POBOLJŠAVA LI UČINKOVITIJA HEMODIJALIZA ODGOVOR NA CIJEPLJENJE PROTIV VIRUSA HEPATITISA B?

VEDRAN KOVAČIĆ, MILENKA ŠAIN, VALENTINA VUKMAN

Bolesnici na kroničnoj hemodijalizi (BKHD) slabije odgovaraju na cijepljenje rekombinantnim cjepivom protiv virusa hepatitisa B (HBV). Želeći pokazati koji čimbenici na to utječu, proveli smo ovu studiju. Ispitanici su bili 30 BKHD. Svi ispitanici su cijepljeni s 4 40 µg rekombinantnog cjepiva u razmacima 0, 1, 2 i 6 mjeseci. Ispitanici su podijeljeni u skupine prema razini stvorenih protutijela (HbsAt): nereaktori (<10 i.j./L), slabi reaktori (10–100 i.j./L) i dobri reaktori (>100 i.j./L). Između reaktora i nereaktora na cijepljenje nađena je statistički značajna razlika u učinkovitosti dijalize (Kt/V) (p=0,027). Multivarijatnom analizom varijanci nađena je značajna razlika među skupinama nereaktora, slabih i dobrih reaktora u vrijednostima Kt/V (p=0,028) i dobi ispitanika (p=0,080). Pokazana je pozitivna korelacija između razine HBsAt i Kt/V (r=0,46; p=0,006), a negativna između razine HBsAt i: dobi ispitanika (r=–0,40; p=0,026), postojanja šećerne bolesti (r=–0,32; p=0,041), broja leukocita u krvi (r=–0,31; p=0,050) i indeksa tjelesne mase (r=–0,42; p=0,011). Višestruka linearna regresija pokazala je najveću korelaciju između razine HBsAt i Kt/V (p=0,002) uz negativnu korelaciju između razine HBsAt i dobi ispitanika (p=0,047). Neučinkovita dijaliza i starija dob povezane su sa slabim odgovorom na cijepljenje protiv HBV-a u BKHD. Na razinu protutijela stvorenih cijepljenjem najviše utječe Kt/V.

Summary. Patients on chronic haemodialysis (PCHD) elicit a weaker response to vaccination with recombinant hepatitis B virus vaccine. We conducted this study to demonstrate factors which could affect response to HBV vaccination. Subjects were 30 PCHD. All subjects were vaccinated with 4×40 μg recombinant HBV vaccine given i.m. at intervals 0, 1, 2, and 6 months. Subjects were divided into groups according to the level of antibody (HbsAb): nonresponders (<10 i.u./L), weak responders (10–100 i.u./L), and good responders (>100 i.u./L). A statistically significant difference was found between responders and nonresponders in the dialysis efficiency (Kt/V) (p=0.027). A multivariate analysis of variance unveiled a significant difference between the groups of nonresponders, weak and good responders in the Kt/V value (p=0.028), and the subject age (p=0.080). Positive correlation between HBsAb level and Kt/V (r=0.46; p=0.006), and negative correlations between HBsAb and: subject age (r=–0.40; p=0.026), existence of diabetes (r=–0.32; p=0.041), blood leukocyte number (r=–0.31; p=0.050), and body mass index (r=–0.42; p=0.011) were demonstrated. A multiple linear regression analysis demonstrated the most significant positive correlation between HBsAb level and the Kt/V values (p=0.002), and negative correlation between HBsAb level and the subject age (p=0.047). The HBV vaccination response was weaker in PCHD with inefficient dialysis and older age. Efficient haemodialysis most significantly improves the response to vaccination.