摘要
目的有效的免疫保护方法对血液透析(hemodialysis,HD)患者这种乙肝病毒(hepatitisB virus,HBV)感染的高危人群有极大的益处,然而大部分HD患者对乙肝疫苗的血清转换率低下。本研究探讨了对HD患者应用两种接种方法的免疫效果。方法 50例具备正常转氨酶水平、HBsAg(-)、anti-HBc(-)及anti-HBs(-)的慢性HD患者分为两组,A组:维持性HD患者32例,进行长疗程(O月、l月、6月、9月)肌肉注射基因重组乙肝疫苗,每次注射剂量为20ìg;B组:维持性HD患者18例,进行多次小剂量皮内注射基因重组乙肝疫苗,总共6次,间隔时间为2周,每次皮内注射剂量5ìg。以乙肝表面抗体滴度≥l0mIU/ml为产生保护性血清转换。注射结束后l～3月检测乙肝表面抗体滴度,分析两组之间保护性血清转换率及抗体滴度水平的差异。结果 A组患者有25例产生了保护性抗体,保护性血清转换率为78.12%,B组患者有16例产生了保护性抗体,保护性血清转换率为88.89%,两组差异无统计学意义(χ2=0.904,P>0.05);A组的抗体滴度高于B组,两组差异有统计学意义(t=2.197,P<0.05)。两组患者抗体滴度水平与患者性别、年龄、病程、肌酐水平、白蛋白水平、血红蛋白水平等无明显相关性(P>0.05)。结论血液透析患者长疗程肌肉注射以及多次小剂量皮内注射基因重组乙型肝炎疫苗与传统方法的乙肝疫苗注射相比,均可较高比率的产生保护性抗体,多次小剂量皮内接种乙肝疫苗阳性率更高一些,但长疗程肌肉注射的抗体滴度明显高于小剂量组。本实验的样本量较小,可能需要扩大样本量进一步研究。
Objective Effective immunoprotection is beneficial for hemodialysis （HD） patients who are at the high risk of hepatitis B virus （HBV） infection. However,lower response to hepatitis B vaccination is frequently observed in HD patients. The aim of this study was to evaluate the effect of the two inoculation methods for HBV vaccination. Methods Fifty maintenance HD patients with normal serum aminotransferases levels,negative HBsAg,and negative anti-HBc and anti-HBs antibodies were divided into two groups：group A （32 HD patients） receiving 4 doses of 20ìg recombinant hepatitis B vaccine intramuscularly in the deltoid region at intervals of 1,6 and 9 months,and group B （18 HD patients） receiving 5ìg recombinant hepatitis B vaccine intradermally on volar surface of forearm every two weeks for 6 times. Protective seroconversion is indicated by the serum anti-hepatitis B surface antibody （anti-HBs） ≥ 10 mIU/ml. Serum anti-HBs antibody was tested 1-3 months after the completion of vaccination. The rate of protective antibody seroconversion was compared between the two groups. Results The protective antibody seroconversion rate was 78.12% （25 patients） in group A and 88.89% （16 patients） in group B （χ^2 =0.904,P〉0.05,as compared with the rate between the 2 groups）. However,the antibody titer was signifi-cantly higher in group A than in group B （t=2.197,P〈 0.05）. The antibody titer did not correlate with sex,age,disease course,serum creatinine,serum albumin and hemoglobin in the 2 groups （P〉0.05）. Conclusion For HD patients with hepatitis B vaccination,both intramuscular injections with protracted interval method and multiple intradermal injections of lower dose method achieved higher protective antibody seroconversion rate,as compared with the rate from the traditional vaccination method. Multiple intradermal injections of lower dose method induced higher protective antibody seroconversion rate but lower antibody titer,as compared with those from intramuscular injections
出处
《中国血液净化》
2010年第5期261-264,共4页
Chinese Journal of Blood Purification
关键词
基因重组乙肝疫苗
血液透析患者
血清转换率
Recombinant hepatitis B vaccine （rHBV）
Hemodialysis patients
Seroconversion
