血液透析患者两种方法接种乙型肝炎疫苗的疗效分析

›› 2010, Vol. 9 ›› Issue (5): 261-264.

血液透析患者两种方法接种乙型肝炎疫苗的疗效分析

苏伟张焕巧尚有全张岩郅

宝鸡市中心医院肾内科

收稿日期:2009-11-20 修回日期:1900-01-01 出版日期:2010-05-12 发布日期:2010-05-12

Therapeutic effect of two inoculation methods for hepatitis B vaccination in hemodialysis patients

SU Wei, ZHANG Huan-qiao, SHANG You-quan, ZHANG Yan-zhi.

Department of Nephrology, BaoJi Central Hospital, Shanxi 721008, China

Received:2009-11-20 Revised:1900-01-01 Online:2010-05-12 Published:2010-05-12

摘要/Abstract

摘要：

【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（hepatitis B 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20 靏；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5 靏。以乙肝表面抗体滴度≥l0 mIU/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%, 两组差异有统计学意义(2=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。

关键词: 基因重组乙肝疫苗, 血液透析患者, 血清转换率

Abstract: 【Abstract】Objective Effective immunoprotection has great benefits for hemodialysis(HD) patients who have the high risk of infection with hepatitis B virus (HBV).However, the lower response to hepatitis B vaccination is observed in HD patients. The aim of this study was to research the effects of vaccination by two ways. Methods 50 chronic HD patients with normal aminotransferase levels, seronegative for HBsAg, anti-HBc, and anti-HBs antibodies were divided into two groups.:patients of group A (32 HD patients) received 4 doses of 20ug recombinant hepatitis B vaccine by i.m route in the deltoid region at 0, 1, 6 and 9 months,;patients of group B (18 chronic HD patients)received 6 doses of 5ug recombinant hepatitis B vaccine at 2 every two weeks by i.d route on the volar surface of the forearm. Protective seroconversion is indicated by the serum levels of hepatitis B surface antibody (anti-HBs) equal to or higher than 10 mIU/ml. Serum anti-HBs were tested 1-3 months after completion of vaccination.The differences of protective antibody seroconversion rate between the two groups were analyzed. Results 25 patients in group A have had the protective antibody (protective seroconversion rate was 78.12%) while 16 patients in group B have had the protective antibody (protective seroconversion rate was 88.89%),there are difference between the two groups.The level of antibody titers in group A is higher than group B,there is significant difference between two groups .There are no differences among two groups for the sex, age, course, creatinine level, albumin level, hemoglobin level(P>0.05). Conclusion Compared with the traditional methods of hepatitis B vaccination, Long course of intramuscular injection as well as repeated low-dose intradermal injection of recombinant hepatitis B vaccine may produce a higher percentage of protective antibodies,while the latter was more higher. The level of antibody titers in group of long period、routine doses with i.m route is higher than in group of multiple low doses with i.d route .The sample is small in this study,,it need further study .

Key words: Hemodialysis patients, Seroconversion

中图分类号:

R692.5

苏伟张焕巧尚有全张岩郅. 血液透析患者两种方法接种乙型肝炎疫苗的疗效分析[J]. , 2010, 9(5): 261-264.

SU Wei;ZHANG Huan-qiao;SHANG You-quan;ZHANG Yan-zhi.. Therapeutic effect of two inoculation methods for hepatitis B vaccination in hemodialysis patients[J]. , 2010, 9(5): 261-264.