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

卢晓晓; 姚添; 武媛婷; 曹娜; 王建民; 柳红婷; 冯永亮; 王素萍

doi:10.16462/j.cnki.zhjbkz.2023.05.019

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

doi: 10.16462/j.cnki.zhjbkz.2023.05.019

卢晓晓^{1, 2},
姚添³,
武媛婷^{1, 2},
曹娜^{1, 2},
王建民⁴,
柳红婷⁵,
冯永亮^{1, 2},
王素萍^{1, 2, ,}

1.
030001 太原，山西医科大学公共卫生学院流行病学教研室
2.
030001 太原，山西医科大学临床流行病学与循证医学中心
3.
030001太原，山西医科大学第一医院胃肠外科
4.
041000 临汾，临汾市中心医院肾内科
5.
044000 运城，运城市中心医院肾内科

基金项目:

国家科技重大专项 2018ZX10721202

详细信息

通讯作者:
王素萍，E-mail: supingwang@sxmu.edu.cn

中图分类号: R181.3
计量
- 文章访问数: 145
- HTML全文浏览量: 118
- PDF下载量: 21
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-06
- 修回日期: 2022-11-22
- 刊出日期: 2023-05-10

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

LU Xiaoxiao^{1, 2},
YAO Tian³,
WU Yuanting^{1, 2},
CAO Na^{1, 2},
WANG Jianmin⁴,
LIU Hongting⁵,
FENG Yongliang^{1, 2},
WANG Suping^{1, 2
, ,}

1.
Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan 030001, China
2.
Center of Clinical Epidemiology and Evidence Based Medicine, Shanxi Medical University, Taiyuan 030001, China
3.
Department of Gastrointestinal Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
4.
Department of Nephrology, Linfen Central Hospital, Linfen 041000, China
5.
Department of Nephrology, Yuncheng Central Hospital, Yuncheng 044000, China

Funds:

National Science and Technology Major Project of China 2018ZX10721202

More Information

Corresponding author: WANG Suping, E-mail: supingwang@sxmu.edu.cn

摘要

摘要: 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。
- 慢性肾脏病 /
- 乙型肝炎病毒 /
- 乙型肝炎病毒表面抗体 /
- 贝叶斯网络模型
Abstract: 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 relationship 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 obtained 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 relationship among the influencing factors were performed by χ² 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 confounding 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 correlated 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, actively 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.
- Chronic kidney disease /
- Hepatitis B virus /
- Anti-HBs /
- Bayesian network model

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图 1 CKD患者抗-HBs阳性影响因素贝叶斯网络模型

Figure 1. Bayesian network model of anti-HBs positive influencing factors in CKD patients

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表 1 CKD患者抗-HBs阳性情况[n(%)]

Table 1. Anti-HBs positive in CKD patients [n(%)]

变量	合计(N=623)	抗-HBs		χ²值	P值	变量	合计(N=623)	抗-HBs		χ²值	P值
变量	合计(N=623)	阴性(n=420)	阳性(n=203)	χ²值	P值	变量	合计(N=623)	阴性(n=420)	阳性(n=203)	χ²值	P值
性别				0.08	0.778	eGFR[mL·min^-1·(1.73 m²)^-1]				0.16	0.686
男	361(57.95)	245(67.87)	116(32.13)			<60	113(18.14)	78(69.03)	35(30.97)
女	262(42.05)	175(66.79)	87(33.21)			≥60	510(81.86)	342(67.06)	168(32.94)
年龄组(岁)				0.90	0.638	服用激素或免疫抑制剂				0.14	0.711
<40	126(20.22)	84(66.67)	42(33.33)			否	387(62.12)	263(67.96)	124(32.04)
40~<60	329(52.81)	227(69.00)	102(31.00)			是	236(37.88)	157(66.53)	79(33.47)
≥60	168(26.97)	109(64.88)	59(35.12)			慢性病				2.13	0.144
BMI (kg/m²)				2.00	0.368	无	287(46.07)	202(70.38)	85(29.62)
<18.5	18(2.89)	10(55.56)	8(44.44)			有	336(53.93)	218(64.88)	118(35.12)
18.5~<24.0	214(34.35)	150(70.09)	64(29.91)			肾穿刺活检				1.83	0.176
≥24.0	391(62.76)	260(66.50)	131(33.50)			无	341(54.74)	222(65.10)	119(34.90)
户籍				0.89	0.345	有	282(45.26)	198(70.21)	84(29.79)
农村	430(69.02)	295(68.60)	135(31.40)			手术、外伤史				2.40	0.121
城镇	193(30.98)	125(64.77)	68(35.23)			无	365(58.59)	255(69.86)	110(30.14)
文化程度				4.18	0.123	有	258(41.41)	165(63.95)	93(36.05)
初中及以下	409(65.65)	283(69.19)	126(30.81)			既往乙肝疫苗接种				6.42	0.011
高中及中专	134(21.51)	91(67.91)	43(32.09)			无/不详	535(85.87)	371(69.35)	164(30.65)
大专及以上	80(12.84)	46(57.50)	34(42.50)			有	88(14.13)	49(55.68)	39(44.32)
CKD患病年限(年)				2.77	0.096	乙肝家族史				5.72	0.017
<3	400(64.21)	279(69.75)	121(30.25)			无/不详	604(96.95)	412(68.21)	192(31.79)
≥3	223(35.79)	141(63.23)	82(36.77)			有	19(3.05)	8(42.11)	11(57.89)

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表 2 CKD患者的乙肝血清标志物模式

Table 2. Serum markers of hepatitis B in CKD patients

模式	序号	检测指标			例数(n)	构成比(%)
模式	序号	HBsAg	抗-HBs	抗-HBc	例数(n)	构成比(%)
易感模式	1	-	-	-	333	53.45
免疫模式	2	-	+	-	66	10.59
	3	-	+	+	128	20.55
感染模式	4	+	-	-	4	0.64
	5	-	-	+	62	9.95
	6	+	-	+	21	3.37
	7	+	+	-	2	0.32
	8	+	+	+	7	1.13
合计					623	100.00

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表 3 CKD患者抗-HBs阳性影响因素logistic回归分析模型分析

Table 3. Logistic regression analysis of influencing factors of anti-HBs positive in CKD patients

变量	OR值(95% CI)	OR值(95% CI)^a
既往乙肝疫苗接种
无/不详	1.00	1.00
有	1.80(1.14~2.85)	1.71(1.07~2.72)
乙肝家族史
无/不详	1.00	1.00
有	2.95(1.17~7.45)	2.63(1.03~6.73)
注：^a调整变量包括性别、年龄、户籍、文化程度、患病年限、eGFR、激素/免疫抑制剂的使用。

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表 4 乙肝家族史、年龄和文化程度为父节点时既往乙肝疫苗接种情况条件概率分布

Table 4. Conditional probability distribution of history of hepatitis B vaccination with family history of hepatitis B, age and education as paternal nodes

父节点			既往乙肝疫苗接种(%)
乙肝家族史	文化程度	年龄组(岁)	无/不详	是
无/不详	初中及以下	60~70	93.75	6.25
有	大专及以上	18~<40	33.33	66.67

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表 5 乙肝家族史和既往乙肝疫苗接种为父节点时抗-HBs阳性情况条件概率分布

Table 5. Conditional probability distribution of anti-HBs positive with family history of HBV and history of HBV vaccination as parent node

父节点		抗-HBs阳性(%)
乙肝家族史	既往乙肝疫苗接种	无/不详	是
无/不详	无/不详	30.10	69.90
无/不详	有	43.37	56.63
有	无/不详	55.56	44.44
有	有	57.14	42.86

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参考文献(24)

[1]	World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021 [EB/OL]. (2021-07-15) [2022-06-01]. https://www.who.int/publications/i/item/9789240027077.
[2]	Syed-Ahmed M, Narayanan M. Immune dysfunction and risk of infection in chronic kidney disease [J]. Adv Chronic Kidney Dis, 2019, 26(1): 8-15. DOI: 10.1053/j.ackd.2019.01.004.
[3]	Rabbi FJ, Alam MM, Rezwan K, et al. Hepatitis B virus infection and anti-HBc (total) positivity in CKD patients before dialysis [J]. J Enam Med Col, 2016, 6(3): 128-133. DOI: https://doi.org/ 10.3329/jemc.v6i3.29678.
[4]	Peters MG. Special populations with hepatitis B virus infection [J]. Hepatology, 2009, 49(5 Suppl): S146-S155. DOI: 10.1002/hep.22965.
[5]	Fabrizi F, Martin P, Messa P. Hepatitis B and hepatitis C virus and chronic kidney disease [J]. Acta Gastroenterol Belg, 2010, 73(4): 465-471.
[6]	Fabrizi F, Cerutti R, Dixit V, et al. Hepatitis B virus vaccine and chronic kidney disease. The advances [J]. Nefrologia (Engl Ed), 2021, 41(2): 115-122. DOI: 10.1016/j.nefroe.2020.08.005.
[7]	李凡, 徐志凯. 医学微生物学[M]. 第9版. 北京: 人民卫生出版社, 2018: 257-263. Li F, Xu ZK. Medical Microbiology [M]. 9rd ed. Beijing: People's Medical Publishing House, 2018: 257-263.
[8]	Unger JK, Peters H. Hepatitis B in chronic kidney disease: moving toward effective prevention [J]. Kidney Int, 2008, 73(7): 799-801. DOI: 10.1038/ki.2008.57.
[9]	Sit D, Kadiroglu AK, Kayabasi H, et al. Seroprevalence of hepatitis B and C viruses in patients with chronic kidney disease in the predialysis stage at a university hospital in Turkey [J]. Intervirology, 2007, 50(2): 133-137. DOI: 10.1159/000098239.
[10]	Tanaka A, Inaguma D, Watanabe Y, et al. Hepatitis B virus infection among patients with chronic kidney disease who attended an educational program in Japan [J]. Ther Apher Dial, 2018, 22(6): 588-593. DOI: 10.1111/1744-9987.12708.
[11]	高培, 王怀, 陈维欣, 等. 北京市自然人群乙型肝炎血清流行病学研究[J]. 中华流行病学杂志, 2016, 37(5): 658-662. DOI: 10.3760/cma.j.issn.0254-6450.2016.05.014. Gao P, Wang H, Chen WX, et al. A sero-epidemiological study of hepatitis B among general population in Beijing [J]. Chin J Epidemiol, 2016, 37(5): 658-662. DOI: 10.3760/cma.j.issn.0254-6450.2016.05.014.
[12]	Stevens PE, Levin A. Kidney disease: improving global outcomes chronic kidney disease guideline development work group members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline [J]. Ann Intern Med, 2013, 158(11): 825-830. DOI: 10.7326/0003-4819-158-11-201306040-00007.
[13]	Ma YC, Zuo L, Chen JH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease [J]. J Am Soc Nephrol, 2006, 17(10): 2937-2944. DOI: 10.1681/ASN.2006040368.
[14]	王丹, 刘小甜, 范开辉, 等. 育龄期妇女乙型肝炎流行现状及危险因素分析[J]. 职业与健康, 2021, 37(16): 2230-2234. DOI: 10.13329/j.cnki.zyyjk.2021.0545. Wang D, Liu XT, Fan KH, et al. Analysis on epidemic status and risk factors of hepatitis B among women of childbearing age [J]. Occup and Health, 2021, 37(16): 2230-2234. DOI: 10.13329/j.cnki.zyyjk.2021.0545.
[15]	高文花, 苏祥, 杨奕, 等. 山东某高校大学新生乙型肝炎病毒感染及免疫分析[J]. 中华实验和临床病毒学杂志, 2017, 31(3): 237-239. DOI: 10.3760/cma.j.issn.1003-9279.2017.03.012. Gao WH, Su X, Yang Y, et al. Analysis of hepatitis B infection and immune status of the first-year students in a university [J]. Chin J Exp Clin Virol, 2017, 31(3): 237-239. DOI: 10.3760/cma.j.issn.1003-9279.2017.03.012.
[16]	李文龙, 刘小锦, 刘婷婷, 等. 四川省绵阳市15~49岁育龄期妇女抗-HBs流行现状分析[J]. 现代预防医学, 2018, 45(2): 243-246, 254. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201802014.htm Li WL, Liu XJ, Liu TT, et al. Seroprevalences of hepatitis B surface antibody among 15-49 childbearing-age women in Mianyang, Sichuan Province [J]. Modern Preventive Medicine, 2018, 45(2): 243-246, 254. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201802014.htm
[17]	翟如芳, 光明, 常少英, 等. 山西省人群乙型病毒性肝炎血清流行病学调查[J]. 中华流行病学杂志, 2010, 31(4): 479-480. DOI: 10.3760/cma.j.issn.0254-6450.2010.04.033. Zhai RF, Guang M, Chang SY, et al. Serological survey on viral hepatitis B in the population of Shanxi Province [J]. Chin J Epidemiol, 2010, 31(4): 479-480. DOI: 10.3760/cma.j.issn.0254-6450.2010.04.033.
[18]	聂黎, 王焱焱, 庞星火, 等. 北京市朝阳区60岁及以上老年人乙肝病毒感染状况调查[J]. 首都公共卫生, 2019, 13(2): 72-75. DOI: 10.16760/j.cnki.sdggws.2019.02.004. Nie L, Wang YY, Pang XH, et al. Seroeipdemiology of HBV infection among adults aged 60 years and older in Chaoyang District of Beijing [J]. Capital Journal of Public Health, 2019, 13(2): 72-75. DOI: 10.16760/j.cnki.sdggws.2019.02.004.
[19]	刘小锦, 李文龙, 彭友悦, 等. 四川省绵阳市1~12岁儿童乙肝表面抗原和乙肝表面抗体的分布现况[J]. 四川大学学报(医学版), 2018, 49(2): 304-308. DOI: 10.13464/j.scuxbyxb.2018.02.031. Liu XJ, Li WL, Peng YY, et al. Prevalence of hepatitis B surface antigens and hepatitis B surface antibodies in 1-12 years-old children in Mianyang, Sichuan [J]. J Sichuan Univ (Med Sci), 2018, 49(2): 304-308. DOI: 10.13464/j.scuxbyxb.2018.02.031.
[20]	苏彦萍, 王宝兰, 刘秀军, 等. 北京市通州区20岁以上人群乙肝疫苗接种率影响因素分析[J]. 现代预防医学, 2016, 43(21): 3999-4002. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201621041.htm Su YP, Wang BL, Liu XJ, et al. Influencing factors of vaccination rate of hepatitis B vaccine among people over 20 years old in Tongzhou District, Beijing [J]. Modern Preventive Medicine, 2016, 43(21): 3999-4002. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201621041.htm
[21]	于艳丽, 杨海东, 余运贤. 北仑区乙肝患者家属主动接种乙肝疫苗现状及其影响因素调查[J]. 浙江预防医学, 2016, 28(5): 498-499, 502. DOI: 10.19485/j.cnki.issn1007-0931.2016.05.020. Yu YL, Yang HD, Yu YX. The prevelance in family members of patient with hepatitis B who actively vaccinated against HBV and its influence factors in Beilun District [J]. Zhejiang Prev Med, 2016, 28(5): 498-499, 502. DOI: 10.19485/j.cnki.issn1007-0931.2016.05.020.
[22]	马田莉, 潘璐璐, 高招, 等. 河北省成年人乙肝疫苗接种率影响因素研究[J]. 中国预防医学杂志, 2019, 20(4): 303-307. DOI: 10.16506/j.1009-6639.2019.04.014. Ma TL, Pan LL, Gao Z, et al. Influencing factors of coverage rate of hepatitis B vaccine among adults in Hebei Province [J]. Chinese Preventive Medicine, 2019, 20(4): 303-307. DOI: 10.16506/j.1009-6639.2019.04.014.
[23]	朱大伟, Knut R. Wangen, 王健, 等. 中国农村地区成人乙肝疫苗接种及影响因素[J]. 中国公共卫生, 2012, 28(10): 1291-1293. doi: 10.11847/zgggws2012-28-10-10 Zhu DW, Wangen KR, Wang J, et al. Influencing factors of vaccination of hepatitis B vaccine in rural adults in China [J]. Chin J Publ Heal, 2012, 28(10): 1291-1293. doi: 10.11847/zgggws2012-28-10-10
[24]	张国杰, 王镇, 汪洋, 等. 我国农村成人选择乙肝疫苗接种的内在动因—基于健康信念模型的分析[J]. 中国卫生政策研究, 2012, 5(11): 60-64. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWZ201211016.htm