24% taking biologics were found to be seroimmune.
Nearly two-thirds of pediatric patients with IBD have low titers against hepatitis B virus. Titers were highest in the younger patients. No patient-specific variable, such as the use of immunosuppressants, appeared to influence these low titers.
炎症性肠病（IBD）患者常接受免疫抑制治疗，这可能使他们易感染如乙型肝炎等疾病。我们推测，接种疫苗的IBD儿科患者的乙型肝炎病毒滴度较低。我们研究的目的是确定乙型肝炎表面抗体（HBsAb）滴度较低的发生率，并确定哪些患者因素可能与较低的HBsAb滴度相关。
前瞻性纳入5至18岁诊断为IBD的患者。确认患者已完成全程乙型肝炎疫苗接种。测量血清HBsAb定量滴度，并对年龄、性别、种族、疾病表型、手术、药物等自变量与足够的HBsAb滴度（>10 mIU/mL）的因变量进行逻辑回归分析。
纳入的116例患者中，57例为男孩，59例为女孩。75例诊断为克罗恩病；32例诊断为溃疡性结肠炎；9例诊断为不确定性结肠炎。研究时，15例患者正在服用皮质类固醇，66例正在服用免疫调节剂，53例正在服用生物制剂。5至10岁年龄组60%的患者具有保护性滴度，而年龄较大组为22%至27%，P = 0.04。116例患者中只有28%的HBsAb滴度>10 mIU/mL。服用皮质类固醇的患者中有20%、服用免疫调节剂的患者中有27%、服用生物制剂的患者中有24%被发现具有血清免疫性。
近三分之二的IBD儿科患者对乙型肝炎病毒的滴度较低。年轻患者的滴度最高。没有患者特异性变量，如使用免疫抑制剂，似乎会影响这些低滴度。
