开放期刊系统

破伤风被动免疫与主动免疫策略的精准优化探讨——基于抗体滴度检测的价值评估

曾献忠*, 张三军, 陈露

摘要

目的探讨在具备条件的医疗机构中，基于破伤风抗体滴度检测优化免疫策略的可行性与临床价值。方法通过文献回顾和理论分析，比较现行规范与基于抗体检测策略的差异及潜在效益。结果对于高风险伤口患者，快速检测(15-20分钟)破伤风抗体滴度：≥0.1 IU/mL者无需额外免疫干预；滴度<0.1 IU/mL者需同时给予破伤风免疫球蛋白（TIG）和疫苗。该策略的核心优势在于能显著减少约40%不必要的TIG使用，同时确保所有患者获得充分保护。结论在高风险伤口处理中，在具备快速检测条件的医疗机构逐步推广基于抗体滴度的策略，具有精准化、资源优化和提升患者安全的价值。

关键词

破伤风；被动免疫；主动免疫；抗体滴度；精准医疗；成本效益

全文:

PDF

参考

[1]KRETSINGER K, BRODER K R, CORTESE M M, et al. Preventing tetanus, diphtheria, and pertussis among adults; use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP)[J]. 2006.

[2]NING X, WANG C, YU H, et al. Progress in research on safety of vaccination in pregnancy: a review of the literature[J]. Chinese Journal of Public Health, 2024, 40: 1122-1131.

[3]GERGEN P J, MCQUILLAN G M, KIELY M, et al. A population-based serologic survey of immunity to tetanus in the United States[J]. New England Journal of Medicine, 1995, 332: 761-767.

[4]中华人民共和国国家卫生健康委员会.非新生儿破伤风诊疗规范(2024年版)(二)[J].全科医学临床与教育,2025,23:101-104.

[5]MARSHALL H, MCINTYRE P, ROBERTON D, et al. Primary and booster immunization with a diphtheria, tetanus, acellular pertussis, hepatitis B (DTPa–HBV) and Haemophilus influenzae type b (Hib) vaccine administered separately or together is safe and immunogenic[J]. International Journal of Infectious Diseases, 2010, 14: e41-e49.

[6]张晓萌,王艳华,王传林.成人重症破伤风的诊断与治疗[J].中国急救复苏与灾害医学杂志,2018,13:7.

[7]HALL E, WODI A, HAMBORSKY J, et al. Epidemiology and prevention of vaccine-preventable diseases[M]. 2021. US Department of Health and Human Services, Centers for Disease Control and Prevention.

[8]LIANG J L. Prevention of pertussis, tetanus, and diphtheria with vaccines in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP)[J]. MMWR. Recommendations and reports, 2018, 67.

[9]WORLD HEALTH ORGANIZATION = ORGANISATION MONDIALE DE LA S. Weekly Epidemiological Record, 2017, vol. 92, 17 [full issue][J]. Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire,2017,92:205-228.

[10]GOWIN E, WYSOCKI J, KALUZNA E, et al. Does vaccination ensure protection? Assessing diphtheria and tetanus antibody levels in a population of healthy children: a cross-sectional study[J]. Medicine,2016,95:e5571.

[11]HAMMARLUND E, THOMAS A, POORE E A, et al. Durability of vaccine-induced immunity against tetanus and diphtheria toxins: a cross-sectional analysis[J]. Clinical Infectious Diseases,2016,62:1111-1118.

[12]GOU Y, LI S-M, ZHANG J-F, et al. 6084 Cases of adult tetanus from China: a literature analysis[J]. Infection and Drug Resistance, 2023: 2007-2018.

[13]SCOTT T. Point-of-care tetanus immunoassay: An audit of unscheduled tetanus prophylaxis[J]. International Journal of Orthopaedic and Trauma Nursing, 2012, 16: 97-103.

[14]CHITHRA A, CARIAPPA K, KAMATH A T, et al. Role of rapid tetanus antibody test in accident and emergency department[J]. Journal of maxillofacial and oral surgery, 2015, 14:784-788.

(1 摘要 Views, 1 PDF Downloads)

Refbacks

当前没有refback。

用户名
密码
记住我