南宁市维持性血液透析患者乙型肝炎病毒感染与免疫状况及相关影响因素分析

摘要

Objective To determine the HBV infection and immune status in maintenance hemodialysis pa-tients in Nanning of Guangxi Zhuang Autonomous Region, and to investigate the influencing factors. Methods The general demographic characteristics, related data of hemodialysis, behavioral risk factors, history of hepatitis B vacci-nation and family history of hepatitis B of maintenance hemodialysis patients, who were hospitalized in three hospitals, were collected by face-to-face questionnaire interviews and medical records. Venous blood 5 ml in each subject was collected, and the serum HBsAg and anti-HBs were determined by chemiluminescence immunoassay. The HBV infec-tion and immune status and their influencing factors were determined by cross-sectional study and case-control study. Results A total of 628 subjects were included in this study. The positive rate of HBsAg and anti-HBs was 10.19%(64/628) and 66.88% (420/628), respectively. The mean concentration, positive rate and high-level positive rate in HBsAg-negative patients were higher than those in HBsAg-positive patients, and the differences were statistically sig-nificant (P<0.01). The hepatitis B vaccination rate in hemodialysis patients was 27.39% (172/628). The hepatitis B vaccination rate in anti-HBs positive patients was higher than that in anti-HBs negative patients, and the difference was statistically significant (P=0.013). The influencing factors of HBsAg and anti-HBs were analyzed by unconditional logistic regression, and the findings showed that the risk of HBsAg positive in patients with family history of hepatitis B was 3.19 times that of patients with no family history of hepatitis B [OR=3.186, 95%CI(1.713, 11.029)];the risk of HBsAg positive in anemic patients was 5.03 times that of non-anemic patients [OR=5.028, 95% CI(2.185, 18.534)]. The risk of anti-HBs negative in HBsAg-positive patients was 6.54 times that of HBsAg-negative patients [OR=6.536,95%CI(2.817, 15.152)]. Conclusion The positive rate of HBsAg in maintenance hemodialysis patients is high, and we should further strengthen regular screening of hepatitis B serology and improve hepatitis B vaccination rate to in-crease the level of protective antibody and decrease the risk of HBV infection.%目的 分析广西壮族自治区南宁市维持性血液透析患者乙型肝炎病毒(HBV)感染与免疫状况,并探讨相关影响因素.方法 采用面对面问卷调查和病历采集的方式收集3所医院血液透析中心维持性血液透析患者一般情况、血液透析相关资料、行为危险因素、乙型病毒性肝炎(乙肝)疫苗接种史及乙肝家族史等.采集研究对象5 ml静脉血,使用化学发光免疫试验检测患者血清乙肝表面抗原(HBsAg)与乙肝表面抗体(抗-HBs);采用横断面研究与病例对照研究的方法分析HBV感染与免疫状况及相关影响因素.结果 本次研究共纳入研究对象628例,HBsAg阳性率为10.19%(64/628),抗-HBs阳性率为66.88%(420/628).HBsAg阴性的患者抗-HBs平均浓度、阳性率及强阳性率均高于HBsAg阳性的患者,且差异均具有统计学意义(P<0.01).血液透析患者乙肝疫苗接种率27.39%(172/628),抗-HBs阳性患者乙肝疫苗接种率高于抗-HBs阴性患者,差异具有统计学意义(P=0.013).采用非条件Logistic回归分析HBsAg及抗-HBs影响因素,结果显示,有乙肝家族史者HBsAg阳性的风险是无家族史者的3.19倍[OR=3.186,95%CI(1.713,11.029)];贫血患者HBsAg阳性的风险是非贫血患者的5.03倍[OR=5.028,95%CI(2.185,18.534)].HBsAg阳性患者抗-HBs阴性的风险是HBsAg阴性患者的6.54倍[OR=6.536,95%CI(2.817,15.152)].结论 维持性血液透析患者HBsAg阳性率较高,应进一步加强患者乙肝血清学定期筛查并提高乙肝疫苗接种率,提高该人群保护性抗体水平,降低其HBV感染风险.