Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
BMC Nephrol. 2012 Aug 30;13:97. doi: 10.1186/1471-2369-13-97.
The status of immunocompromised patients is well recognized in end stage renal disease (ESRD). As described recently, this acquired immune dysfunction in the uremic milieu may be one of the main pathogenic factors for mortality in ESRD. The aim of this study was to determine the relationship between the immune response following a hepatitis B vaccination (HBV vaccination) and the survival of maintenance dialysis patients.
A total of 156 patients (103 on hemodialysis and 53 on continuous ambulatory peritoneal dialysis) were recruited. After receiving a full dose of the HBV vaccination, all patients were followed up for to 5 years to evaluate the association of patient survival, cause of mortality, and immune response.
The response rate to the hepatitis B vaccination was 70.5%. There was no significant association between the immune response and the 5-year survival rate (p =0.600) or between the post-vaccination anti-HBs titers and the 5-year survival rate (p = 0.201). The logistic prediction model with the coefficient as non-response following HBV vaccination, diabetes mellitus, old age, and low albumin level could significantly predict infection-cause mortality (sensitivity = 0.842, specificity = 0.937).
There was no significant association between the immune response to HBV vaccination and the 5-year survival rate. However, non-response following HBV vaccination might be associated with infection-cause mortality in dialysis patients.
免疫功能低下患者在终末期肾病（ESRD）中的状况已得到充分认识。如最近所述，这种尿毒症环境中的获得性免疫功能障碍可能是 ESRD 患者死亡的主要致病因素之一。本研究旨在确定乙型肝炎疫苗接种（HBV 疫苗接种）后的免疫反应与维持性透析患者的生存之间的关系。
共招募了 156 名患者（103 名血液透析患者和 53 名持续不卧床腹膜透析患者）。所有患者接受了全剂量 HBV 疫苗接种后，随访 5 年，以评估患者生存、死亡原因和免疫反应之间的关联。
HBV 疫苗接种的反应率为 70.5%。免疫反应与 5 年生存率之间无显著相关性（p=0.600），或与接种后抗-HBs 滴度与 5 年生存率之间无显著相关性（p=0.201）。以 HBV 疫苗接种无反应、糖尿病、高龄和低白蛋白水平为系数的逻辑预测模型可显著预测感染性死因死亡率（灵敏度=0.842，特异性=0.937）。
HBV 疫苗接种后的免疫反应与 5 年生存率之间无显著相关性。然而，HBV 疫苗接种无反应可能与透析患者的感染性死因死亡率有关。
