| 冯永亮,常越,石璟,蓝光华,鲁鸿燕,向绍密,王富珍,王素萍.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[J].中华流行病学杂志,2021,42(9):1559-1565 |
| 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 with different CD4+T cell levels |
| 收稿日期:2021-03-19 出版日期:2021-09-27 |
| DOI：10.3760/cma.j.cn112338-20210319-00222 |
| 中文关键词: 艾滋病病毒 乙型肝炎疫苗 CD4+T淋巴细胞 免疫原性 持久性 |
| 英文关键词: HIV Hepatitis B vaccine CD4+T cells Immunogenicity Persistence |
| 基金项目:国家科技重大专项（2018ZX10721202，2012ZX10002001） |
| 作者 | 单位 | E-mail | | 冯永亮 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001
山西医科大学临床流行病学与循证医学中心, 太原 030001 | | | 常越 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001
山西医科大学临床流行病学与循证医学中心, 太原 030001 | | | 石璟 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001
山西医科大学临床流行病学与循证医学中心, 太原 030001 | | | 蓝光华 | 广西壮族自治区疾病预防控制中心艾滋病防制所, 南宁 530028 | | | 鲁鸿燕 | 广西壮族自治区疾病预防控制中心艾滋病防制所, 南宁 530028 | | | 向绍密 | 宁明县疾病预防控制中心 532500 | | | 王富珍 | 中国疾病预防控制中心免疫规划中心, 北京 100050 | | | 王素萍 | 山西医科大学公共卫生学院流行病学教研室, 太原 030001
山西医科大学临床流行病学与循证医学中心, 太原 030001 | supingwang@sxmu.edu.cn |
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| 中文摘要: |
| 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。 |
| 英文摘要: |
| 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 20 μg and 60 μg 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 hepatitis B vaccination and poor immune persistence. It is necessary to strengthen the anti-HBs monitoring in HIV-infected patients, with special attention to those with CD4 <350 cells/μl. When anti-HBs is negative, hepatitis B vaccine should be injected as early as possible. |
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