基于贝叶斯网络模型的慢性肾脏病患者抗-HBs阳性影响因素分析

Analysis of anti⁃HBs positive influencing factors in patients with chronic kidney disease based on Bayesian network model

目的了解慢性肾脏病(chronic kidney disease,CKD)患者抗-HBs阳性率并探讨其影响因素及因素间的网络关系。方法以2019年4―7月在2家医院就诊治疗的623名18~70岁的CKD患者为研究对象,通过问卷调查和病历查阅获得其一般人口学特征、CKD患病情况、乙型肝炎(简称乙肝)相关信息的资料,检测HBsAg、抗-HBs和抗-HBc,了解CKD患者抗-HBs阳性率,并通过χ^(2)检验、非条件logistic回归分析模型和贝叶斯网络模型分析CKD患者抗-HBs阳性的影响因素及因素间的网络关系。结果CKD患者既往乙肝疫苗接种率为14.13%(88/623),抗-HBs阳性率为32.58%(203/623);控制混杂因素后,非条件logistic回归分析模型分析显示既往接种过乙肝疫苗和有乙肝家族史者抗-HBs阳性概率高(OR=1.71,95%CI:1.07~2.72;OR=2.63,95%CI:1.03~6.73);贝叶斯网络模型结果显示既往乙肝疫苗接种、乙肝家族史与抗-HBs直接相关,乙肝家族史、年龄、文化程度通过既往乙肝疫苗接种与抗-HBs间接相关。结论CKD患者乙肝疫苗接种情况不佳,抗-HBs阳性率低。要加强CKD患者健康教育,积极进行乙肝血清标志物的检测、及早进行乙肝疫苗接种,尤其是高龄、低学历和无乙肝家族史者。

Objective To evaluate the positive rate of anti⁃HBs in patients with chronic kidney disease(CKD),and to explore influencing factors of the positive rate of anti⁃HBs and the network rela⁃tionship among them.Methods A total of 623 CKD patients who were aged 18 to 70 years and treated in two hospitals between April and July 2019 were selected as the research subjects.General demographic characteristics,disease progression and the information related to hepatitis B of CKD patients were ob⁃tained through questionnaire survey and medical records.Quantification of HBsAg,anti⁃HBs and anti⁃HBc were detected.The influencing factors of anti⁃HBs positive in CKD patients and the network re⁃lationship among the influencing factors were performed byχ2 test,unconditional logistic regression and Bayesian network model.Results The history of hepatitis B vaccination rate in CKD patients was 14.13%(88/623),and the positive rate of anti⁃HBs was 32.58%(203/623).After controlling the con⁃founding factors,the positive rate of anti⁃HBs in CKD patients with history of hepatitis B vaccination and family history was higher than those without such histories,with the OR(95%CI)of 1.71(95%CI:1.07-2.72)and 2.63(95%CI:1.03-6.73),respectively.The results of Bayesian network model showed that history of hepatitis B vaccination and family history of hepatitis B virus were directly correla⁃ted with anti⁃HBs,while age and education level were indirectly correlated with anti⁃HBs through history of hepatitis B vaccination.Conclusions The positive rate of anti⁃HBs in CKD patients was low,and the hepatitis B vaccination was poor.It is necessary to strengthen the health education of CKD patients,ac⁃tively carry out the detection of hepatitis B serum markers,early hepatitis B vaccination,especially the elderly,those with low education background,and no family history of hepatitis B virus.