Girndt M, Pietsch M, Köhler H
Medical Department IV, University of Homburg/Saar, Germany.
Am J Kidney Dis. 1995 Sep;26(3):454-60. doi: 10.1016/0272-6386(95)90491-3.
A defect in the immune response of patients with chronic renal failure leads to low response rates and insufficient antibody concentrations following a number of highly recommended vaccinations. This has been shown before for immunization against hepatitis B and influenza. Few data are available concerning the efficacy of vaccination with tetanus toxoid in these patients. In a prospective, controlled study we vaccinated seronegative patients with chronic renal failure not on dialysis, patients on chronic intermittent hemodialysis, and patients after kidney transplantation with tetanus toxoid. The results were compared with those of a control group consisting of 13 age-matched patients with mild essential hypertension and normal kidney function. Only 11 of 20 (55%) patients in the chronic renal failure group and 16 of 23 (69%) in the dialysis group had a protective antibody response after triple vaccination. In contrast, all the patients in the control group and six of seven transplant patients seroconverted. The response to tetanus toxoid was highly associated with the response to a previously administered vaccination against hepatitis B. Responders to this vaccination also had a better response rate to tetanus toxoid. The antibody concentrations after vaccination were lower in all patient groups compared with the controls; the lowest titers were found in the transplant patients. Therefore, renal patients will need revaccination much earlier, and tetanus toxoid antibody levels should be checked if a patient is injured and potentially requires vaccination.
慢性肾衰竭患者的免疫反应存在缺陷，导致在接种多种强烈推荐的疫苗后，反应率较低且抗体浓度不足。此前针对乙肝和流感疫苗接种已证实了这一点。关于这些患者接种破伤风类毒素疫苗的疗效，现有数据较少。在一项前瞻性对照研究中，我们为未接受透析的慢性肾衰竭血清阴性患者、接受慢性间歇性血液透析的患者以及肾移植后的患者接种了破伤风类毒素。将结果与由13名年龄匹配、患有轻度原发性高血压且肾功能正常的患者组成的对照组进行比较。慢性肾衰竭组20名患者中只有11名（55%）、透析组23名患者中只有16名（69%）在三次接种后产生了保护性抗体反应。相比之下，对照组的所有患者以及7名移植患者中的6名出现了血清转化。对破伤风类毒素的反应与之前接种乙肝疫苗的反应高度相关。对该疫苗有反应者对破伤风类毒素的反应率也更高。与对照组相比，所有患者组接种后的抗体浓度均较低；移植患者的滴度最低。因此，肾病患者需要更早地重新接种疫苗，如果患者受伤且可能需要接种疫苗，应检查破伤风类毒素抗体水平。
