| ObjectiveTo study the relationship between the percentage of Th1 cells in peripheral blood and the percentage of toxic T lymphocyte(CTL)in CD4 + T cells and the success of hepatitis B vaccination in liver transplantation recipients with different hepatitis B vaccine vaccination schemes,and explore new methods and related immunological mechanisms to improve the success rate of hepatitis B vaccination.MethodsA prospective control study was conducted among liver transplantation recipients with hepatitis B-related liver disease who had been followed up for a long time in the Department of Liver Transplantation,Third Medical Center of PLA General Hospital.After signing the informed consent,the patients were randomly divided into the following two groups according to the pre-generated coding:(1)Rapid group: one dose of hepatitis B vaccine at 0,1,2 and 3 months,and one dose of hepatitis B vaccine at 4,5 and 6 months;(2)Rapid intensification group: one dose of hepatitis B vaccine at 0,1,2 and 3 months,and one dose of hepatitis B vaccine at 4,5 and 6 months.The serum levels of anti-HBs,alanine aminotransferase,blood routine and immunosuppressive agents were measured monthly starting from the first injection of vaccine.The blood routine,urine routine,liver function,renal function,blood sugar,blood lipid,serum anti-HBs concentration and serum immunosuppressive drug concentration were measured before and after the experiment.The flow cytometry of Beckmann Kurt FC500 and related reagents were used to detect the serum levels of anti-HBs and immunosuppressive agents.The percentage of fixed Th1 cells in CD4 + T cells and CTL cells in CD8 + T cells.In the initial stage of vaccination,HBIg was discontinued if the titer of serum anti-HBs was more than twice the baseline value(the trough value of serum anti-HBs was 60+10U/L)after vaccination.If the titer of anti-HBs after discontinuation of HBIg is still greater than or equal to 60U/L and lasts longer than 3 months,the successful vaccination of hepatitis B vaccine will be judged.To observe the safety of vaccination and the occurrence of rejection.Relevant index values after the test minus the values before the test are regarded as the increase.ResultsIn this study,122 subjects were enrolled,and 2 patients withdrew from the study(1 in the rapid group and 1 in the rapid intensification group,respectively,due to insufficient confidence in vaccination and living abroad).The effective sample size was 120.The success rate of vaccination in the rapid intensification group was significantly higher than that in the rapid group(c2=4.348,P=0.046).The increase of Anti-HBs(U=143,P=0.011),Th1 cell proportion(U=176,P=0.009)and CTL cell proportion(U=139,P=0.013)in the rapid intensification group were significantly higher than those in the rapid group.The percentage of Th1 cells(U=192,P<0.001)and CTL cells(U=118,P=0.031)in the successful group were significantly higher than those in the unsuccessful group.The increase of Anti-HBs 61.4(42.5,94.2)was positively correlated with the increase of Th1 cell percentage 7(2,11)(r=0.695,P<0.001),but not with the increase of CTL cell percentage 1(0,3)(r=0.150,P=0.099).There was no significant difference in blood routine,urine routine,liver function,kidney function,blood sugar,blood lipid and serum concentration of immunosuppressive agents in 120 subjects before and after the study.No rejection occurred during the study.ConclusionUnder this experimental condition,for liver transplantation recipients with hepatitis B-related liver disease,reasonable increase of hepatitis B vaccine dosage can improve the success rate of vaccination.The possible mechanism is to promote the production of anti-HBs by up-regulating the expression of Th1 cells and enhancing the immune response of the body. |
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