Cheng C H, Huang C C, Leu M L, Chiang C Y, Wu M S, Lai P C
Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Vaccine. 1997 Aug-Sep;15(12-13):1353-7. doi: 10.1016/s0264-410x(97)00037-6.
Patients on hemodialysis therapy are at a relatively high risk of exposure to hepatitis B virus (HBV) infection. The prevalence of hepatitis C virus (HCV) infection is even higher and was reported as 33.2% in Taiwan. Although the efficacy of hepatitis B vaccine was well documented, the vaccination schedule in hemodialysis patients is not clearly defined. And under such a high prevalence of HCV infection, little is known about the influence of HCV imposing on HBV vaccination. We studied 50 chronic hemodialysis patients who were serologically negative for the hepatitis B surface antigen (HBsAg), the antibody to the hepatitis B surface antigen (anti-HBs) and the antibody to the hepatitis B core antigen (anti-HBc); 26 of them were positive for the antibody to hepatitis C virus (anti-HCV) test. Recombinant hepatitis B vaccine (Engerix-B) 40 micrograms per dose was administered by the intramuscular route at deltoid region at 0, 1, 2, 6 and 12 months respectively to all the patients. Forty-six patients had completed the study. The effective seroconversion rate (serum anti-HBs titer > 10 mIU ml-1) at 1 month after the final vaccine was 76.1% (35/46). The effective conversion rates of the anti-HCV(+) group to the anti-HCV(-) were 75% versus 77.3% (P = 0.857). Geometric mean anti-HBs titers were 177.67 mIU ml-1 versus 189.28 mIU ml-1 (P = 0.867). Our results showed that five-dose injections of HBV vaccine do not present a superior outcome to the four-dose regimen comparing to published data. The status of positivity of anti-HCV do not pose an suboptimal effect on HBV vaccination of hemodialysis patients.
接受血液透析治疗的患者感染乙型肝炎病毒（HBV）的风险相对较高。丙型肝炎病毒（HCV）感染的患病率甚至更高，台湾地区报告的患病率为33.2%。虽然乙肝疫苗的疗效已有充分记录，但血液透析患者的疫苗接种方案尚无明确规定。在HCV感染如此高的患病率情况下，关于HCV对HBV疫苗接种的影响知之甚少。我们研究了50例慢性血液透析患者，这些患者的乙肝表面抗原（HBsAg）、乙肝表面抗体（抗-HBs）和乙肝核心抗体（抗-HBc）血清学检测均为阴性；其中26例丙肝病毒抗体（抗-HCV）检测呈阳性。所有患者分别在0、1、2、6和12个月时，于三角肌区域通过肌肉注射途径接种每剂40微克的重组乙肝疫苗（安在时-B）。46例患者完成了研究。最后一剂疫苗接种后1个月时的有效血清转化率（血清抗-HBs滴度>10 mIU/ml）为76.1%（35/46）。抗-HCV阳性组转为抗-HCV阴性组的有效转化率分别为75%和77.3%（P = 0.857）。抗-HBs几何平均滴度分别为177.67 mIU/ml和189.28 mIU/ml（P = 0.867）。我们的结果表明，与已发表的数据相比，五剂次注射乙肝疫苗并不比四剂次方案有更好的效果。抗-HCV阳性状态对血液透析患者的HBV疫苗接种没有产生次优影响。
