维持性血液透析患者乙肝表面抗体滴度衰减的临床观察

Clinical observation on decline of hepatitis B surface antibody titer in maintenance hemodialysis patients

目的观察维持性血液透析(HD)患者抗乙型肝炎表面抗原的抗体(anti-HBs)滴度的衰减变化。方法将anti-HBs滴度≥10 mU/ml的维持性血液透析患者88例分为两组:A组45例,透析前就已经产生保护性抗体;B组43例,接种乙型肝炎疫苗后产生保护性抗体(分两种方法接种疫苗:①长疗程的肌内注射法:在第0、1、3、6个月分别通过肌内途径给药,20μg/剂,有25例;②小剂量多次皮内注射:每2周重复1次,每次剂量5μg,共6次,有18例)。观察其半年的抗体滴度衰减情况。结果 A组患者抗体滴度衰减19.66%,B组抗体衰减57.84%,两组差异有统计学意义(P<0.01)。其中第1种接种方法抗体衰减45.41%;第2种接种方法抗体衰减62.78%,差异有统计学意义(P<0.05)。结论患者在透析前已产生保护性抗体的滴度较透析后强化接种乙肝疫苗产生的抗体滴度衰减缓慢,免疫保护更为持久。长疗程的肌内注射法较小剂量法的抗体滴度衰减慢。该试验的样本量较小,可能需要扩大样本量进一步观察。

[ Objective]To observe the decline changes of hepatitis B surface antibody titer in maintenance hemodialysis patients. [ Methods] 88 maintenance hemodialysis patients whose anti-HBs titers were higher than 10mIU/ml were divided into two groups. Group A （45 cases） have had the protective antibody before hemodialysis, and group B （43 cases） have had the protective antibody after hepatitis B vaccination. There were two methods of vaccination. ①long-term intramuscular injection： 25 patients received 4 does by intramuscular injection at O, 1,3 and 6 months, 20 μg per dose. ②Low-dose multiple intracutaneous injection： 18 patients were given 6 does by intracutaneous injection every two weeks, 5 p.g per dose. The decline of hepatitis B surface anti- body titer was observed in 6 months. [Results]The antibody titer of group A had descended by 19.66%, that of group B had descended by 57.84%, and the difference between two groups was significant （ P 〈 0.01 ）. The antibody titer of first vaccination method had descended by 45.41%, that of second vaccination method had descended by 62.78%, and the difference was significant （ P 〈0.05）. [ Conclusion ] The decline of antibody titer of patients have had the protective antibody before hemodialysis is slower than that of patients inoculated hepatitis B vaccination after hemodialysis, and its immune protection lasts for a long time. The antibody titer decline of long-term intramuscular injection is slower than that of low-dose multiple intracutaneous injection. The sampie size of this study is small, so it may need further study by enlarging sample size.