Cordova E, Miglia I, Festuccia F, Sarlo M G, Scornavacca G, Punzo G, Menè P, Fofi C
Nephrology Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
Public Health Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
Ann Ig. 2017 Jan-Feb;29(1):27-37. doi: 10.7416/ai.2017.2129.
Despite universal infection control precautions, the risk of hepatitis B virus (HBV) infection in patients on chronic haemodialysis (HD) remains high. For this reason anti-HBV vaccination is recommended in these subjects. In hemodialyzed patients vaccinal response is often suboptimal and it's not clear what factors may influence it.
The aim of our study is to assess the influence of some clinical and laboratory factors on seroconversion rate after anti HBV vaccination in a cohort of patients on maintenance HD.
We analysed 60 patients on regular HD, 40 men and 20 women (age 64±12 years, range 40-88 years), immunized with Engerix B ® vaccine, followed for an average time of 62 month (12-120 months). For each patient the following data were collected: age, serum albumin (sAlb), Blood urea nitrogen before HD session (BUN), age at vaccination, dialysis vintage, presence of systemic disease, type of vascular access, dialysis modality. Correlation between these factors and anti Hbs titer was estimated with multiple regression analysis.
Anti-Hbs seroconversion rate ( Anti Hbs > 10 IU/l) was 77%. Better rate of seroconversion (86%) was observed in patients with arteriovenous fistula (AVF) and serum albumin > 3,5 g/dL (93%), while higher rate of not responders (50%) in patients with systemic diseases. The only parameter correlated to anti Hbs titer was sAlb (p =0,0012). sAlb was correlated to age in all patients (p=0,01) and age was correlated to higher anti Hbs titer in the responder group (p=0,018).
In our experience an early vaccination, when patients on chronic HD are younger and in better nutritional conditions, improves anti-HBV response.
尽管采取了普遍的感染控制预防措施，但慢性血液透析（HD）患者感染乙型肝炎病毒（HBV）的风险仍然很高。因此，建议对这些患者进行抗HBV疫苗接种。在血液透析患者中，疫苗接种反应往往不理想，尚不清楚哪些因素可能会影响它。
我们研究的目的是评估一些临床和实验室因素对一组维持性HD患者抗HBV疫苗接种后血清转化率的影响。
我们分析了60例接受常规HD的患者，其中40例男性和20例女性（年龄64±12岁，范围40 - 88岁），用重组酵母乙型肝炎疫苗（Engerix B®）进行免疫，平均随访时间为62个月（12 - 120个月）。收集了每位患者的以下数据：年龄、血清白蛋白（sAlb）、HD治疗前的血尿素氮（BUN）、接种疫苗时的年龄、透析龄、全身性疾病的存在情况、血管通路类型、透析方式。通过多元回归分析估计这些因素与抗-Hbs滴度之间的相关性。
抗-Hbs血清转化率（抗-Hbs>10 IU/l）为77%。动静脉内瘘（AVF）患者和血清白蛋白>3.5 g/dL的患者血清转化率较高（86%），而全身性疾病患者中无反应者的比例较高（50%）。与抗-Hbs滴度相关的唯一参数是sAlb（p = 0.0012）。sAlb在所有患者中与年龄相关（p = 0.01），在反应者组中年龄与较高的抗-Hbs滴度相关（p = 0.018）。
根据我们的经验，在慢性HD患者较年轻且营养状况较好时尽早接种疫苗，可改善抗HBV反应。
