维持性血液透析患者乙型肝炎疫苗免疫后2年乙型肝炎表面抗体阳性影响因素的Logistic回归模型和决策树模型分析

Factors influencing hepatitis B surface antibody positivity two years after hepatitis B vaccination of maintenance hemodialysis patients:logistic regression and decision tree model analyses

目的分析维持性血液透析(Maintenance hemodialysis,MHD)患者接种乙型肝炎疫苗(Hepatitis B vaccine,HepB)后2年乙型肝炎表面抗体(Hepatitis B surface antibody,HBsAb)阳性率及其影响因素。方法在前期已完成的MHD患者按0-1-6月免疫程序接种20μg和60μg HepB的免疫原性随机对照试验基础上,选取全程接种后2年的MHD患者采集静脉血,采用化学发光微粒子免疫分析法检测HBsAb;采用多因素Logistic回归模型和χ^(2)自动交互检测法(Chi-squared automatic interaction detector,CHAID)分析HBsAb阳性的影响因素。结果MHD患者全程接种20μg、60μg HepB后2年HBsAb阳性率分别为42.98%(52/121)、59.63%(65/109)(χ^(2)=6.37,P=0.012)。Logistic回归模型显示,接种60μg HepB者HBsAb阳性率高于接种20μg HepB者而透析年限≥5年者低于<5年者[OR(95%CI):1.99(1.15-3.46)、0.42(0.24-0.74)]。CHAID决策树模型显示,HepB接种剂量是首要影响因素,其次为透析年限;接种20μg HepB且透析年限≥5年者的HBsAb阳性率从42.98%降至30.77%。结论MHD患者接种60μg HepB后2年的免疫持久性较好;接种剂量和透析年限是HepB免疫后2年HBsAb阳性的影响因素,二者之间存在交互作用。

Objective To determine the hepatitis B surface antibody(HBsAb)positivity rate and factors influencing positivity among maintenance hemodialysis(MHD)patients two years after receiving hepatitis B vaccine(HepB).Methods Following on a randomized controlled trial of the immunogenicity of a 0-1-6-month immunization schedule with 20μg vs 60μg HepB vaccines,we obtained blood samples from subjects two years after vaccination and tested them for HBsAb using chemiluminescence microparticle immunoassay.We used multivariate logistic regression and Chi-squared automatic interaction detector(CHAID)to identify factors influencing HBsAb positivity.Results HBsAb positivity rates among MHD patients two years after receiving 20μg or 60μg HepB were 42.98%(52/121)and 59.63%(65/109)(χ^(2)=6.37,P=0.012),respectively.Logistic regression analysis showed that positivity was higher among subjects who received 60μg HepB than among subjects who received 20μg HepB,but lower among subjects who had been on MHD for≥5 years compared with subjects on MHD<5 years[OR(95%CI):1.99(1.15-3.46)and 0.42(0.24-0.74)].The CHAID decision tree model showed that HepB dose was the factor most influential of positivity,followed by MHD duration.HBsAb positivity decreased from 42.98%to 30.77%among 20μg subjects with≥5 years of MHD.Conclusions Two-year immune persistence in MHD patients was greater after 60μg HepB doses than after 20μg HepB doses.Dose size of HepB and duration of maintenance hemodialysis influenced HBsAb positivity two years after vaccination,and there was an interaction between these two factors.