Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: Earlier is better
Stage of chronic kidney disease predicts seroconversion after hepatitis B immunization: Earlier is better
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DOI：
10.1053/j.ajkd.2003.08.019
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发表时间：
2003-12-01
影响因子：
13.2
通讯作者：
Levin, A
中科院分区：
文献类型：
--
作者：
DaRoza, G;Loewen, A;Levin, A
背景资料：8型肝炎病毒（HBV）感染仍然是透析人群的一个问题，疫苗接种计划不如普通人群成功。反应差的原因包括营养不良、尿毒症和慢性肾病（CKD）患者的全身免疫抑制状态。这项前瞻性队列研究评价了透析治疗开始前影响疫苗接种计划有效性的因素，包括肾功能水平。研究方法：所有在肾功能诊所（圣保罗医院，温哥华，加拿大）接受治疗的患者均接受既往HBV感染或疫苗接种筛查。那些标志物阴性的人接受了推荐给CKD患者的标准化B肝炎疫苗接种计划。主要结局指标血清转换定义为完成疫苗接种计划后3个月IS型肝炎表面抗体滴度大于10 IU。结果如下：165例患者的研究人群包括64%的男性，平均年龄为60岁，平均血清肌酐水平为3.4 +/- 1.5 mg/dL（300 +/- 133 mumol/L），中位估计肾小球滤过率（GFR）为20 mL/min（四分位数间距，14 - 20）。血清阳转率为82%。多因素分析显示肾小球滤过率水平是独立的预测指标。该模型显示，肾功能水平最低、年龄较大、患有糖尿病的患者发生血清转换的可能性较小（P < 0.05）。结论：这是最大规模的研究，在一个充分表征的队列中显示，GFR水平较高的患者更有可能对B肝炎疫苗接种计划产生血清转换反应，与其他因素无关。未来的研究将探索解释这一现象的具体机制。
Background: Hepatitis 8 virus (HBV) infection remains a concern in dialysis populations, and vaccination programs have been less successful than those in the general population. Reasons for poor response include malnutrition, uremia, and the generalized immunosuppressive state of patients with chronic kidney disease (CKD). This prospective cohort study evaluated factors impacting on the effectiveness of a vaccination program before dialysis therapy initiation, including level of kidney function. Methods: All patients receiving care in the Kidney Function Clinic (St Paul's Hospital, Vancouver, Canada) were screened for previous HBV infection or vaccination. Those who were marker negative were administered a standardized hepatitis B vaccination schedule recommended for patients with CKD. The primary outcome measure, seroconversion, is defined as hepatitis IS surface antibody titer greater than 10 IU 3 months after completion of the vaccination schedule. Results: The study population of 165 patients included 64% men with a mean age of 60 years, mean serum creatinine level of 3.4 +/- 1.5 mg/dL (300 +/- 133 mumol/L), and median estimated glomerular filtration rate (GFR) of 20 mL/min (interquartile range, 14 to 20). Seroconversion rate was 82%. Multivariate analyses showed the independent predictive value of level of GFR. The model showed that patients with the lowest level of kidney function and who were older and had diabetes were less likely to seroconvert (P < 0.05). Conclusion: This is the largest study to show in a well-characterized cohort that patients with higher GFR levels are more likely to respond to hepatitis B vaccination programs with seroconversion, independent of other factors. Future studies will explore specific mechanisms to explain this phenomenon.