Zitt Emanuel, Hafner-Giessauf Hildegard, Wimmer Birgitta, Herr Alexander, Horn Sabine, Friedl Claudia, Sprenger-Mähr Hannelore, Kramar Reinhard, Rosenkranz Alexander R, Lhotta Karl
Department of Nephrology and Dialysis, Feldkirch Academic Teaching Hospital, Feldkirch, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.
Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Vaccine. 2017 Feb 1;35(5):814-820. doi: 10.1016/j.vaccine.2016.12.032. Epub 2016 Dec 31.
All patients with advanced chronic kidney disease or on renal replacement therapy should receive active hepatitis B vaccination. The aim of this retrospective cohort study was to investigate the association between the immune response to hepatitis B vaccination and all-cause, cardiovascular or infection-related mortality in incident dialysis patients starting dialysis between 2001 and 2008 (n=426) in two Austrian dialysis centers. Vaccination response was defined as follows: absent anti-HBs antibody titer or a titer <10IU/L was classified as non-response, seroconversion (SC) was defined as a titer ⩾10IU/L, and seroprotection (SP) as a titer ⩾100IU/L. Kaplan-Meier survival curves and multivariable adjusted Cox Proportional Hazards Models were used to determine the association between vaccination response and all-cause, cardiovascular and infection-related mortality. Of all patients 207 (48.6%) were non-responders, SC was observed in 219 (51.4%), SP in 118 (27.7%) patients. During a median follow-up of 51.2 months 228 (53.5%) patients died. Patients with SP and SC showed a significantly lower all-cause (p<0.001 for both) and cardiovascular mortality (p=0.006 for SP, p=0.01 for SC). SP and SC were independently associated with a significant risk reduction for all-cause mortality (SP: HR 0.69, 95% CI 0.49-0.97, p=0.03; SC: HR 0.72, 95% CI 0.55-0.95, p=0.02). In conclusion, achieving seroconversion and seroprotection after active hepatitis B vaccination is associated with significantly reduced all-cause mortality in incident dialysis patients. This simple and readily available tool allows estimation of patient survival independently of other well-known key parameters such as age, gender, the presence of diabetes and markers of malnutrition and inflammation.
所有晚期慢性肾病患者或接受肾脏替代治疗的患者均应接受乙肝疫苗主动接种。本回顾性队列研究的目的是调查2001年至2008年间在奥地利两个透析中心开始透析的新发病透析患者（n = 426）中，乙肝疫苗免疫反应与全因、心血管或感染相关死亡率之间的关联。疫苗接种反应定义如下：抗-HBs抗体滴度缺失或滴度<10IU/L被分类为无反应，血清转化（SC）定义为滴度⩾10IU/L，血清保护（SP）定义为滴度⩾100IU/L。采用Kaplan-Meier生存曲线和多变量调整的Cox比例风险模型来确定疫苗接种反应与全因、心血管和感染相关死亡率之间的关联。在所有患者中，207例（48.6%）无反应，219例（51.4%）观察到血清转化，118例（27.7%）患者有血清保护。在中位随访51.2个月期间，228例（53.5%）患者死亡。有血清保护和血清转化的患者全因死亡率（两者均p<0.001）和心血管死亡率显著较低（血清保护p = 0.006，血清转化p = 0.01）。血清保护和血清转化与全因死亡率显著降低独立相关（血清保护：HR 0.69，95%CI 0.49 - 0.97，p = 0.03；血清转化：HR 0.72，95%CI 0.55 - 0.95，p = 0.02）。总之，乙肝疫苗主动接种后实现血清转化和血清保护与新发病透析患者全因死亡率显著降低相关。这个简单且易于获得的工具能够独立于其他众所周知的关键参数（如年龄、性别、糖尿病的存在以及营养不良和炎症标志物）来估计患者的生存率。
