不同CD4^(+)T淋巴细胞水平的HIV感染者乙型肝炎疫苗免疫效果及持久性研究  

Immunization effect and persistence of hepatitis B vaccine in HIV-infected patients withdifferent CD4+T cell levels

作　　者：冯永亮 常越[1,2] 石璟 蓝光华 鲁鸿燕[3] 向绍密[4] 王富珍[5] 王素萍 Feng Yongliang;Chang Yue;Shi Jing;Lan Guanghua;Lu Hongyan;Xiang Shaomi;Wang Fuzhen;Wang Suping(Department of Epidemiology,School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Center of Clinical Epidemiology and Evidence Based Medicine,Shanxi Medical University,Taiyuan 030001,China;Institute of AIDS Prevention and Control,Guangxi Zhuang Autonomous Region Center for Disease Prevention and Control,Nanning 530028,China;Ningming County Center for Disease Control and Prevention,Ningming 532500,China;Department of National Immunization Program,Chinese Center for Disease Control and Prevention,Beijing 100050,China)

机构地区：[1]山西医科大学公共卫生学院流行病学教研室,太原030001 [2]山西医科大学临床流行病学与循证医学中心,太原030001 [3]广西壮族自治区疾病预防控制中心艾滋病防制所,南宁530028 [4]宁明县疾病预防控制中心,532500 [5]中国疾病预防控制中心免疫规划中心,北京100050

出　　处：《中华流行病学杂志》2021年第9期1559-1565,共7页Chinese Journal of Epidemiology

基　　金：国家科技重大专项(2018ZX10721202,2012ZX10002001)。

摘　　要：目的分析HIV感染者CD4^(+)T淋巴细胞(CD4)水平对乙肝疫苗免疫应答的影响,探讨不同CD4水平的HIV感染者乙肝疫苗免疫效果及其持久性,为优化HIV感染者乙肝疫苗免疫策略提供理论支持。方法以2014年广西壮族自治区CDC和宁明县CDC管理的参加0-1-6月20μg和60μg乙肝疫苗接种随机对照试验的182名HIV感染者为研究对象,在首针接种后6个月和全程接种后1个月、6个月、1年和3年时,采集研究对象静脉血5 ml,并采用化学发光微粒子免疫分析方法定量检测乙肝表面抗体(抗-HBs)。本研究在既往研究基础上,着重分析不同CD4水平下乙肝疫苗接种后的免疫效果及持久性。结果CD4<350个/μl的HIV感染者乙肝疫苗全程接种后1个月时,抗-HBs几何平均浓度(GMC)为442.50 mIU/ml,抗-HBs阳性率为71.05%(27/38),强阳性率为44.74%(17/38),明显低于CD4≥350个/μl者[583.90 mIU/ml、92.13%(117/127)和77.95%(99/127)](P<0.05);多因素分析结果显示,控制混杂因素后,CD4<350个/μl者乙肝疫苗抗-HBs阳性的概率是CD4≥350个/μl者的0.14倍(95%CI:0.03~0.62),CD4水平较低是乙肝疫苗无应答的危险因素。全程接种后6个月到3年时,CD4<350个/μl者抗-HBs GMC(195.00~27.55 mIU/ml比300.10~45.81 mIU/ml)、阳性率(56.67%~36.67%比78.57%~51.58%)和强阳性率(33.33%~6.67%比44.64%~15.79%)不同程度下降,且均低于CD4≥350个/μl者。结论CD4<350个/μl的HIV感染者乙肝疫苗无应答风险高,免疫持久性较差,应定期监测HIV感染者抗-HBs水平,并特别关注CD4<350个/μl者,抗-HBs阴性时应尽早全程及加强接种乙肝疫苗。Objective To explore the immunogenicity and persistence of hepatitis B vaccine in HIV-infected patients with different CD4+T cell(CD4)levels,and analyze the influence effect of CD4 levels on immunization response.Methods A total of 182 HIV-infected patients who participated in a randomized controlled trial of 20μg and 60μg hepatitis B vaccination at month 0,1,and 6 in 2014 by Guangxi Zhuang Atonomous Region CDC and Ningming county CDC were surveyed.Six months later after the first dose and 1 month,6 months,1 year,and 3 years later after the full course of the vaccination,5 ml of the venous blood of the patients was collected,and the anti-HBs was detected by Chemiluminescent Microparticle Immunoassay(CMIA).On the basis of previous studies,this study focused on analyzing the immunogenicity and persistence of hepatitis B vaccine under different CD4 levels.Results One month later after the whole course of hepatitis B vaccination,the anti-HBs geometric mean concentration(GMC),anti-HBs positive rate(≥10 mIU/ml)and strong positive rate(≥100 mIU/ml)in HIV patients with CD4<350 cells/μl were 442.50 mIU/ml,71.05%(27/38)and 44.74%(17/38),respectively,which were significantly lower than those HIV-infected patients with CD4≥350 cells/μl[583.90 mIU/ml,92.13%(117/127)and 77.95%(99/127)](P<0.05).After controlling the confounding factors,the probability of being anti-HBs positive induced by hepatitis B vaccine in patients with CD4<350 cells/μl was 0.14 times higher than in those with CD4≥350 cells/μl(95%CI:0.03-0.62),and patients with CD4<350 cells/μl had higher risk of no response.From 6 months to 3 years after the whole course of the vaccination,the anti-HBs GMC(195.00-27.55 mIU/ml vs.300.10-45.81 mIU/ml),the positive rate(56.67%-36.67%vs.78.57%-51.58%)and the strong positive rate(33.33%-6.67%vs.44.64%-15.79%)in patients with CD4<350 cells/μl gradually declined,lower than the levels in those with CD4≥350 cells/μl.Conclusions HIV-infected patients with CD4<350 cells/μl have high risk of no response to hepatit

关 键 词：艾滋病病毒 乙型肝炎疫苗 CD4^(+)T淋巴细胞 免疫原性 持久性 

分 类 号：R186[医药卫生—流行病学]