血液透析与血液透析滤过的终末期肾病患者对流感疫苗的免疫反应。
Immune response to influenza vaccination in ESRD patients undergoing hemodialysis vs. hemodiafiltration.
机构信息
Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand.
出版信息
PLoS One. 2020 Feb 3;15(2):e0227719. doi: 10.1371/journal.pone.0227719. eCollection 2020.
BACKGROUND
On-line hemodiafiltration (HDF) clears more azotemic toxins compared to high-flux hemodialysis (HD). The response to vaccination is impaired in dialysis patients. We wished to determine whether the immune responses to influenza vaccine in dialysis patients treated by HDF were stronger than those treated by HD.
MATERIALS AND METHODS
We conducted a prospective cohort study in chronic dialysis patients during the 2016 and 2017 influenza seasons. All participants received a single standard dose of trivalent influenza vaccine, and we studied the elicited humoral immune response by hemagglutination inhibition test, and cell-mediated immune response by enumeration of lymphocyte cellular markers and proliferation assays.
RESULTS
We immunized 60 end-stage renal disease (ESRD) patients: 42 (70%) treated with HD and 18 patients (30%) with HDF. The median (interquartile range) age was 65.0 (55.0-74.5) years. All patients developed seroprotection to at least one influenza vaccine strain at one month post-vaccination, and did not differ between groups. By logistic regression, age was the only factor independently associated with seroconversion to all vaccine strains (odds ratio 0.89, 95% confidence interval 0.80-0.98; p = 0.022). Seroprotection to all vaccine strains was sustained for longer in patients treated with HDF, and the results remained the same after age adjustment. For cellular immune response, patients who seroconverted to all vaccine strains had higher CD38+ T cell subpopulations pre-vaccination. Patients treated by HDF had higher lymphocyte proliferation to circulating influenza A strains.
CONCLUSIONS
Seroconversion to all influenza vaccine strains was associated with age. Patients treated with HDF demonstrated seroprotection was sustained for longer compared to those treated by HD and greater lymphocyte proliferation to circulating influenza A strains. These encouraging results for HDF require confirmation in a larger dialysis population.
TRIAL REGISTRATION
ClinicalTrial.gov, NCT04122222.
背景
与高通量血液透析（HD）相比，在线血液透析滤过（HDF）能清除更多的氮质毒素。透析患者的疫苗接种反应受损。我们希望确定 HDF 治疗的透析患者对流感疫苗的免疫反应是否强于 HD 治疗的患者。
材料和方法
我们在 2016 年和 2017 年流感季节对慢性透析患者进行了前瞻性队列研究。所有参与者均接受了一剂标准的三价流感疫苗，我们通过血凝抑制试验研究了诱导的体液免疫反应，通过计数淋巴细胞细胞标志物和增殖试验研究了细胞介导的免疫反应。
结果
我们共免疫了 60 例终末期肾病（ESRD）患者：42 例（70%）接受 HD 治疗，18 例（30%）接受 HDF 治疗。中位（四分位距）年龄为 65.0（55.0-74.5）岁。所有患者在接种疫苗后 1 个月均至少对一种流感疫苗株产生了血清保护作用，且两组间无差异。通过逻辑回归，年龄是与所有疫苗株血清转化率独立相关的唯一因素（比值比 0.89，95%置信区间 0.80-0.98；p=0.022）。HDF 治疗组所有疫苗株的血清保护持续时间更长，且在年龄调整后结果仍相同。对于细胞免疫反应，所有疫苗株血清转化率高的患者在接种疫苗前 CD38+T 细胞亚群更高。HDF 治疗的患者对循环流感 A 株的淋巴细胞增殖反应更高。
结论
所有流感疫苗株的血清转化率与年龄有关。与 HD 治疗的患者相比，HDF 治疗的患者血清保护持续时间更长，对循环流感 A 株的淋巴细胞增殖反应更强。这些令人鼓舞的 HDF 结果需要在更大的透析人群中得到证实。
试验注册
ClinicalTrials.gov，NCT04122222。
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