狂犬疫苗免疫效果影响因素的logistic回归分析

目的分析狂犬疫苗免疫效果影响因素。方法以2011年2月至2013年3月期间在广西北海市疾病预防控制中心门诊部使用辽宁依生生物制药有限公司或广州诺诚生物制品股份有限公司的狂犬疫苗并完成全程接种、且同意进行狂犬病病毒抗体（以下简称狂犬病抗体）检测的所有被动物致伤人员为调查对象，完成全程疫苗接种后进行狂犬病病毒IgG抗体检测，采用问卷调查的方法对动物致伤人员进行调查，调查内容包括个人基本情况、动物致伤及伤口处理情况、狂犬疫苗及人狂犬病免疫球蛋白应用情况、吸烟、喝酒等生活习惯和是否有慢病等，并对可能影响狂犬疫苗免疫效果的因素进行单因素及多因素logistic回归分析。结果共调查2091例被动物致伤人员，其中男性1087例，女性1004例，平均年龄为（31．01±19．53）岁。抗体阳性2024例，抗体阳性率为96．8％，1—19、20—39、40—85岁组调查对象抗体阳性率分剐为98．2％（637／649）、97．0％（690／711）、95．3％（697／731）；头面、躯干暴露或多处暴露者的抗体阳性率为92．2％（165／179），四肢暴露的为97．2％（1859／1912）；暴露前有狂犬疫苗免疫史的抗体阳性率为98．5％（528／536），无免疫史的为96．2％（1496／1555）；有慢病者的抗体阳性率是86．8％（46／53），无慢病的是97．1％（1978／2038）；在免疫期间吸烟者的抗体阳性率是94．0％（282／300），无吸烟的是97．3％（1742／1791）。多因素logistic回归分析结果显示，年龄越高，狂犬疫苗抗体阳性可能性越低（OR=0．59）；患有慢性病的动物致伤者其抗体阳性可能性低于无慢性病者（OR=0．22）；疫苗接种期间吸烟的动物致伤者其抗体阳性可能性低于无吸烟者（OR=0．50），头面、躯干或多处暴露的动物致伤者其抗体阳性可能性低于四肢暴露者（OR=0．31）；而暴露前有狂犬疫苗接种史的动物致伤者的抗体阳性可能性高于无狂犬疫苗接种史者（OR=2．55）。结论年龄、是否患有慢性病、免疫期间是否吸烟、犬伤暴露部位、暴露前是否有狂犬疫苗免疫史等可能是影响狂犬疫苗免疫效果的因素。

Logistic regression analysis of factors influencing the efficacy of rabies vaccination

Objective To study factors affecting the efficacy of rabies immunization. Methods People with rabies exposure were investigated by the method of questionnaire and their anti-rabies virus IgG levels were detected by ELISA after immunization. Single factor analysis and multivariate logistic regression analysis were performed for factors influencing immunological effect of rabies vaccination. Contents of the questionnaire included demographic situation, animal handling injuries and wounds, rabies vaccine and hu- man rabies immune globulin application, smoking and drinking habits, and history of chronic diseases. Results A total of 2 091 subjects （ 1 087 males, 1 004 females, mean age [31.01 ± 19. 53] years） were studied. The anti-rabies virus IgG positive rate was 96. 8% （2 024/2 091 ）. Positive rates in groups of 1 - 19, 20 -39, and 40 -85 years were 98.2% （637/649）, 97.0% （690/711）, and 95.3% （697/731）, respectively. The positive rates were 92. 2% （165/179） in people with head-face, body exposure, or multi-position exposure and 97.2% （ 1 859/1 912） in people with limbs exposure. The positive rates in people with or without immunization history before exposure to rabies were 98.5% （528/536） and 96. 2% （ 1 496/1 555 ）, respectively. The positive rates in people with and without chronic diseases were 86. 8% （46/53） and 97. 1% （1 978/2 038）. The positive rates in smoking or nonsmoking people during the treatment was 94.0% （282/300） and 97.3% （ 1 742/1 791 ）, respectively. The multivariate logistic re- gression analysis revealed that the higher the people age was, the lower the positive rate would be （ OR = 0. 59 ）. The positive rate was lower in people with chronic diseases than those without chronic diseases （ OR = 0. 22）, lower in smokers than those in nonsmokers during the treatment （ OR = 0. 50）, lower in people with head-face or body exposure or multi-position exposure than those with limbs exposure （ OR = 0. 31 ）, but higher in people with immunization history before exposure to rabies than those without immunization history （ OR = 2. 55）. Conelttsion The effect of rabies vaccination might be related to the age, chronic disease, smoking status during the treatment, exposed parts, and immunization history before exposure to rabies virus.