广西HIV感染儿童乙肝疫苗基础免疫情况回顾性调查分析  

Retrospective analysis of basic immune effect of hepatitis B vaccine in children with HIV in⁃fection

作　　者：鲁鸿燕[1] 梁江明[1] 陆春燕[1] 韦利玲 Lu Hongyan;Liang Jiangming;Lu Zhenzhen;Wei Liling(Guangxi Center for Disease Prevention and Control,Nanning530028,China)

机构地区：[1]广西壮族自治区疾病预防控制中心,南宁530028

出　　处：《广西医科大学学报》2021年第3期617-622,共6页Journal of Guangxi Medical University

基　　金：国家十三五科技重大专项-儿童艾滋病适宜治疗和预防策略研究与应用资助项目(No.2018ZX10302-102);艾滋病儿童乙肝疫苗免疫效果研究资助项目(No.Z20180982);个案管理模式在艾滋病抗病毒治疗儿童中的应用研究资助项目(No.Z20180984)。

摘　　要：目的:了解广西人获得性免疫缺陷病毒(HIV)感染儿童乙肝疫苗基础免疫情况,为HIV感染儿童制定优化的乙肝免疫方案提供依据。方法:回顾性选取2007—2018年到广西壮族自治区疾病预防控制中心(广西CDC)艾滋病门诊首诊的347例0~15岁HIV感染儿童作为调查对象,采用查阅该群儿童的首诊病历及预防接种本,并收集患儿的乙肝表面抗原(HBsAg)及乙肝表面抗原(HBsAb)等乙肝标志物检测结果进行统计分析,了解该群儿童乙肝疫苗基础免疫的效果。结果:该群儿童乙肝疫苗接种率较低,为89.3%(310/347);HBsAg阳性率为2%(7/347);HBsAb阳性率为37.2%(129/347);年龄及WHO分期与HBsAb阳性呈负相关关系(P<0.05),年龄≥5岁及处于WHO中晚期,HBsAb阳性率低;而CD4^(+)、CD8^(+)和CD4^(+)%与HBsAb阳性率呈正相关关系(P<0.05);多因素分析发现,CD4^(+)水平是HBsAb阳性的一个保护因素(P<0.05)。结论:HIV儿童接种乙肝疫苗后应定期复查HBsAb水平,如果HBsAb<10 mIU/mL,且没有进行HIV高效抗逆转录病毒疗法(HARRT)治疗,应治疗且抑制HIV病毒载量(HIV RNA)后再重新接种乙肝疫苗,以达到有效的免疫效果。Objective:To investigate the basic immunization status of hepatitis B vaccine in children infected with acquired immunodeficiency virus(HIV)in Guangxi,provide a basis for the formulation of an optimized hepatitis B immunization program for HIV-infected children.Methods:From 2007 to 2018,a total of 347 cases of HIV infected children from 0-15 years old were selected as the survey subjects,using first-visit medical records and vaccination books for this group of children.The detection results of hepatitis B surface antigen(HBsAg)and hepatitis B surface antigen(HBsAb)were collected and analyzedto understand the effect of basic immunization of hepatitis B vaccine in this group of children.Results:Hepatitis B vaccination rate was low in this group,at 89.3%(310/347);HBsAg positive rate was 2%(7/347);HBsAb positive rate was 37.2%(129/347).Age and WHO stage were negatively correlated with positive HBsAb rate(P<0.05).HBsAb positive rate was low in the children with age≥5 years old and middle or late stage of WHO;while CD4^(+)T lymphocytes(CD4),CD8^(+)T lymphocytes(CD8)and CD4^(+)%were positively correlated with the positive HBsAb rate(P<0.05).Multivariate analysis found that,CD4^(+)level was a protective factor for the positive rate of HBsAb(P<0.05).Conclusion HIV infected children should regularly review the level of HBsAb after vaccination with hepatitis B vaccine.If HBsAb was less than 10 mIU/mL and HIV was not being treated with highly active antiretroviral therapy(HARRT),they should receive HARRT to inhibit the HIV viral load(HIV RNA)and then revaccinate against hepatitis Bto achieve effective immune effectagainst hepatitis B.

关 键 词：HIV感染儿童 乙肝疫苗 HBSAB 

分 类 号：R186[医药卫生—流行病学]