≥18岁维持性血液透析患者乙型肝炎疫苗不同免疫程序无或弱应答的影响因素及其交互作用  

Factors influencing immune response to different immunization schedules with hepatitis B vaccine in adult hemodialysis patients,and interactions between factors

作　　者：刘黎明 屈晓群 门朝月 姚添 常越 王建民 王富珍[6] 王素萍 闫三华[1] 冯永亮 Liu Liming;Qu Xiaoqun;Men Zhaoyue;Yao Tian;Chang Yue;Wang Jianmin;Wang Fuzhen;Wang Suping;Yan Sanhua;Feng Yongliang(Department of Nephrology,Linfen Central Hospital,Linfen 041000,Shanxi,China;Department of Epidemiology,School of Public Health,Shanxi Medical University,Taiyuan 030001,Shanxi,China;Center of Clinical Epidemiology and Evidence Based Medicine,Shanxi Medical University,Taiyuan 030001,Shanxi,China;Key Laboratory of Coal Environmental Pathogenicity and Prevention,Shanxi Medical University,Ministry of Education,Taiyuan 030001,Shanxi,China;First Clinical Medical College of Shanxi Medical University,Taiyuan 030001,Shanxi,China;National Immunization Program,Chinese Center for Disease Control and Prevention,Beijing 100050,China)

机构地区：[1]临汾市中心医院肾病内科,山西临汾041000 [2]山西医科大学公共卫生学院流行病学教研室,山西太原030001 [3]山西医科大学临床流行病学与循证医学中心,山西太原030001 [4]山西医科大学煤炭环境致病与防治教育部重点实验室,山西太原030001 [5]山西医科大学第一临床医学院,山西太原030001 [6]中国疾病预防控制中心免疫规划中心,北京100050

出　　处：《中国疫苗和免疫》2024年第4期383-388,共6页Chinese Journal of Vaccines and Immunization

基　　金：国家科技重大专项(2018ZX10721-202)。

摘　　要：目的探讨维持性血液透析(Maintenance hemodialysis,MHD)患者乙型肝炎(乙肝)疫苗(Hepatitis B vaccine,HepB)不同免疫程序无/弱应答的影响因素及其交互作用。方法在山西省11所医院招募≥18岁MHD患者,随机分为0-1-6月20μg、0-1-2-6月20μg和0-1-2-6月60μg HepB免疫程序组,检测接种后1个月血清乙肝表面抗体(Hepatitis B surface antibody,HBsAb),分析无/弱应答(HBsAb<100 mIU/mL)的影响因素及其交互作用。结果MHD患者全程接种HepB后HBsAb无/弱应答率为25.55%(116/454)。多因素Logistic回归分析显示,与0-1-6月20μg程序相比,0-1-2-6月60μg和20μg程序的无/弱应答率低(OR=0.44,95%CI:0.26-0.75;OR=0.52,95%CI:0.31-0.88);≥50岁、有糖尿病者的无/弱应答率分别较<50岁、无糖尿病者高(OR=2.02,95%CI:1.29-3.18;OR=1.91,95%CI:1.16-3.12)。免疫程序与年龄之间存在相乘交互作用(OR=1.91,95%CI:1.16-3.14)。结论采用常规免疫程序、高年龄和有糖尿病的MHD患者易发生HepB接种后无/弱应答,免疫程序与年龄之间存在交互作用。Objective To explore factors influencing immune response to different immunization schedules with hepatitis B vaccine(HepB)in maintenance hemodialysis(MHD)patients and interactions between factors.Methods We recruited MHD patients aged≥18 years from 11 hospitals in Shanxi province and randomized consenting patients to receive either a 0-1-6-month 20μg,a 0-1-2-6-month 20μg,or a 0-1-2-6-month 60μg HepB immunization schedule.We tested sera for hepatitis B surface antibody(HBsAb)obtained one month after the last dose of the assigned HepB series schedule to determine factors influencing non-/hypo-response(HBsAb<100 mIU/mL)and interactions among factors.Results The overall non-/hypo-response rate was 25.55%(116/454)among MHD patients after full-series HepB vaccination.Multivariate logistic regression analysis showed that the non-/hypo-response rate was lower among subjects who received a 0-1-2-6-month 60μg or a 0-1-2-6-month 20μg schedule than among subjects who received a 0-1-6-month 20μg schedule(OR=0.44,95%CI:0.26-0.75;OR=0.52,95%CI:0.31-0.88);and was higher among subjects≥50 years of age and subjects with diabetes compared with subjects<50 years of age and subjects without diabetes(OR=2.02,95%CI:1.29-3.18;OR=1.91,95%CI:1.16-3.12),respectively.There was a multiplicative interaction between immunization schedule and age(OR=1.91,95%CI:1.16-3.14).Conclusions MHD patients who received a routine 0-1-6-month 20μg HepB immunization schedule,who were older,and who had diabetes were prone to non-/hypo-response to HepB vaccination.There was an interaction between age and immunization schedule.

关 键 词：维持性血液透析 乙型肝炎疫苗 预防接种 无/弱应答 影响因素 交互作用 

分 类 号：R186.3[医药卫生—流行病学]