背景:乙型肝炎疫苗的问世在根除和减轻乙型肝炎感染负担方面取得了巨大的成功,这是肝细胞癌的主要罪魁祸首,肝细胞癌是全球最致命的恶性肿瘤之一。对疫苗的反应在约90-95%的健康个体中实现,并且在免疫受损的患者中高达仅50%。这篇综述旨在概述乙肝疫苗无应答,所涉及的机制,B细胞健忘症,以及克服它的策略。
方法:数据库,包括谷歌学者,PubMed,Scopus,科克伦,和ClinicalTrials.org,用于搜索和检索文章使用关键词乙肝疫苗无应答和B细胞健忘症。在确定研究时遵循了PRISMA指南,筛选,选择,并报告调查结果。
结果:共有133项关于乙肝疫苗无应答的研究,机制,在筛查和最终选择后,审查中纳入了预防/管理策略.导致乙肝疫苗无应答的因素被发现包括遗传,免疫因素,健康个体的B细胞健忘症。遗传因素是性别,HLA单倍型,和免疫反应标记(细胞因子)中的遗传多态性。无反应在免疫缺陷的情况下很常见,比如肾衰竭,血液透析,乳糜泻,炎症性肠病,丙型肝炎合并感染,和潜伏的乙型肝炎感染。其他包括糖尿病和HIV感染。所涉及的机制是通过抑制应答(T辅助细胞)或诱导的应答抑制(通过调节性B和T细胞)而受损的免疫应答。
结论:全面而仔细地了解患者因素和疫苗的性质有助于制定有效的预防措施。这些包括再接种或加强剂量,通过皮内途径接种疫苗,以及在疫苗中使用佐剂。
BACKGROUND: The advent of the hepatitis B vaccine has achieved tremendous success in eradicating and reducing the burden of hepatitis B infection, which is the main culprit for hepatocellular carcinoma-one of the most fatal malignancies globally. Response to the vaccine is achieved in about 90-95% of healthy individuals and up to only 50% in immunocompromised patients. This review aimed to provide an overview of hepatitis B vaccine non-response, the mechanisms involved, B cell amnesia, and strategies to overcome it.
METHODS: Databases, including Google Scholar, PubMed, Scopus, Cochrane, and ClinicalTrials.org, were used to search and retrieve articles using keywords on hepatitis B vaccine non-response and B cell amnesia. The PRISMA guideline was followed in identifying studies, screening, selection, and reporting of findings.
RESULTS: A total of 133 studies on hepatitis B vaccine non-response, mechanisms, and prevention/management strategies were included in the review after screening and final selection. Factors responsible for hepatitis B vaccine non-response were found to include genetic, immunological factors, and B cell amnesia in healthy individuals. The genetic factors were sex, HLA haplotypes, and genetic polymorphisms in immune response markers (cytokines). Non-response was common in conditions of immunodeficiency, such as renal failure, haemodialysis, celiac disease, inflammatory bowel disease, hepatitis C co-infection, and latent hepatitis B infection. Others included diabetes mellitus and HIV infection. The mechanisms involved were impaired immune response by suppression of response (T helper cells) or induced suppression of response (through regulatory B and T cells).
CONCLUSIONS: A comprehensive and careful understanding of the patient factors and the nature of the vaccine contributes to developing effective preventive measures. These include revaccination or booster dose, vaccine administration through the intradermal route, and the use of adjuvants in the vaccine.