中性粒细胞与淋巴细胞比率和成人乙型肝炎疫苗接种后持续免疫应答状态的关联  

Association of neutrophil-to-lymphocyte ratio with sustained immune response status afterhepatitis B vaccination in adults

作　　者：董建龙[1] 虎月燕[1] 邓文君[1] 古嫚 瞿秋[1] 兰青[1] 刘怀鄂[1] DONG Jianlong;HU Yueyan;DENG Wenjun;GU Man;QU Qiu;LAN Qing;LIU Huaie(Department of Geriatric Gastroenterology,The First Affiliated Hospital of Kunming Medical University,Kunming,Yunnan 650032,China)

机构地区：[1]昆明医科大学第一附属医院老年消化内科,云南昆明650032

出　　处：《中国热带医学》2025年第3期282-288,共7页China Tropical Medicine

基　　金：云南省科技计划项目(No.202401AY070001-245);兴滇英才支持计划项目。

摘　　要：目的 探究中性粒细胞与淋巴细胞比率(neutrophil-to-lymphocyte ratio,NLR)与成人乙型肝炎(简称“乙肝”)疫苗接种后持续免疫应答状态的相关性,探讨其用于乙肝疫苗接种效果预测的可能。方法 分析1999—2018年美国全国健康与营养调查(National Health and Nutrition Examination Survey,NHANES)中10 153名18岁及以上、已接种3剂乙肝疫苗且符合纳入标准的个体数据。根据疫苗接种后乙肝标记物检测结果分为血清抗体持续阳性组和血清抗体阴性组。运用多变量加权逻辑回归模型、广义线性分析、平滑曲线拟合等多种方法评估NLR与乙肝疫苗接种后持续免疫应答状态的关联。结果 本研究纳入10 153名对象,平均年龄35.36岁,男性占42.82%,女性占57.18%。调整后的多变量加权逻辑回归模型表明,NLR水平每升高1个单位,接种乙肝疫苗后持续免疫应答率降低7%(OR=0.93,95%CI:0.88~0.97)。对NLR水平进行分层分析,NLR水平最高组(T4)持续免疫应答率相比NLR水平最低组(T1)降低37%(OR=0.63,95%CI:0.47~0.85),T3组持续免疫应答率较T1组降低30%(OR=0.70,95%CI:0.53~0.91)。限制性立方样条分析显示,NLR与乙肝疫苗接种后持续免疫应答状态呈非线性关系(P_(非线性)<0.05),近似“L”型曲线。拐点分析显示,当NLR<2.16时,NLR升高会显著降低乙肝疫苗接种后持续免疫应答状态的发生;NLR>2.16时,其升高对疫苗接种后产生持续免疫应答的影响趋于平稳。结论 NLR水平与乙肝疫苗接种后持续免疫应答的产生呈负相关。较低的NLR水平与乙肝疫苗接种后持续免疫应答具有较强的正相关性,而较高的NLR水平则可能削弱乙肝疫苗的接种效果。Objective To investigate the association between neutrophil-to-lymphocyte ratio(NLR)and the state of sustained immune response after hepatitis B vaccination,to explore the possibility to predict the effect of hepatitis B vaccination.Methods Data were analysed from 10153 individuals aged 18 years and older who had received three doses of hepatitis B vaccine and met the inclusion criteria in the National Health and Nutrition Examination Survey(NHANES)1999-2018.They were divided into seropositive and seronegative groups based on the results of post-vaccination hepatitis B marker testing.The association between NLR and sustained immune response status after hepatitis B vaccination was assessed using a variety of methods,including multivariate weighted logistic regression models,generalised linear analysis,and smoothed curve fitting.Results This study included 10153 subjects with a mean age of 35.36 years,42.82%male and 57.18%female.Adjusted multivariate weighted logistic regression models showed that for each unit increase in NLR level,the odds of a sustained immune response after hepatitis B vaccination decreased by 7%(OR=0.93,95%CI:0.88-0.97).Stratified analysis of NLR levels showed that the odds of a sustained immune response were 37%lower in the group with the highest NLR levels(T4)compared with the lowest group(T1)(OR=0.63,95%CI:0.47-0.85),and the odds of a sustained immune response were 30%lower in the T3 group compared with the T1 group(OR=0.70,95%CI:0.53-0.91).Restricted cubic spline analysis showed a non-linear relationship between NLR and sustained immune response status after hepatitis B vaccination(P_(non-linear)<0.05),approximating an 'L' curve. Inflection point analysis showed that when NLR <2.16, elevated NLR significantly reduced theoccurrence of sustained immune response status after hepatitis B vaccination;when NLR >2.16, the effect of its elevation on theproduction of sustained immune response after vaccination leveled off.Conclusion NLR levels were negatively associatedwith the development of a su

关 键 词：中性粒细胞与淋巴细胞比率 乙型肝炎疫苗 接种 应答 

分 类 号：R575[医药卫生—消化系统]