Division of Nephrology, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, 10330, Thailand.
Department of Medicine, St. Elizabeth's Medical Center, Boston, MA, USA.
J Nephrol. 2020 Apr;33(2):343-354. doi: 10.1007/s40620-019-00668-1. Epub 2019 Nov 7.
We performed a systematic review and meta-analysis to examine factors associated with HBV immune response in dialysis patients, and the association between the immune response to the HBV vaccine and mortality.
Electronic databases were searched for studies of dialysis patients that compared the characteristics of HBV vaccine responders and non-responders. Mortality was also analyzed according to the vaccine immune response (defined by hepatitis B surface antibody titer > 10 mIU/mL). Random-effects model meta-analyses were performed to compute a weighted mean difference (WMD), a pooled odds ratio (OR), and a pooled risk ratio (RR) between groups.
We identified 61 studies with a total of 6628 dialysis patients who completed the course of HBV vaccination, 4582 responders (69%) and 2046 non-responders (31%). By meta-analysis, relative to non-responders, HBV vaccine responders had a higher dialysis adequacy as measured by Kt/V (WMD 0.08, P < 0.001), a higher serum albumin (WMD 0.12 gm/dL, P < 0.001), a higher normalized protein catabolic rate (WMD 0.12 gm/kg/day, P = 0.001), a higher hemoglobin (WMD 0.15 gm/L, P = 0.03), and a higher parathyroid hormone level (WMD 44 pg/mL, P = 0.004). HBV vaccine responders were younger (WMD - 4.68 years, P < 0.001), had been on dialysis for longer (WMD 2.60 months, P < 0.001), were less likely to have diabetes mellitus (pooled OR 0.65, P < 0.001), and were less likely to carry the human leukocyte antigen (HLA) DR3 (pooled OR 0.38, P = 0.01). Compared to non-responders, HBV vaccine responders had lower risk for all-cause mortality (pooled RR 0.64, P < 0.001), and lower risk for cardiovascular-related mortality (pooled RR 0.74, P = 0.02).
In dialysis patients, the lack of immune response to the HBV vaccine is associated with older age, diabetes mellitus, HLA-DR3 status, shorter time on dialysis, lower nutritional status, lower hemoglobin, lower PTH level, and lower dialysis adequacy. Tackling some of these modifiable factors might improve the HBV vaccine immune response.
我们进行了一项系统回顾和荟萃分析，以研究与透析患者乙型肝炎病毒（HBV）免疫反应相关的因素，以及 HBV 疫苗免疫反应与死亡率之间的关系。
检索了比较 HBV 疫苗应答者和无应答者特征的透析患者研究的电子数据库。根据乙型肝炎表面抗体滴度>10 mIU/mL（定义为疫苗免疫反应），还分析了死亡率。采用随机效应模型荟萃分析计算组间加权均数差（WMD）、合并优势比（OR）和合并风险比（RR）。
我们确定了 61 项研究，共纳入 6628 名完成 HBV 疫苗接种疗程的透析患者，其中 4582 名（69%）为应答者，2046 名（31%）为无应答者。荟萃分析显示，与无应答者相比，HBV 疫苗应答者的透析充分性更高（Kt/V：WMD 0.08，P<0.001），血清白蛋白水平更高（WMD 0.12 gm/dL，P<0.001），校正蛋白分解率更高（WMD 0.12 gm/kg/day，P=0.001），血红蛋白水平更高（WMD 0.15 gm/L，P=0.03），甲状旁腺激素水平更高（WMD 44 pg/mL，P=0.004）。HBV 疫苗应答者年龄更小（WMD -4.68 岁，P<0.001），透析时间更长（WMD 2.60 个月，P<0.001），糖尿病（OR 0.65，P<0.001）和人类白细胞抗原（HLA）DR3（OR 0.38，P=0.01）携带率较低。与无应答者相比，HBV 疫苗应答者全因死亡率（RR 0.64，P<0.001）和心血管相关死亡率（RR 0.74，P=0.02）较低。
在透析患者中，HBV 疫苗无免疫反应与年龄较大、糖尿病、HLA-DR3 状态、透析时间较短、营养状况较差、血红蛋白较低、甲状旁腺激素水平较低以及透析充分性较低有关。解决其中一些可改变的因素可能会提高 HBV 疫苗的免疫反应。
