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目的比较艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)抗反转录病毒治疗(ART)后,与健康者接种乙型肝炎(乙肝)疫苗后免疫应答的差异。方法健康对照者和ART后CD_4~+T淋巴细胞(简称CD_4细胞)计数均≥200个/μL的HIV/AIDS病人,分别在0、1、6个月肌内注射重组乙肝疫苗20μg,并在第3次疫苗注射后1个月检测抗乙肝病毒表面抗原抗体(抗-HBs)的水平,高于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。结果健康对照组19例,在第3次乙肝疫苗注射后1个月,抗-HBs阳性率94.7%(18例);HIV/AIDS病人组30例,在第3次乙肝疫苗注射后1个月,抗-HBs阳性率93.3%(28例);两组比较差异无统计学意义(P=1.000)。CD_4细胞≥350个/μL组HIV/AIDS病人23例,第3次乙肝疫苗注射后1个月,抗-HBs阳性率95.7%(22/23);CD4细胞<350个/μL、>200个/μL组7例,第3次乙肝疫苗注射后1个月,抗-HBs阳性率85.7%(6/7),两组比较差异无统计学意义(P=0.418)。CD_4细胞≥350个/μL组在第3次乙肝疫苗注射后1个月,血清抗-HBs效价中位数为251.24mlU/mL,CD_4细胞<350个/μL、>200个/μL组在第3次乙肝疫苗注射后1个月,抗-HBs效价中位数为237.6mlU/mL,两组比较差异无统计学意义(Z=-0.368,P=0.737)。所有接种者均未出现不良反应。结论 ART后,CD_4细胞计数≥200/μL的HIV/AIDS病人,对乙肝疫苗接种能获得相对较好的免疫应答,因此针对严重免疫抑制的HIV/AIDS病人,为提高接种乙肝疫苗的应答效果,较好的接种时机可选择在ART后且CD4细胞计数≥200个/μL时。
Objective To compare the difference of immune response between hepatitis B virus (Hepatitis B) vaccine and healthy people after antiretroviral therapy (ART) of HIV / AIDS patients. Methods HIV / AIDS patients with CD_4 ~ + T lymphocytes count≥200 pcs / μL after ART were injected intramuscularly with 20 μg recombinant hepatitis B vaccine at 0, One month after the third vaccine injection, the level of anti-hepatitis B virus surface antigen antibody (anti-HBs) was tested, which was positive above 10 mIU / mL. The positive rates of serum anti-HBs in both groups were compared using the chi-square test, and the comparison of the anti-HBs titer was performed using the Mann-Whitney test in the nonparametric test. Results Nineteen cases were healthy control group. The positive rate of anti-HBs was 94.7% (18 cases) one month after the third hepatitis B vaccine injection. Thirty cases of HIV / AIDS patients were treated one month after the third hepatitis B vaccine , And the positive rate of anti-HBs was 93.3% (28 cases). There was no significant difference between the two groups (P = 1.000). 23 cases of HIV / AIDS patients with ≥ 350 cells / μL CD_4 cells and 95.7% (22/23) of anti-HBs positive cells at one month after the third hepatitis B vaccine injection; CD4 cells> 350 cells / μL and> 200 cells / L group 7 cases, one month after the third hepatitis B vaccine, the positive rate of anti-HBs was 85.7% (6/7). There was no significant difference between the two groups (P = 0.418). CD_4 cells ≥350 cells / μL group The median serum anti-HBs titer was 251.24 mlU / mL at 1 month after the third hepatitis B vaccine injection, <350 cells / μL CD_4 cells,> 200 cells / μL One month after the third hepatitis B vaccine injection, the median titer of anti-HBs was 237.6 mlU / mL, with no significant difference between the two groups (Z = -0.368, P = 0.737). No adverse reactions occurred in all vaccinates. Conclusion After ART, HIV / AIDS patients with CD_4 cell count≥200 / μL can obtain a relatively good immune response to hepatitis B vaccination. Therefore, in order to improve the response to hepatitis B vaccine in HIV / AIDS patients with severe immunosuppression, The preferred timing of seeding is after ART and with a CD4 cell count of ≥200 / μL.