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[目的]了解成年人乙型肝炎病毒(HBV)感染者乙型肝炎疫苗(HepB)免疫的状况及相关情况,查找成人HBV感染的原因。[方法]采用ELISA法检测所有调查对象的乙肝病毒5项血清标志物、查看乙肝血检报告单和HepB预防接种记录、用自制的调查表进行问答式调查等方法以了解调查对象的相关情况。[结果]21岁以上的已感染HBV者HepB接种率仅为43.0%,其中市区为55.3%、乡村为37.4%,乡村明显低于市区(P<0.01)。已感染HBV组HepB免疫中:每剂用5μg重组酵母(或10μgCHO)HepB者占98.2%,完成3剂(次)基础免疫接种者占73.4%,接种>3剂(次)者占0.0%(对照组分别为84.3%、100.0%和26.6%);乙肝疫苗首针(HepB1)接种时间距HBV血清学检测结果阴性时间<24h者占39.5%(对照组为80.4%);HBV暴露后应急预防接种率为0.0%(对照组为33.3%);HepB接种前后、接种期间地塞米松等免疫抑制剂使用率占28.8%,其中“常用”率占19.9%(对照组分别为4.0%、0.0%);接种前HBV血清学总检测率为12.7%,其中“乙肝5项”检测率占2.4%,接种后抗-HBs检测率为0.0%(对照组分别为18.0%、7.4%和69.9%)。以上已感染HBV组与对照组比较,除HBV血清学总检测率组间差异不明显(P>0.05)外,其余各项率的组间差异均有统计学意义(P<0.01)。[结论]没有预防接种HepB和HepB基础免疫失败是成人HBV感染的主要原因,而上述5个方面的问题可能是成人HepB免疫失败的症结所在。需克服各种影响因素,全面开展成人HepB免疫和优质“达标”接种,迅速提升成人对HBV的总体免疫水平。
[Objective] To investigate the status of Hepatitis B vaccine (HepB) immunity in adults with hepatitis B virus (HBV) infection and to find out the causes of HBV infection in adults. [Methods] The five serological markers of hepatitis B virus in all the investigated subjects were detected by ELISA, the record of hepatitis B blood test report and vaccination record of HepB were examined, and the questionnaires of self-made questionnaire were used to investigate the related situation of the surveyed subjects. [Results] HepB vaccination rate was 43.0% in those infected with HBV over 21 years old, 55.3% in urban areas, 37.4% in rural areas and significantly lower in rural areas than in urban areas (P <0.01). HepB immunization in infected HBV group was 98.2% with 5μg of recombinant yeast (or 10μg CHO) per dose, 73.4% with 3 doses of basic immunization, and 0.0% (with 3 doses) Control group were 84.3%, 100.0% and 26.6% respectively). HepB1 vaccination time was 39.5% (HBV DNA negative control group was 39.5% The vaccination rate was 0.0% (33.3% in the control group). Before and after HepB inoculation, the usage of immunosuppressants such as dexamethasone was 28.8% 0.0%). The total serological detection rate of HBV before inoculation was 12.7%, of which the detection rate of “5 items of hepatitis B” was 2.4% and the detection rate of anti-HBs was 0.0% (18.0%, 7.4% And 69.9%). Compared with the control group, there was no significant difference (P> 0.05) between the infected HBV group and the control group, and there were significant differences among the groups (P <0.01). [Conclusion] The failure of basic immunization without HepB and HepB vaccination is the main reason of adult HBV infection, and the above five aspects may be the crux of adult HepB immunodeficiency. It is necessary to overcome all kinds of influencing factors and fully carry out HepB immunization and high quality “standard ” vaccination in adults so as to promptly raise the overall level of immunity to HBV in adults.