Jiang Hai-Yin, Wang Shu-Yin, Deng Min, Li Yu-Chuan, Ling Zong-Xin, Shao Li, Ruan Bing
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Hangzhou, Zhejiang 310003, China.
Department of Nosocomial Infection Management, Hangzhou First People's Hospital, Hangzhou 310006, China.
Vaccine. 2017 May 9;35(20):2633-2641. doi: 10.1016/j.vaccine.2017.03.080. Epub 2017 Apr 9.
The response rate to hepatitis B virus (HBV) vaccination in patients with inflammatory bowel disease (IBD) is low and varies markedly. We performed a systematic review and meta-analysis to determine the response rate to HBV vaccination and identified the factors predictive of an immune response.
We searched PubMed, Cochrane Library, and Embase databases, and reviewed the titles and abstracts of studies on the efficacy of HBV vaccination in IBD patients performed through July 2016. Anti-HBs levels>10IU/L was considered to be an effective immune response. The primary outcome measure was the response rate to HBV vaccination after series completion, and the secondary outcome was identification of factors at baseline predictive of an immune response.
Thirteen studies including 1688 patients were eligible for inclusion. Based on a random-effects model, the pooled rate of a response to HBV vaccination among patients with IBD was 61% (95% confidence interval [CI]: 53-69). Young age (mean difference [MD]: -5.7; 95% CI: -8.46, -2.95) and vaccination during disease remission (relative risk [RR]: 1.62; 95% CI: 1.15-2.29) were associated with a positive response to HBV vaccination. In addition, no immunosuppressive therapy was predictive of an immune response compared to immunomodulatory (RR: 1.33; 95% CI: 1.08-1.63) or anti-tumor necrosis factor-α (anti-TNF-α) (RR: 1.57; 95% CI: 1.19-2.08) therapy.
Based on this meta-analysis, only three of five IBD patients will show a serological response to HBV vaccination. Vaccination should be performed at the time of IBD diagnosis, during disease remission, or before starting immunosuppressive therapy.
炎症性肠病（IBD）患者对乙型肝炎病毒（HBV）疫苗接种的反应率较低且差异显著。我们进行了一项系统评价和荟萃分析，以确定HBV疫苗接种的反应率，并确定预测免疫反应的因素。
我们检索了PubMed、Cochrane图书馆和Embase数据库，并回顾了截至2016年7月进行的关于IBD患者HBV疫苗接种疗效研究的标题和摘要。抗-HBs水平>10IU/L被认为是有效的免疫反应。主要结局指标是系列接种完成后HBV疫苗接种的反应率，次要结局是确定基线时预测免疫反应的因素。
13项研究（包括1688例患者）符合纳入标准。基于随机效应模型，IBD患者中HBV疫苗接种的合并反应率为61%（95%置信区间[CI]：53-69）。年轻（平均差异[MD]：-5.7；95%CI：-8.46，-2.95）以及在疾病缓解期接种疫苗（相对风险[RR]：1.62；95%CI：1.15-2.29）与HBV疫苗接种的阳性反应相关。此外，与免疫调节治疗（RR：1.33；95%CI：1.08-1.63）或抗肿瘤坏死因子-α（抗-TNF-α）治疗（RR：1.57；95%CI：1.19-2.08）相比，未进行免疫抑制治疗可预测免疫反应。
基于这项荟萃分析，五分之三的IBD患者对HBV疫苗接种会出现血清学反应。疫苗接种应在IBD诊断时、疾病缓解期或开始免疫抑制治疗之前进行。
