Ghadiani Mohammad H, Besharati Shahin, Mousavinasab Nouraddin, Jalalzadeh Mojgan
Department of Nephrology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Res Med Sci. 2012 Jun;17(6):527-33.
Hepatitis-B virus (HBV) infection is a big problem in chronic kidney disease (CKD) population. We attempted to compare the response rate to HB vaccine in CKD stages3-4 patients with that in hemodialysis (CKD stage-5; HD patients) and medical staff.
Three hundred and three participants were enrolled into the study to test the seroconversion rate after vaccination. Participants formed three groups: Group-A:HD patients, Group-B: diagnosed with CKD stages 3-4, and Group-C: healthy medical staff. CKD stages 3-4 participants were vaccinated from February to November 2010. HD patients were vaccinated at the time of initial HD. While the medical staffs were vaccinated at the time they started working at the hospital. Group-A, Group-B and Group-C received four 40μg (in 0,1,2 and 6 months), three 40μg (0, 1 and 6 months) and three 20μg (0, 1and 6 months) doses of HB vaccine, respectively. Three months after completion of the vaccination schedule, seroconversion and seroprotection rates in each group were investigated.
Seroconversion rates were 44.3%, 89.7%, and 96.2% for groups A, B and C, respectively. CKD stages 3-4 patients showed higher response rate than dialysis patients [χ(2)(1):30.6, P <0.001]. But a significant difference in the seroconversion rate between CKD stages 3-4 patients and medical staffs was not observed [χ(2)(1):3.4, P = 0.064]. Multivariate analyses showed patients with more advanced CKD and who were older had less seroconversion rates [odds ratio: 0.09(95%CI: 0.04 - 0.25) and [odds ratio: 0.39(95% CI: 0.18-0.85)], respectively. But sex was not associated with seroconversion (P>0.05).
Stages 3-4 patients with higher dosages of routine HB vaccine had higher seroconversion rate than HD patients. Future studies should evaluate the recommended dosage of HB vaccine among these patients.
乙型肝炎病毒（HBV）感染在慢性肾脏病（CKD）人群中是一个大问题。我们试图比较CKD 3 - 4期患者与血液透析患者（CKD 5期；HD患者）及医护人员对乙肝疫苗的反应率。
303名参与者被纳入该研究以检测疫苗接种后的血清转化率。参与者分为三组：A组：HD患者；B组：诊断为CKD 3 - 4期；C组：健康医护人员。CKD 3 - 4期参与者于2010年2月至11月接种疫苗。HD患者在首次血液透析时接种。医护人员在开始在医院工作时接种。A组、B组和C组分别接受四剂40μg（0、1、2和6个月）、三剂40μg（0、1和6个月）和三剂20μg（0、1和6个月）的乙肝疫苗。在完成疫苗接种计划三个月后，调查每组的血清转化率和血清保护率。
A组、B组和C组的血清转化率分别为44.3%、89.7%和96.2%。CKD 3 - 4期患者的反应率高于透析患者[χ(2)(1):30.6，P <0.001]。但未观察到CKD 3 - 4期患者与医护人员之间血清转化率的显著差异[χ(2)(1):3.4，P = 0.064]。多因素分析显示，CKD病情更严重及年龄较大的患者血清转化率较低[优势比：0.09(95%CI: 0.04 - 0.25)和[优势比：0.39(95% CI: 0.18 - 0.85)]，分别]。但性别与血清转化无关（P>0.05）。
CKD 3 - 4期患者使用较高剂量的常规乙肝疫苗比HD患者有更高的血清转化率。未来研究应评估这些患者中乙肝疫苗的推荐剂量。
