Resić Halima, Kukavica Nihad, Masnić Fahrudin, Prohić Nejra, Sahović Vahidin, Ajanović Selma, Corić Aida, Avdić Emir, Helać-Cvijetić Dzana
Clinic of Hemodialysis, Clinical Center of the University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
Acta Med Croatica. 2011 Dec;65(5):405-14.
Patients with end stage renal disease (ESRD) have a reduced response to vaccination against hepatitis B infection. The aim of the study has been to determine the adequacy of immune response with new protocol of vaccination against hepatitis B infection.
The study included incident hemodialysis patients since 2008 until 2011 at the Clinic of Hemodialysis of the Clinical Center of the University of Sarajevo. We started the new vaccination protocol in September 2009. New protocol implied vaccination six month before starting renal replacement therapy (RRT) and "ic" (intracutaneously) application vaccine vs. "sc" (subcutaneously) application. Vaccination was carried out for over 12 months. The follow up period lasted from 2009 to 2011.
The study included 64 patients, men were represented with 57,81% (37), and 42,19% women (27), who were divided in two groups. The first group included patients from the period from 2008 to 2009, who have been vaccinated under the old vaccination protocol, while the second group included patients with the new protocol from September 2009 to 2011. The first group had 28 patients, mean age of patients was 55,17 +/- 11.84 and mean duration of hemodialysis was 24,65 +/- 5,32 months. The second group had 36 patients, mean age of patients was 62,79 +/- 15,88 years, and mean duration of hemodialysis was 22,16 +/- 24,53 month. Neither group of patient has been previously vaccinated, nor these had positive in serum antiHBs before vaccination in second group. Five patients received a booster dose of vaccine, after which 4 showed adequate responses to anti HbS. In the first group of patients, out of total of 28 patients, 15 patients did not respond response with the adequate anti-HbS titer at the end of vaccination. In the second group of patients, out of 36 patients 31 of them responded to the vaccination with the new protocol, which was statistically significant (p<0,005). The total percentage of patients with adequate titer of antiHBs after vaccination towards a new protocol was 97.43% and the percentage of patients who required booster dose of vaccines was 12.82%.
Vaccination of patients in ESRD,six months before renal replacement therapy and intradermal application of vaccine vs. subcutaneously, improved immune response of our patients.
终末期肾病（ESRD）患者对乙型肝炎感染疫苗接种的反应降低。本研究的目的是确定采用新的乙型肝炎感染疫苗接种方案时免疫反应的充分性。
本研究纳入了2008年至2011年在萨拉热窝大学临床中心血液透析诊所的初发血液透析患者。我们于2009年9月开始采用新的疫苗接种方案。新方案意味着在开始肾脏替代治疗（RRT）前6个月进行疫苗接种，且采用皮内（“ic”）接种疫苗而非皮下（“sc”）接种。疫苗接种持续超过12个月。随访期从2009年持续至2011年。
本研究纳入64例患者，男性占57.81%（37例），女性占42.19%（27例），这些患者被分为两组。第一组包括2008年至2009年期间按照旧疫苗接种方案接种的患者，而第二组包括2009年9月至2011年采用新方案的患者。第一组有28例患者，患者平均年龄为55.17±11.84岁，血液透析平均时长为24.65±5.32个月。第二组有36例患者，患者平均年龄为62.79±15.88岁，血液透析平均时长为22.16±24.53个月。两组患者之前均未接种过疫苗，且第二组患者在接种前血清抗-HBs均为阴性。5例患者接受了疫苗加强剂量接种，其中4例对抗-HBs显示出充分反应。在第一组的28例患者中，共有15例患者在疫苗接种结束时抗-HBs滴度未达到充分反应。在第二组的36例患者中，31例对新方案疫苗接种有反应，这具有统计学意义（p<0.005）。采用新方案接种疫苗后抗-HBs滴度充分的患者总百分比为97.43%，需要疫苗加强剂量的患者百分比为12.82%。
对ESRD患者在肾脏替代治疗前6个月进行疫苗接种，并采用皮内接种而非皮下接种，改善了我们患者的免疫反应。
