HIV感染者不同免疫程序乙型肝炎疫苗无/弱应答情况及其影响因素分析  

Non/hypo-response to hepatitis B vaccination and influencing factors in HIV-infected patients in the context of different immunization schedules

作　　者：常越 姚添 石璟 武媛婷 杨峰 原琛利[3] 聂晓勇[3] 王富珍[4] 冯永亮 王素萍 Chang Yue;Yao Tian;Shi Jing;Wu Yuanting;Yang Feng;Yuan Chenli;Nie Xiaoyong;Wang Fuzhen;Feng Yongliang;Wang Suping(Department of Epidemiology,School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Department of Infectious Diseases,The Second Hospital of Yuncheng,Yuncheng 044000,China;Department of STD/AIDS Prevention and Control,Shanxi Provincial Center for Disease Control and Prevention,Taiyuan 030012,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]运城市第二医院感染性疾病科,运城044000 [3]山西省疾病预防控制中心性病艾滋病防控科,太原030012 [4]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》2022年第5期696-701,共6页Chinese Journal of Epidemiology

基　　金：国家科技重大专项(2018ZX10721202)。

摘　　要：目的了解HIV感染者全程接种乙型肝炎(乙肝)疫苗的无/弱应答情况,探讨无/弱应答影响因素,为制定特殊人群乙肝防制策略及措施提供依据。方法在HIV感染者0-1-6月和0-1-2-6月20μg、0-1-2-6月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个月随访者为研究对象,定量检测其抗-HBs,收集其一般人口学特征、疾病史、HIV感染和治疗情况等,采用χ^(2)检验、t检验、非条件logistic回归和交互作用进行统计学分析。结果研究对象的0-1-6月和0-1-2-6月20μg、0-1-2-6月60μg组乙肝疫苗无/弱应答率分别为34.65%(35/101)、24.49%(24/98)和10.99%(10/91)(P<0.001)。控制混杂因素后,按照0-1-2-6月60μg方案接种乙肝疫苗者发生无/弱应答的风险是0-1-6月20μg者的0.22倍(95%CI:0.10~0.50);男性(OR=3.65,95%CI:1.88~7.07)和无乙肝疫苗接种史(OR=2.64,95%CI:1.10~6.32)HIV感染者乙肝疫苗无/弱应答的发生风险高,免疫方案与性别(OR=2.49,95%CI:1.24~5.00)之间存在相乘交互作用。结论HIV感染者0-1-2-6月60μg接种者的乙肝疫苗无/弱应答率明显低于0-1-6月和0-1-2-6月20μg接种者,性别、接种方案及乙肝疫苗接种史是无/弱应答的影响因素,免疫方案与性别之间存在相乘交互作用,男性接种20μg乙肝疫苗的无/弱应答风险更高。Objective To study the non/hypo-response to hepatitis B vaccination in HIV-infected patients,identify the influencing factors and provide evidence for the development of hepatitis B prevention and control strategies and measures for special population.Methods On the basis of the randomized controlled trial of 20µg hepatitis B vaccine immunization at 0-1-6 month,0-1-2-6 month and 60µg hepatitis B vaccine immunization at 0-1-2-6 month,the HIV-infected patients who completed one-month follow-up after the full course vaccination were selected as study subjects.Quantification of antibody to hepatitis B surface antigen(anti-HBs)in serum samples was performed by using chemiluminescent microparticle immunoassay(CMIA)and demographic characteristics,disease history,HIV infection and treatment status of the study subjects were collected.Statistical analysis was conducted byχ^(2) test,t test,unconditional logistic regression and interaction analyses.Results The non/hypo-response rates to hepatitis B vaccination were 34.65%(35/101),24.49%(24/98)and 10.99%(10/91)in 20µg group at 0-1-6 month or 0-1-2-6 month and 60µg group at 0-1-2-6 month(P<0.001),respectively.Logistic regression analysis showed that after controlling for confounding factors,the risk for non/hypo-response was 0.22 times higher in HIV-infected patients receiving 60µg hepatitis B vaccine at 0-1-2-6 month than in patients receiving 20µg hepatitis B vaccine at 0-1-6 month(95%CI:0.10-0.50),the risk for non/hypo-response was higher in men than in women(OR=3.65,95%CI:1.88-7.07),and the risk for non/hypo-response was 2.64 times higher in those without hepatitis B vaccination history than in those with hepatitis B vaccination history(95%CI:1.10-6.32).Moreover,there were multiplicative interactions between immunization schedule and gender(OR=2.49,95%CI:1.24-5.00).Conclusion The non/hypo-response rate to hepatitis B vaccination was significantly lower in HIV-infected patients receiving 60µg hepatitis B vaccine at 0-1-2-6 month than in those receiving 20µg hepati

关 键 词：艾滋病病毒 乙型肝炎疫苗 无/弱应答 影响因素 交互作用 

分 类 号：R512.91[医药卫生—内科学]