Krishnamurthy G, Kher Vijay, Naik Sita
Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Scand J Urol Nephrol. 2002;36(5):377-82. doi: 10.1080/003655902320783908.
The aim of this study was to investigate whether the inability of chronic renal failure patients to mount an adequate antibody response following hepatitis B vaccination was due to an inherent defect in the antibody producing capacity of their B cells.
Peripheral blood mononuclear cells of end stage renal disease (ESRD) patients, who were not on maintenance hemodialysis (CRF) and those undergoing long-term hemodialysis (HD) were stimulated in vitro with pokeweed mitogen, a B cell mitogen or hepatitis B surface antigen. The total immunoglobulin (IgG, IgM and IgA) levels and anti-HBs specific IgM and IgG were quantitiated by sandwich ELISA and levels between patients who had a good antibody response in vivo and those who failed to mount an antibody response were compared.
Spontaneous IgG production was significantly higher than normals in CRF and HD group; PWM induced IgM, IgG and IgA production was comparable to normals in both groups of patients. The spontaneous IgG and PWM stimulated IgM and IgG production was significantly higher in HD patients as compared to CRF. The in vitro Ig levels in the vaccine responders and non-responders was comparable except for the spontaneous IgG which was highest in the responders. The in vitro anti-HBs production was comparable in HB vaccine responders and non-responders; the in vivo and in vitro anti-HBs titers showed a significant correlation coefficient thereby indicating that the in vitro assay reflects the in vivo functional status of B cells.
Our results demonstrate that the B cells in ESRD patients are functionally normal and cannot be the cause of the compromised vaccine response in these patients.
本研究旨在调查慢性肾衰竭患者在接种乙型肝炎疫苗后无法产生足够抗体反应是否是由于其B细胞产生抗体能力的内在缺陷。
用美洲商陆丝裂原（一种B细胞丝裂原）或乙型肝炎表面抗原体外刺激未进行维持性血液透析的终末期肾病（ESRD）患者（慢性肾衰竭，CRF）以及接受长期血液透析（HD）患者的外周血单个核细胞。通过夹心ELISA定量总免疫球蛋白（IgG、IgM和IgA）水平以及抗-HBs特异性IgM和IgG，并比较体内抗体反应良好的患者和未能产生抗体反应的患者之间的水平。
CRF组和HD组的自发IgG产生显著高于正常人；两组患者中美洲商陆丝裂原诱导的IgM、IgG和IgA产生与正常人相当。与CRF患者相比，HD患者的自发IgG以及美洲商陆丝裂原刺激的IgM和IgG产生显著更高。除了自发IgG在疫苗应答者中最高外，疫苗应答者和无应答者的体外Ig水平相当。HB疫苗应答者和无应答者的体外抗-HBs产生相当；体内和体外抗-HBs滴度显示出显著的相关系数，从而表明体外检测反映了B细胞的体内功能状态。
我们的结果表明，ESRD患者的B细胞功能正常，不可能是这些患者疫苗反应受损的原因。
