Momeni Ali, Rajaei Mohammad
Department of Internal Medicine, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.
J Res Med Sci. 2011 Apr;16(4):536-40.
Hepatitis B is the most important cause of cirrhosis in developing countries. Hemodialysis patients are susceptible to infection due to repeated contact with dialysis machines and blood products. The aim of this study was to compare the efficacy of intradermal low dose with intramuscular high dose hepatitis B vaccination in hemodialysis patients.
In a cross-sectional study on 24 hemodialysis patients that not responded to conventional method of vaccination in this center (double dose in 0, 1 and 6 months) and have antibody titer less than 10 mu/ml were enrolled to intramuscular or intradermal group, randomly. In intradermal (ID) group 10 μg (0.5 ml) recombinant vaccine, every 2 weeks to 6 months and in intramuscular (IM) group 40 μg (2 ml) at 0, 1, 2, and 6 months were prescribed and antibody titer were checked after 1 and 3 months of the end of vaccination.
Mean HBS antibody titer in patients was 4.4 ± 3.1 mu/ml at the beginning of study (minimum: 1.1 mu/ml and maximum: 9.2 mu/ml) and after 1 month and 3 months, mean HBS antibody were 190.4 ± 59 and 223.3 ± 83.9, respectively (p < 0.001). After one month, in intradermal and intramuscular groups, mean HBS antibody was 198.8 ± 75.6 mu/ml and 181.2 ± 61.8 mu/ml, respectively (p = 0.5) and after 3 months it was 230 ± 76 mu/ml and 216.2 ± 94.3 mu/ml, respectively (p = 0.83).
Antibody titer was high (> 50 mu/ml) in two groups after 1 and 3 months of vaccination and no significant difference was found between the 2 groups. Therefore, two methods of vaccination (high dose IM and low dose SC) are equally effective and the selection of vaccination method is based on health policy.
在发展中国家，乙型肝炎是肝硬化的最重要病因。血液透析患者由于反复接触透析机和血液制品，易受感染。本研究的目的是比较皮内低剂量与肌肉内高剂量乙型肝炎疫苗接种在血液透析患者中的疗效。
在一项横断面研究中，选取本中心24例对常规疫苗接种方法（0、1和6个月时双倍剂量）无反应且抗体滴度低于10 mu/ml的血液透析患者，随机分为肌肉内注射组或皮内注射组。皮内注射（ID）组每2周接种10 μg（0.5 ml）重组疫苗，共接种6个月；肌肉内注射（IM）组在0、1、2和6个月时分别接种40 μg（2 ml）疫苗，并在接种结束后1个月和3个月检查抗体滴度。
研究开始时患者的平均乙肝表面抗体（HBS）滴度为4.4±3.1 mu/ml（最低：1.1 mu/ml，最高：9.2 mu/ml），接种后1个月和3个月时，平均HBS抗体分别为190.4±59和223.3±83.9（p<0.001）。接种1个月后，皮内注射组和肌肉内注射组的平均HBS抗体分别为198.8±75.6 mu/ml和181.2±61.8 mu/ml（p = 0.5）；接种3个月后，分别为230±76 mu/ml和216.2±94.3 mu/ml（p = 0.83）。
接种1个月和3个月后，两组的抗体滴度均较高（>50 mu/ml），两组之间未发现显著差异。因此，两种疫苗接种方法（高剂量肌肉内注射和低剂量皮下注射）同样有效，接种方法的选择应基于卫生政策。
