Прогностические факторы поствакцинального иммунного ответа к вирусному гепатиту B у сотрудников медицинских организаций и перспективы оптимизации тактики иммунопрофилактики

Введение . Сотрудники медицинских организаций являются профессиональной группой риска заражения гемоконтактными инфекциями, что требует постоянного совершенствования мер профилактики, в т. ч. оптимизации подходов к иммунопрофилактике вирусного гепатита В.

Материалы и методы . В 2024–2025 гг. проведен анализ прививочного анамнеза и данных серологического скрининга 1 380 работников медицинской организации на анти-HBs. Лабораторные исследования выполнены в клинико-диагностической лаборатории Европейского медицинского центра «УГМК-Здоровье» методом иммуноферментного анализа (тест-система «Векто HBsAg-антитела»).

Результаты . Доля лиц с концентрацией анти-HBs ≥10 мМЕ/мл составила 81,8 %. На основе модели бинарной логистической регрессии были установлены прогностические факторы, влияющие на концентрацию антител: возраст сотрудников, период, прошедший с момента последнего введения вакцины, и количество введенных доз вакцины ( p < 0,001). Для модифицируемых факторов риска линейная регрессионная модель позволила выявить, что концентрация анти-HBs снижалась на 10,992 мМЕ/мл с каждым последующим от иммунизации годом ( p < 0,001) и увеличивалась на 59,757 мМЕ/мл с каждой дополнительной введенной дозой вакцины ( p < 0,001). Среди построенных ROC-кривых прогностической ценностью обладала модель для количества введенных доз вакцины с пороговым значением в точке отсечения 4 (AUC = 0,745±0,018; 95 % ДИ: 0,709–0,781; чувствительность 83,2 %; специфичность 57,0 %; p < 0,001).

Заключение . Проведенное исследование позволило определить прогностические факторы, влияющие на поствакцинальный иммунитет к вирусному гепатиту В у медицинских работников, что обосновывает необходимость дальнейших исследований для разработки оптимальной стратегии бустерной иммунизации с учетом комплексного анализа гуморального и клеточного иммунного ответа, клинико-анамнестических данных и общесоматического статуса персонала.

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