不同CD4＋T淋巴细胞计数的人类免疫缺陷病毒-1感染者对重组乙型肝炎疫苗的免疫应答

Immune responses to recombinant hepatitis B virus vaccine in human immunodeficiency virus-l-infectedpatients with different CD4＋ T-lymphocyte

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20μg，并于首剂注射后1个月、7个月检测血清抗-HBs效价，≥10mIU／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。结果最终人组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／＋L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个月抗一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10．44mIU／mL，≥200／μL组为222．73mIU／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。

Objective To compare the difference of immune responses to hepatitis B virus （HBV） vaccine in human immunodeficiency virus （HIV）-l-infected patients with different CD4＋ T-lymphocyte counts. Methods HIV-l-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 atl and 7 months after first dose. The serum anti-hepatitis B sarfaee 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-l-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, whichwere 47. 50/oo （19/40） and 75.0% （30/40） in group of CD4＋ T lymphocytes ≥200/μL. There was no significant difference of serum antbHBs 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 of CD4＋ T-lymphocytes 〈200/μL after 7 months （X2 =0. 531, P=0. 466）. The median titers of anti HBs at 7 months were 10. 44 mlU/mL in group of CD4＋ T-lymphocytes 〈C 200/μL and 222.73 mlU/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＋ T lymphocytes was related to anti-HBs posixivity after HBV vaccination. Conclusions HIV-l-infected patiems with CD4＋ T-lymphocytes ≥200/tzL 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.