Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis
Hepatitis B virus vaccine immune response and mortality in dialysis patients: a meta-analysis
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DOI：
10.1007/s40620-019-00668-1
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发表时间：
2019-11-07
影响因子：
3.4
通讯作者：
Susantitaphong, Paweena
中科院分区：
文献类型：
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作者：
Udomkarnjananun, Suwasin;Takkavatakarn, Kullaya;Susantitaphong, Paweena
我们进行了一项系统回顾和荟萃分析，以检查透析患者中与HBV免疫应答相关的因素，以及对HBV疫苗的免疫应答与死亡率之间的关系。方法检索电子数据库中关于透析患者的研究，比较HBV疫苗应答者和无应答者的特征。还根据疫苗免疫应答（定义为B型肝炎表面抗体滴度> 10 mIU/mL）分析死亡率。进行随机效应模型荟萃分析以计算组间加权平均差（WMD）、合并优势比（OR）和合并风险比（RR）。结果我们确定了61项研究，共6628例完成HBV疫苗接种的透析患者，4582例应答者（69%）和2046例无应答者（31%）。通过荟萃分析，相对于无应答者，HBV疫苗应答者具有更高的透析充分性（通过Kt/V测量）（WMD 0.08，P < 0.001），血清白蛋白（ALB）高于对照组（P < 0.001）（WMD 0.12 gm/dL，P < 0.001），较高的标准化蛋白质分解率（WMD 0.12 gm/kg/天，P = 0.001），较高的血红蛋白（WMD 0.15 gm/L，P = 0.03）和较高的甲状旁腺激素水平（WMD 44 pg/mL，P = 0.004）。HBV疫苗应答者较年轻（WMD - 4.68岁，P < 0.001），透析时间较长（WMD 2.60个月，P < 0.001），不太可能患有糖尿病（合并OR 0.65，P < 0.001），携带人类白细胞抗原（HLA）DR 3的可能性较小（合并OR 0.38，P = 0.01）。与无应答者相比，HBV疫苗应答者的全因死亡风险较低（合并RR 0.64，P < 0.001），心血管相关死亡风险较低（合并RR 0.74，P = 0.02）。结论透析患者对乙肝疫苗免疫应答的缺乏与年龄、糖尿病、HLA-DR 3状态、透析时间短、营养状况差、血红蛋白、甲状旁腺素水平和透析充分性差有关。解决其中一些可改变的因素可能会改善HBV疫苗的免疫反应。
Background We performed a systematic review and meta-analysis to examine factors associated with HBV immune response in dialysis patients, and the association between the immune response to the HBV vaccine and mortality. Methods Electronic databases were searched for studies of dialysis patients that compared the characteristics of HBV vaccine responders and non-responders. Mortality was also analyzed according to the vaccine immune response (defined by hepatitis B surface antibody titer > 10 mIU/mL). Random-effects model meta-analyses were performed to compute a weighted mean difference (WMD), a pooled odds ratio (OR), and a pooled risk ratio (RR) between groups. Results We identified 61 studies with a total of 6628 dialysis patients who completed the course of HBV vaccination, 4582 responders (69%) and 2046 non-responders (31%). By meta-analysis, relative to non-responders, HBV vaccine responders had a higher dialysis adequacy as measured by Kt/V (WMD 0.08, P < 0.001), a higher serum albumin (WMD 0.12 gm/dL, P < 0.001), a higher normalized protein catabolic rate (WMD 0.12 gm/kg/day, P = 0.001), a higher hemoglobin (WMD 0.15 gm/L, P = 0.03), and a higher parathyroid hormone level (WMD 44 pg/mL, P = 0.004). HBV vaccine responders were younger (WMD - 4.68 years, P < 0.001), had been on dialysis for longer (WMD 2.60 months, P < 0.001), were less likely to have diabetes mellitus (pooled OR 0.65, P < 0.001), and were less likely to carry the human leukocyte antigen (HLA) DR3 (pooled OR 0.38, P = 0.01). Compared to non-responders, HBV vaccine responders had lower risk for all-cause mortality (pooled RR 0.64, P < 0.001), and lower risk for cardiovascular-related mortality (pooled RR 0.74, P = 0.02). Conclusion In dialysis patients, the lack of immune response to the HBV vaccine is associated with older age, diabetes mellitus, HLA-DR3 status, shorter time on dialysis, lower nutritional status, lower hemoglobin, lower PTH level, and lower dialysis adequacy. Tackling some of these modifiable factors might improve the HBV vaccine immune response.