Department of Infectology, Faculdade de Medicina do ABC, Santo André-São Paulo, Brazil.
Department of General Practice, Faculdade de Medicina do ABC, Santo André-São Paulo, Brazil.
Int J Gen Med. 2014 Feb 3;7:109-14. doi: 10.2147/IJGM.S57254. eCollection 2014.
Hepatitis B is responsible for the development of half of hepatocellular carcinoma cases and is a major cause of hepatic insufficiency. The vaccine against hepatitis B virus does not exhibit the same high efficacy in patients on hemodialysis as it does in immunocompetent individuals. The medical literature recommends vaccination with four doses (40 mg each) of the hepatitis B virus vaccine before beginning hemodialysis; however, approximately one-third of hemodialysis patients do not respond to this vaccination schedule. A new serologic test should be performed each year for individuals who respond adequately, whereas a booster dose should be offered to those with antibody titers below 10 mIU/mL. In this study, we followed 83 hemodialysis patients and collected quantitative serologic measurements every 2 months over a 1-year period. We made the measurements 1 month after the vaccination period. We found that 41% of the patients had antibody titers below 10 mIU/mL (nonresponders), 21.7% had antibody titers between 10 mIU/mL and 100 mIU/mL (poor responders), and 37.3% had antibody titers higher than 100 mIU/mL (good responders). Patients with diabetes and/or hypertension exhibited worse response to vaccination. All subjects displayed decreasing antibody titers during the observation period. The group of poorly responsive patients had antibody titers below 10 mIU/mL at the 6-month follow-up period.
乙型肝炎是导致半数肝细胞癌病例发生的原因，也是肝功能不全的主要原因。乙型肝炎病毒疫苗在血液透析患者中的疗效不如免疫功能正常者。医学文献建议在开始血液透析前接种四剂（每剂 40 毫克）乙型肝炎病毒疫苗；然而，约有三分之一的血液透析患者对该疫苗接种方案无反应。对于应答充分的个体，每年应进行一次新的血清学检测，而对于抗体滴度低于 10 mIU/mL 的个体，应提供加强剂量。在这项研究中，我们对 83 名血液透析患者进行了随访，并在 1 年内每 2 个月收集一次定量血清学测量值。我们在接种期结束后 1 个月进行测量。我们发现 41%的患者抗体滴度低于 10 mIU/mL（无应答者），21.7%的患者抗体滴度在 10 mIU/mL 至 100 mIU/mL 之间（应答不佳者），37.3%的患者抗体滴度高于 100 mIU/mL（应答良好者）。患有糖尿病和/或高血压的患者对疫苗接种的反应更差。所有患者在观察期间的抗体滴度均呈下降趋势。在 6 个月的随访期间，应答不佳的患者组的抗体滴度低于 10 mIU/mL。
