García-Agudo R, Aoufi Rabih S, Araque Torres P, Dolores Fraga Fuentes M, Carlos Valenzuela Gámez J, Mancha Ramos J, María Tenías Burillo J
Nephrology Department, La Mancha-Centro Hospital Complex, Alcázar de San Juan, Ciudad Real, Spain.
Transplant Proc. 2012 Nov;44(9):2532-4. doi: 10.1016/j.transproceed.2012.09.046.
The response to hepatitis B (HB) vaccine remains suboptimal among chronic kidney disease patients. The aim of this study was to analyze the efficacy of a hepatitis B vaccination schedule with two 4-double doses of conventional vaccine and four doses of adjuvant vaccine in chronic kidney disease patients evaluated for renal transplantation.
In this prospective study, we recruited chronic kidney disease patients evaluated for renal transplantation to receive four 40-μg doses of hepatitis B virus vaccine (0, 1, 2 and 6 months) and another four 40 μg doses of hepatitis B virus vaccine and four 20 μg doses of adjuvant vaccine if they were nonresponders. AntiHBs titers were analyzed before every vaccine dose and 1 month after the fourth dose.
One hundred fifty-five patients were enrolled in the study. The response to the vaccination increased until the seventh dose: first dose, 5.4%; second, 29.5%; third, 66.7%; fourth, 75.9%; fifth, 83.3%; sixth, 87.3%; seventh, 92.5%; and eighth, 93.8%. AntiHBs titers after the first and second vaccination with Engerix were 10 to 99 mIU/mL in the 12% and 7.7%, 100 to 999 mIU/mL in the 30.1%, and 46.2%, and 1000 mIU/mL in the 34.9% and 15.4%, respectively. Fendrix was administrated in 6.2% of the patients and 75% of them obtained a response. AntiHBc-positive patients obtained a response with one vaccination cycle in the 71.4%. The response was influenced by age and was greater in women. Adverse events were found in 11.5% of the patients (inflammation and/or local pain), which were less frequent in men (8.9% versus 16.1%) and similar for both vaccines.
The response to the hepatitis B vaccination with four double doses of conventional vaccine and revaccination with the same schedule and adjuvanted vaccine shows a high response rate in chronic kidney disease evaluated for renal transplantation.
慢性肾脏病患者对乙型肝炎（HB）疫苗的反应仍不理想。本研究的目的是分析在接受肾移植评估的慢性肾脏病患者中，采用两剂4倍剂量的传统疫苗和四剂佐剂疫苗的乙肝疫苗接种方案的疗效。
在这项前瞻性研究中，我们招募了接受肾移植评估的慢性肾脏病患者，给予四剂40μg的乙肝病毒疫苗（0、1、2和6个月），如果他们无反应，则再给予四剂40μg的乙肝病毒疫苗和四剂20μg的佐剂疫苗。在每次接种疫苗前和第四剂接种后1个月分析抗-HBs滴度。
155名患者参与了该研究。接种疫苗后的反应率一直上升至第七剂：第一剂，5.4%；第二剂，29.5%；第三剂，66.7%；第四剂，75.9%；第五剂，83.3%；第六剂，87.3%；第七剂，92.5%；第八剂，93.8%。接种第一剂和第二剂安在时后，抗-HBs滴度在12%和7.7%的患者中为10至99mIU/mL，在30.1%和46.2%的患者中为100至999mIU/mL，在34.9%和15.4%的患者中≥1000mIU/mL。6.2%的患者接种了富时，其中75%获得了反应。抗-HBc阳性患者在一个接种周期后71.4%获得了反应。反应受年龄影响，女性的反应更大。11.5%的患者出现不良事件（炎症和/或局部疼痛），男性中较少见（8.9%对16.1%），两种疫苗相似。
在接受肾移植评估的慢性肾脏病患者中，采用四剂双倍剂量的传统疫苗接种并按相同方案和佐剂疫苗进行再接种，对乙肝疫苗的反应率较高。
