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

武媛婷; 姚添; 石璟; 王建民; 刘广明; 王富珍; 冯永亮; 王素萍

Abstract

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].Chinese journal of Epidemiology,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

Received:March 19, 2021

DOI：10.3760/cma.j.cn112338-20210319-00221

KeyWord: 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

English Key Word: Maintained hemodialysis patients Hepatitis B vaccine Immune persistence Influence factors Interaction

FundProject:国家科技重大专项（2018ZX10721202，2012ZX10002001）

Author Name	Affiliation	E-mail
Wu Yuanting	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan 030001, China
Yao Tian	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan 030001, China
Shi Jing	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan 030001, China
Wang Jianmin	Department of Nephrology, Linfen Central Hospital, Linfen 041000, China
Liu Guangming	Department of Clinical Laboratory, Heping Hospital Affiliated to Changzhi Medical College, Changzhi 046000, China
Wang Fuzhen	Department of National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Feng Yongliang	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan 030001, China	yongliang.feng@sxmu.edu.cn
Wang Suping	Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan 030001, China	supingwang@sxmu.edu.cn

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Abstract:

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。

English Abstract:

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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