Waite N M, Thomson L G, Goldstein M B
St. Michael's Hospital, Toronto, Ontario, Canada.
J Am Soc Nephrol. 1995 May;5(11):1930-4. doi: 10.1681/ASN.V5111930.
Seventy-seven chronic hemodialysis patients were vaccinated against hepatitis B virus with an intramuscular (im) hepatitis B vaccine (HBV), 40 micrograms at 0, 1, 2, and 6 months. Fifty-seven patients (74%) developed antibodies (anti-HBs). The im-responsive patients were significantly younger than the nonresponsive patients (P < 0.05). Nineteen of the 20 im nonresponders received HBV intradermally (id), 5 micrograms every 2 wk until anti-HBs developed; the 20th patient died before receiving the id vaccine. Three patients were lost to follow-up. Fifteen (94%) of the 16 developed anti-HBs after 5.2 +/- 4.7 months. The peak anti-HBs titers were 726 +/- 426 (im) and 211 +/- 260 (id) IU/L (P < 0.05). Twelve (21%) of the 57 im-responsive patients and 8 (53%) of the 15 id-responsive patients had anti-HBs less than 20 IU/L at 18 and 8 months postvaccination, respectively (P < 0.05). Further preliminary data indicate that more prolonged id vaccination can increase both the titer and the duration of anti-HBs in im-nonresponsive patients.
77名慢性血液透析患者接受了肌内注射（im）乙肝疫苗（HBV）的乙肝病毒疫苗接种，剂量为40微克，分别在0、1、2和6个月时注射。57名患者（74%）产生了抗体（抗-HBs）。有免疫应答的患者比无应答的患者明显年轻（P<0.05）。20名肌内注射无应答者中有19名接受了皮内注射（id）乙肝疫苗，每2周注射5微克，直至产生抗-HBs；第20名患者在接受皮内注射疫苗前死亡。3名患者失访。16名患者中有15名（94%）在5.2±4.7个月后产生了抗-HBs。抗-HBs峰值滴度分别为726±426（肌内注射）和211±260（皮内注射）IU/L（P<0.05）。57名肌内注射有应答的患者中有12名（21%）在接种疫苗后18个月时抗-HBs低于20 IU/L，15名皮内注射有应答的患者中有8名（53%）在接种疫苗后8个月时抗-HBs低于20 IU/L（P<0.05）。进一步的初步数据表明，在肌内注射无应答的患者中，延长皮内注射疫苗的时间可以提高抗-HBs的滴度和持续时间。
