汉川市成人乙肝病毒感染与乙肝疫苗接种状况的对比性分析

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10μg CHO）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％（对组分别为84．3％、100．0％和26．600）；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．o％、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HcpB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。

Comparative Analysis on Adult Hepatitis B Virus Infection and Status of Hepatitis B Vaccination in Hanchuan City

Objective]To investigate the status and related cases of the HepB immunization of adult infected by HBV, and find the causes of adult HBV infection. Methods]The five markers of HBV of all respondents were detected by ELISA, Hepatitis B blood examination report cards and vaccination records were examined,and Question-and-answer sur- vey was done using self-made questionnaire. These methods were used to investigate the related eases of respondents. Results]The vaccination rate of the HepB was just 43.0% in the above 21-year-old groups infected by HBV,55.3% in urban area and 37.4% in rueal area,and vaccination rate in the rural area was significantly lower than that in urban area （ P 〈0.02）. In HepB immunization of the group infected by HBV： The usage of a dose of 5 μg Recombinant yeast （or 10μg CHO） accounted for 98.2%, persons with three times basic immunization vaccinations accounted for 73.4 %, and whose vaccinations more than three times accounted for 0.0% （the control group was 84.3%/00,100.0% and 26.6% ）;Whose intervals between HepB1 vaccination time and HBV serological test results negative time less than 24 hours accounted for 39.5% （the control group was 80.4%）;After HBVs were exposed,the rate of emergency prevention vaccinations was 0.0 % （the control group was 33.3 %） ;Pre-and-post and in the period of HepB vaccination, the usage rate of immunosuppressants,such as dexamethasone and so on,was 28.8%,the usual usage rate was 19.9% （the control group was 4.0% and 0. 0 % ） ;Before vaccination, the total H BV serological detection rate was 12.7 % , the detection rate of hepatitis B five i- tems was only 2.4% ,and after vaccination, the detection rate of anti-HBS was 0. 0% （the control group was 18.0%, 7.4% and 69.9%）. Comparing the group of persons infected by HBV with control group for above point,there were statistically significant differences for all of above rates （ P〈0.01） except the total HBV serological detection rate （ P 〈0.05）. Conclusion] No vaccination of HepB and HepB basic immunization failure are the two main causes of adult HBV infection. And the above five problems are the direct causes for adult HepB immunization failure. By overcoming various influence factors,adult HepB immunization should be widely carried out and the standard vaccinations to lift quickly the, level of adult HBV immunization.