文章摘要
常越,姚添,石璟,武媛婷,杨峰,原琛利,聂晓勇,王富珍,冯永亮,王素萍.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[J].中华流行病学杂志,2022,43(5):696-701
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
收稿日期:2021-12-14  出版日期:2022-05-13
DOI:10.3760/cma.j.cn112338-20211214-00982
中文关键词: 艾滋病病毒;乙型肝炎疫苗;无/弱应答;影响因素;交互作用
英文关键词: HIV;Hepatitis B vaccine;Non/hypo-response;Influencing factors;Interaction
基金项目:国家科技重大专项(2018ZX10721202)
作者单位E-mail
常越 山西医科大学公共卫生学院流行病学教研室, 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  
石璟 山西医科大学公共卫生学院流行病学教研室, 太原 030001  
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  
杨峰 运城市第二医院感染性疾病科, 运城 044000  
原琛利 山西省疾病预防控制中心性病艾滋病防控科, 太原 030012  
聂晓勇 山西省疾病预防控制中心性病艾滋病防控科, 太原 030012  
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 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  
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中文摘要:
      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20 µg、0-1-2-6月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χ2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20 µg、0-1-2-6月60 µg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60 µg方案接种乙肝疫苗者发生无/弱应答的风险是0-1-6月20 µg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60 µg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20 µg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20 μg乙肝疫苗的无/弱应答风险更高。
英文摘要:
      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 20 µg hepatitis B vaccine immunization at 0-1-6 month, 0-1-2-6 month and 60 µg 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 by χ2 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 20 µg group at 0-1-6 month or 0-1-2-6 month and 60 µg 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 60 µg hepatitis B vaccine at 0-1-2-6 month than in patients receiving 20 µg 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 60 µg hepatitis B vaccine at 0-1-2-6 month than in those receiving 20 µg hepatitis B vaccine at 0-1-6 month and 0-1-2-6 month. Gender, vaccination schedule and history of hepatitis B vaccination were the influencing factors of the non/hypo-response to hepatitis B vaccination. There was a multiplicative interaction between vaccination schedule and gender, and men receiving 20 µg hepatitis B vaccines had a higher risk for non/hypo-response to hepatitis B vaccination.
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