维持性血液透析患者60μg高剂量乙型肝炎疫苗免疫持久性及影响因素  

Immunity persistence of 60μg high dose hepatitis B vaccine and influencing factors in maintained hemodialysis patients

作　　者：武媛婷 姚添 石璟 王建民[3] 刘广明 王富珍[5] 冯永亮[1,2] 王素萍 Wu Yuanting;Yao Tian;Shi Jing;Wang Jianmin;Liu Guangming;Wang Fuzhen;Feng Yongliang;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;Department of Nephrology,Linfen Central Hospital,Linfen 041000,China;Department of Clinical Laboratory,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046000,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]临汾市中心医院肾内科,041000 [4]长治医学院附属和平医院检验科,046000 [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1566-1572,共7页Chinese Journal of Epidemiology

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

摘　　要：目的比较维持性血液透析患者0-1-6月20μg和60μg乙型肝炎(乙肝)疫苗全程接种后1年抗-HBs情况,探讨乙肝疫苗免疫持久性影响因素及交互作用。方法在维持性血液透析患者0-1-6月20μg和60μg乙肝疫苗免疫接种随机对照试验研究基础上,以完成全程接种后1年随访的患者为研究对象,定量检测其抗-HBs,采用χ2检验、t检验、非条件logistic回归和交互作用进行统计分析。结果全程接种后1年时,20μg组和60μg组各有125例和124例完成抗-HBs检测,60μg组抗-HBs阳性率(77.42%,96/124)明显高于20μg组(65.60%,82/125)(P<0.05)。控制混杂因素后,60μg组抗-HBs阳性的概率是20μg组的1.925倍(95%CI:1.068~3.468);透析年限≥5年(OR=0.523,95%CI:0.293~0.935)和合并糖尿病(OR=0.376,95%CI:0.173~0.818)的患者抗-HBs阳性的概率较低;且透析年限≥5年与合并糖尿病存在相加和相乘交互作用。结论维持性血液透析患者0-1-6月高剂量(60μg)乙肝疫苗接种1年免疫持久性优于20μg,接种剂量、透析年限和合并糖尿病是免疫持久性的影响因素,透析年限≥5年与合并糖尿病存在相加及相乘交互作用。Objective To compare the anti-HBs level in maintained hemodialysis patients one year after receiving 20μg and 60μg hepatitis B vaccination at 0,1 and 6 months,and explore the influence factors for the immunity persistence and their interactions.Methods Based on a randomized controlled trial of 20μg and 60μg hepatitis B vaccine immunization in maintained hemodialysis patients at 0,1,and 6 months,follow up was conducted for the patients for one year after the completion of the vaccination for the quantitative detection of anti-HBs,andχ2 test,t test,unconditional logistic regression and interaction analyses were used for statistical analysis.Results One year after the vaccination,125 and 124 patients in the 20μg and 60μg groups were tested for anti-HBs,respectively.The positive rate of anti-HBs in the 60μg group(77.42%,96/124)was significantly higher than that in the 20μg group(65.60%,82/125)(P<0.05).After adjusting for the confounding factors,the positive probability of anti-HBs in the 60μg group was 1.925 times higher than that in the 20μg group(95%CI:1.068-3.468).Patients with hemodialysis duration≥5 years(OR=0.523,95%CI:0.293-0.935)and diabetes mellitus(OR=0.376,95%CI:0.173-0.818)had lower positive probability of anti-HBs.Moreover,there were additive and multiplicative interactions between hemodialysis duration≥5 years and diabetes mellitus.Conclusions The immunity persistence after one year in 60μg hepatitis B vaccination group was longer than that in 20μg hepatitis B vaccination group in maintained hemodialysis patients,vaccine dose,hemodialysis duration and diabetes mellitus were the influencing factors for the immunity persistence,there were additive and multiplicative interactions between hemodialysis duration≥5 years and diabetes mellitus.

关 键 词：维持性血液透析患者 乙型肝炎疫苗 免疫持久性 影响因素 交互作用 

分 类 号：R186[医药卫生—流行病学]