Hemodiyaliz ve periton diyalizi hastalarının Hepatit B aşısına karşı cevaplarının karşılaştırılması

There is generally a failure in humoral and cellular immunity in most of the patients with chronic renal failure (CRF). In this study, the rate of response of CRF patients to a double-dose hepatitis vaccination and the effect of renal replacement type on the formation of antibodies have been investigated. In our centre, 51 hemodialysis (HD) and 19 continuous ambulatory peritoneal dialysis (CAPD) patients were vaccinated with recombinant hepatitis B in the 0th, 1st, 2nd and 6th months. Antibody titrates over 10 mIU/ml seen 1-3 months after the vaccination were considered as a response to the vaccine. As a result, no meaningful difference has been observed between the responses HD and CAPD patients gave to the vaccine (CAPD 84.2%, HD 78.4%, p=0.591). The effects of the duration of the dialysis, sex, age and hemoglobin, total protein, albumin, c-reactive protein (CRP), total cholesterol and triglyceride levels and the positivity of anti- HCV on hepatitis B seroconversion have also been evaluated. Of all these, only the age being over 50 has been seen to have a relationship with insufficient hepatitis B ceroconversion (p=0.037). The other parameters couldn’t be shown to have an effect on the hepatitis B seroconversion (p> 0.05).

Özet

Kronik böbrek hastalığı (KBH) olan hastaların çoğunda hem humoral hem de hücresel immünitede yetersizlik söz konusudur. Bu çalışmada KBH hastalarında çift doz rekombinant hepatit B aşısına karşı yanıt oranları ve renal replasman türünün antikor oluşumunda etkisi araştırılmıştır. Cumhuriyet Üniversitesi Tıp Fakültesi Hastanesi diyaliz merkezinde 51 hemodiyaliz (HD), 19 sürekli ayaktan periton diyalizi (SAPD) hastası rekombinant hepatit B aşısı ile 0,1,2 ve 6. ayda toplam dört kez aşılandı. Antikor yanıtları Anti-HBs titrasyon düzeylerine göre belirlendi. Aşının son dozundan 1-3 ay sonra bakılan 10 mIU/mL’nin üstündeki antikor titreleri aşıya yanıt olarak kabul edildi. Sonuçta HD ve SAPD hastalarının hepatit B aşısına verdikleri yanıtlar arasında anlamlı bir fark görülmedi (SAPD hastalarında %84,2, HD hastalarında %78,4 , p=0,591). Diyaliz süresinin, cinsiyetin, yaşın, hemoglobin, total protein, albümin, c-reaktif protein (CRP), total kolesterol, trigliserid düzeyinin ve Anti-HCV(+)’liğinin hepatit B serokonversiyonuna etkisi de değerlendirildi. Bunlar arasında sadece yaşın >50 (yıl) olmasının yetersiz hepatit B serokonversiyonu ile ilişkili olduğu görüldü (p=0,037). Diğer parametrelerin hepatit B serokonversiyonu üzerine etkisi gösterilemedi (p>0,05).

Anahtar sözcükler: Hepatit B, aşılama, hemodiyaliz, periton diyalizi

 

Abstract

There is generally a failure in humoral and cellular immunity in most of the patients with chronic renal failure (CRF). In this study, the rate of response of CRF patients to a double-dose hepatitis vaccination and the effect of renal replacement type on the formation of antibodies have been investigated. In our centre, 51 hemodialysis (HD) and 19 continuous ambulatory peritoneal dialysis (CAPD) patients were vaccinated with recombinant hepatitis B in the 0th, 1st, 2nd and 6th months. Antibody titrates over 10 mIU/ml seen 1-3 months after the vaccination were considered as a response to the vaccine. As a result, no meaningful difference has been observed between the responses HD and CAPD patients gave to the vaccine (CAPD 84.2%, HD 78.4%, p=0.591). The effects of the duration of the dialysis, sex, age and hemoglobin, total protein, albumin, c-reactive protein (CRP), total cholesterol and triglyceride levels and the positivity of anti- HCV on hepatitis B seroconversion have also been evaluated. Of all these, only the age being over 50 has been seen to have a relationship with insufficient hepatitis B ceroconversion (p=0.037). The other parameters couldn’t be shown to have an effect on the hepatitis B seroconversion (p> 0.05).

Keywords: Hepatitis B, vaccination, hemodialysis, peritoneal dialysis