文章摘要
武媛婷,姚添,石璟,王建民,刘广明,王富珍,冯永亮,王素萍.维持性血液透析患者60 μg高剂量乙型肝炎疫苗免疫持久性及影响因素[J].中华流行病学杂志,2021,42(9):1566-1572
维持性血液透析患者60 μg高剂量乙型肝炎疫苗免疫持久性及影响因素
Immunity persistence of 60 μg high dose hepatitis B vaccine and influencing factors in maintained hemodialysis patients
收稿日期:2021-03-19  出版日期:2021-09-27
DOI:10.3760/cma.j.cn112338-20210319-00221
中文关键词: 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
英文关键词: Maintained hemodialysis patients;Hepatitis B vaccine;Immune persistence;Influence factors;Interaction
基金项目:国家科技重大专项(2018ZX10721202,2012ZX10002001)
作者单位E-mail
武媛婷 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 
 
姚添 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 
 
王建民 临汾市中心医院肾内科 041000  
刘广明 长治医学院附属和平医院检验科 046000  
王富珍 中国疾病预防控制中心免疫规划中心, 北京 100050  
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 
yongliang.feng@sxmu.edu.cn 
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 比较维持性血液透析患者0-1-6月20 μg和60 μg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20 μg和60 μg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,20 μg组和60 μg组各有125例和124例完成抗-HBs检测,60 μg组抗-HBs阳性率(77.42%,96/124)明显高于20 μg组(65.60%,82/125)(P<0.05)。控制混杂因素后,60 μg组抗-HBs阳性的概率是20 μg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(60 μg)乙肝疫苗接种1年免疫持久性优于20 μg,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。
英文摘要:
      Objective To compare the anti-HBs level in maintained hemodialysis patients one year after receiving 20 μg and 60 μg 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 20 μg and 60 μg 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, and χ2 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 20 μg and 60 μg groups were tested for anti-HBs, respectively. The positive rate of anti-HBs in the 60 μg group (77.42%, 96/124) was significantly higher than that in the 20 μg group (65.60%, 82/125) (P<0.05). After adjusting for the confounding factors, the positive probability of anti-HBs in the 60 μg group was 1.925 times higher than that in the 20 μg 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 60 μg hepatitis B vaccination group was longer than that in 20 μg 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.
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