CAJ | 학술논문

目的比较不同CD4+T淋巴细胞计数的HIV-1感染者接种重组乙型肝炎疫苗后免疫应答的差异.方法成都市公共卫生临床医疗中心门诊就诊的HIV-1感染者,根据CD4+T淋巴细胞计数分为＜200/μL组和≥200/μL组.分别在0、1、6个月肌内注射重组乙型肝炎疫苗20 μg,并于首剂注射后1个月、7个月检测血清抗-HBs效价,≥10 mIU/mL即为阳性.两组血清抗-HBs阳性率的比较采用卡方检验,抗-HBs效价的比较采用非参数检验中的Mann-Whitney检验.结果最终入组95例HIV-1感染者,CD4+T淋巴细胞＜200/μL组55例,CD4+T淋巴细胞≥200/μL组40例.CD4+T淋巴细胞＜200/μL组在首剂注射后1个月、7个月血清抗-HBs阳性率分别为40.0％(22/55)和50.9％(28/55),≥200/μL组在首剂注射后1个月、7个月血清抗-HBs阳性率分别为47.5％(19/40)和75.0％(30/40).两组在首剂注射后1个月抗-HBs阳性率比较差异无统计学意义(x2=0.531、P=0.466),在首剂注射后7个月抗-HBs阳性率比较差异有统计学意义(x2=5.652、P=0.017).＜200/μL组在首剂注射后7个月抗-HBs效价中位数为10.44 mIU/mL,≥200/μL组为222.73 mIU/mL,两组比较差异有统计学意义(Z=-3.600、P＜0.01).所有接种者均未出现不良反应.Logistic回归模型分析结果显示,仅有CD4+T淋巴细胞计数值与注射乙型肝炎疫苗后抗-HBs阳性有关(P=0.031).结论 CD4+T淋巴细胞相对较高的HIV感染者对乙型肝炎疫苗接种能获得相对较好的免疫应答,而对于CD4+T淋巴细胞＜200/μL的感染者也会产生较低的应答,因此对于这些高危人群都应该进行乙型肝炎疫苗接种.
목적 비교불동CD4+T림파세포계수적HIV-1감염자접충중조을형간염역묘후면역응답적차이.방법 성도시공공위생림상의료중심문진취진적HIV-1감염자,근거CD4+T림파세포계수분위＜200/μL조화≥200/μL조.분별재0、1、6개월기내주사중조을형간염역묘20 μg,병우수제주사후1개월、7개월검측혈청항-HBs효개,≥10 mIU/mL즉위양성.량조혈청항-HBs양성솔적비교채용잡방검험,항-HBs효개적비교채용비삼수검험중적Mann-Whitney검험.결과 최종입조95례HIV-1감염자,CD4+T림파세포＜200/μL조55례,CD4+T림파세포≥200/μL조40례.CD4+T림파세포＜200/μL조재수제주사후1개월、7개월혈청항-HBs양성솔분별위40.0％(22/55)화50.9％(28/55),≥200/μL조재수제주사후1개월、7개월혈청항-HBs양성솔분별위47.5％(19/40)화75.0％(30/40).량조재수제주사후1개월항-HBs양성솔비교차이무통계학의의(x2=0.531、P=0.466),재수제주사후7개월항-HBs양성솔비교차이유통계학의의(x2=5.652、P=0.017).＜200/μL조재수제주사후7개월항-HBs효개중위수위10.44 mIU/mL,≥200/μL조위222.73 mIU/mL,량조비교차이유통계학의의(Z=-3.600、P＜0.01).소유접충자균미출현불량반응.Logistic회귀모형분석결과현시,부유CD4+T림파세포계수치여주사을형간염역묘후항-HBs양성유관(P=0.031).결론 CD4+T림파세포상대교고적HIV감염자대을형간염역묘접충능획득상대교호적면역응답,이대우CD4+T림파세포＜200/μL적감염자야회산생교저적응답,인차대우저사고위인군도응해진행을형간염역묘접충.
Objective To compare the difference of immune responses to hepatitis B virus (HBV) vaccine in human immunodeficiency virus (HIV)-1-infected patients with different CD4+ T-lymphocyte counts.Methods HIV-1-infected patients who visited clinic at the Public Health Clinical Center of Chengdu were enrolled and divided into two groups according to CD4+ T-lymphocytes counts.CD4+ T-lymphocytes ＜200/μL,which were and ≥200/μL.All patients were injected intramuscularly with 20 μg of HBV vaccine at month 0,1 and 6,respectively.Vaccination responses were measured at1 and 7 months after first dose.The serum anti-hepatitis B sarface antigen titers of ≥ 10 mIU/mL were considered positive.The serum anti-HBs positive rates was compared by Chi-square test and anti-HBs titers was compared by Mann-Whitney test.Results Ninety-five HIV-1-infected patients were finally enrolled into the analysis,with 55 patients in group of CD4+ T-lymphocytes ＜200/μL and 40 patients in group of CD4+ T-lymphocytes ≥200/μL.The serum anti-HBs positivity rates at 1 and 7 months after first dose in group of CD4+ T-lymphocytes ＜200/μL were 40.0％ (22/55) and 50.9％ (28/55),respectively,which were 47.5％ (19/40) and 75.0％ (30/40) in group of CD4+ Tlymphocytes ≥200/μL.There was no significant difference of serum anti-HBs positivity rates between two groups after 1 month (x2 =5.652,P=0.017).But a significant higher positivity rate was found in group of CD4+ T-lymphocytes ≥200/μL than in group ofCD4+ Tlymphocytes＜200/μL after 7 months (x2=0.531,P=0.466).The median titers of anti-HBs at 7 months were 10.44 mIU/mL in grouP of CD4+ T-lymphocytes ＜ 200/μL and 222.73 mIU/ml in group of CD4+ T-lymphocytes ≥200/μL.There was significant difference of anti-HBs titers between two groups (Z=-3.600,P＜0.01).No patients experienced side effects to HBV vaccine.Logistic regression model analysis indicated that only CD4+ Tlymphocytes was related to anti-HBs positivity after HBV vaccination.Conclusions HIV-1-infected patients with CD4+ T-lymphocytes ≥200/μL have higher serum anti-HBs positivity rates and higher anti HBs titers than patients with CD4+ T-lymphocytes ＜200/μL.However,patients with CD4+ T lymphocytes ＜200/μL also have relatively low immune response.Thus,HBV vaccination should be conducted in all these patients at high risk.