Donati D, Gastaldi L
Department of Nephrology, General Hospital Varese, Italy.
Nephron. 1988;50(2):133-6. doi: 10.1159/000185143.
Uremic patients are at high risk of hepatitis B virus (HBV) infection and, despite the availability and efficacy of hepatitis B vaccine, a high rate of non responders has been reported. Forty uremic patients undergoing maintenance hemodialysis who failed to produce any measurable anti-HBs antibody response after 4 administrations of 5 micrograms of Hevac B Pasteur vaccine were admitted to a randomized controlled clinical trial. Group A (14 patients) received 3 doses of 5 micrograms s.c. each of vaccine at monthly intervals and 12 doses of 50 mg s.c. of thymopentin on alternate days between the first and the second vaccination. Group B (11 patients) received 3 doses of 5 micrograms s.c. each of vaccine at monthly intervals. Group C (15 patients) received 3 doses of 10 micrograms s.c. each of vaccine at monthly intervals. Immunization rates were 86% in group A (on both 1-month and 6-month checks), 36% on the 1-month and 27% on the 6-month check in group B, 53% on the 1-month and 47% on the 6-month check in group C. Anti-HBs antibody titers were similar in group A and C but notably lower in group B. Thymopentin seems as useful therapeutical tool for non responder patients. As it promotes T cell maturation and responsiveness, which are impaired in uremia, it could play a major part in the management of uremic immunodeficiency.
尿毒症患者感染乙型肝炎病毒（HBV）的风险很高，尽管有乙型肝炎疫苗且其疗效显著，但仍有报道称无应答率很高。40例接受维持性血液透析的尿毒症患者在接种4次5微克的巴斯德重组酵母乙型肝炎疫苗（Hevac B）后未产生任何可测量的抗-HBs抗体反应，他们被纳入一项随机对照临床试验。A组（14例患者）每隔一个月皮下注射3剂，每剂5微克疫苗，并在第一次和第二次接种之间每隔一天皮下注射12剂50毫克的胸腺五肽。B组（11例患者）每隔一个月皮下注射3剂，每剂5微克疫苗。C组（15例患者）每隔一个月皮下注射3剂，每剂10微克疫苗。A组的免疫率在1个月和6个月检查时均为86%，B组在1个月检查时为36%，在6个月检查时为27%，C组在1个月检查时为53%，在6个月检查时为47%。A组和C组的抗-HBs抗体滴度相似，但B组明显较低。胸腺五肽似乎是无应答患者有用的治疗工具。由于它能促进在尿毒症中受损的T细胞成熟和反应性，它可能在尿毒症免疫缺陷的管理中发挥重要作用。
