Asan Ali, Demirhan Huriye, Sorkun Hülya Çetin, Özkan Sevgi, Aydın Mehtap, Akın Davut, Tatar Bengü, Çatak Binali, Şener Alper, Köse Şükran
Department of Infectious Diseases and Clinical Microbiology, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey.
Denizli Health Services Vocational College, Pamukkale University, Denizli, Turkey.
Int Urol Nephrol. 2017 Oct;49(10):1845-1850. doi: 10.1007/s11255-017-1616-9. Epub 2017 Jun 15.
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are widespread health problems all over the world and have high morbidity and mortality. Hemodialysis patients are more frequently exposed to these viruses as they have poor immune system and frequently undergo parenteral interventions. The vaccination against HBV prevents infection and it has been recommended for the prevention of HBV infection in all susceptible dialysis patients. This study aimed to determine the seroprevalence of HBV and HCV infections and analyzed the factors affecting inadequate response to HBV vaccine in dialysis patients.
The data for 584 dialysis patients that were followed up at seven dialysis centers were analyzed. The patients received four doses of 40 μg recombinant hepatitis B vaccine at 0, 1, 2, and 6 months and were tested for anti-HBs titer after one month of completion of vaccination. If patients showed a titer of anti-HBs <10 IU/mL, an additional 40 μg in four vaccine doses was administered immediately and they were retested for the anti-HBs following the same schedule. The patients were divided into two groups: responders and non-responders.
HBsAg and anti-HCV seroprevalence was 3.4% and 10.3%, respectively. After vaccination schedule, 264 (83.5%) patients had antibody response to HBV vaccine and 52 (16.5%) had no response. Hepatitis B vaccine unresponsiveness is more common in the patients with hepatitis C positivity (p = 0.011), BMI >30 (p = 0.019), over the age of 65 years (p = 0.009), and duration of dialysis treatment >5 years (p = 0.001). There was no statistically significant difference between gender, causes of renal disease, erythropoietin treatment, and the type of dialysis.
Hepatitis C infection, obesity, being elderly, and having long hemodialysis period reduced the hepatitis B vaccination response in hemodialysis patients.
乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）感染是全球普遍存在的健康问题，发病率和死亡率都很高。血液透析患者由于免疫系统较差且经常接受非肠道干预，更容易接触到这些病毒。乙肝疫苗接种可预防感染，已建议对所有易感透析患者进行乙肝疫苗接种以预防HBV感染。本研究旨在确定透析患者中HBV和HCV感染的血清流行率，并分析影响乙肝疫苗接种反应不足的因素。
分析了在七个透析中心接受随访的584例透析患者的数据。患者在0、1、2和6个月时接受四剂40μg重组乙肝疫苗，并在完成疫苗接种一个月后检测抗-HBs滴度。如果患者的抗-HBs滴度<10IU/mL，则立即额外接种四剂40μg疫苗，并按照相同时间表重新检测抗-HBs。患者分为两组：有反应者和无反应者。
HBsAg和抗-HCV血清流行率分别为3.4%和10.3%。按照疫苗接种方案，264例（83.5%）患者对乙肝疫苗有抗体反应，52例（16.5%）无反应。乙肝疫苗无反应在丙肝阳性患者（p = 0.011）、BMI>30（p = 0.019）、65岁以上患者（p = 0.009）和透析治疗时间>5年的患者（p = 0.001）中更为常见。性别、肾病病因、促红细胞生成素治疗和透析类型之间无统计学显著差异。
丙肝感染、肥胖、老年以及长期血液透析会降低血液透析患者的乙肝疫苗接种反应。
