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IL-lp, IL-6, TNF-a, CRP ve ESH Hemodiyaliz Hastalarında Hepatit B Aşısına Antikor Yanıtsızlığının Göstergesi Olabilir mi?

Can IL-1p, IL-6, TNF-a, CRP and ESR Be the Marker of Unresponsiveness of Antibody Against Hepatitis B Vaccine in Hemodialysis Patients?

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2005

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Aim: The hepatitis B infection is a subject that still keeps its significance for hemodialysis staff members and hemodialysis patients at present. In this study, our aim was to evaluate whether the infections occurring during the hepatitis B vaccination programme have some negative effects on antibody response and also to exa¬ mine the increased proinflammatory cytokins, interleukin-1p (IL- 1P), interleukin-6 (IL-6), tumor necrosis factor-a(TNF-a), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as inflam¬ mation markers in the hemodialysis patients. Materials and Methods: The patients who have hemodialysis adequacy, who are on rHuEPO therapy, whose hepatitis markers were HBsAg (-), antiHBs (-), antiHBcIgG (-) and anti HCV (+) or (-)and the patients who had sufficient antibody response at the begi-ning of the hemodialysis but then the antibody titers fell below the 10 mIU/mL were enrolled in the study in Hemodialysis Center of Dicle University Faculty of Medicine. The patients were divided in¬to two groups according to vaccination procedures. Group A: The 40 |ig hepatitis B vaccine was injected intramuscularly into the left shoulder of patients who were HBsAg (-) and antiHBs (-) at months 0, 1, 2 and 6. Group B: The 40 |ig booster dose of hepatitis B vaccine was injected intramuscularly into the left shoulder of the patients who had sufficient antibody response at the beginning of the hemodialysis but then the antibody titers fell below 10 mIU/mL. Then, the Group A was divided into two subgroups as Group A1 and Group A2 according to antibody response. Recombinant hepatitis B vaccine (Hepavax - Gene-inj (R) recombinant 20 |ig/ml, Gre¬en Cross Vaccine Corp., Korea) was administered. Results: Twenty-eight patients completed the study (Group A: n=21, mean age 41±11 years, mean period of HD time 15.1±14.7 months, mean URR 68.7±7.4, mean Kt/V 1.45±0.23; Group B: n=7, mean age 55±16 years, mean period of HD time 22.2±26.8 months, mean URR 68.2±8.1, mean Kt/V 1.41±0.34). The positive antibody rate was 71.4% and the negative antibody response was 28.6% in group A. The positive antibody response rate was 100% in group B. There were not significant differences between the parameters of demographics, hematologic characteristics and nutritional status of the groups (p>0.05). The inflammation markers were similar in both groups except TNF-a because TNF-a was higher in group B. It was established that the majority of infections occured in group A1 during the study. Conclusions: The patients whose HBV serologic markers were negative should be vaccinated with recommended vaccination schedule, while starting the HD therapy. Also the booster dose should be applied to the vaccinated patients whose antibody titers fell below the 10 mIU/mL. The acute infections that occured during this period and inflammations did not negatively affect the antibody response. It was considered that the acute phase markers did not reflect the negative antibody response.
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Abstract (Original Language): 
Amaç: Hepatit B virüs (HBV) infeksiyonu hemodiyaliz (HD) ünitesi çalışanları ve hastaları için günümüzde hâlâ önemini koruyan bir sorundur. Bu çalışmada amacımız, HD hastalarında hepatit B aşı programı süresince gelişen infeksiyonların antikor yanıtı üzerine olumsuz etkisinin olup olmadığını ve dolayısıyla artan proinflamatuar sitokinler interlökin-1p (IL-1P), interlökin-6 (IL-6), tümör nekrozis faktör-a (TNF-a), C-reaktif protein (CRP) ve eritrosit sedimentasyon hızı (ESH) gibi inflamasyon göstergelerini de¬ ğerlendirmektir. Hastalar ve Yöntem: Dicle Üniversitesi Tıp Fakültesi HD Merkezi'nde, HD yeterliliği olan, rHuEPO tedavisi alan, HBsAg (-), antiHBs (-), antiHBcIgG (-) ve antiHCV (+) veya (-) olan hastalar ile önceden aşılanmış, antikor titresi daha sonra 10 mIU/mL'nin altına düşmüş hastalar çalışmaya alındı. Hastalar aşılanma durumuna göre iki gruba ayrıldı: Grup A'daki HBsAg (-) ve antiHBs (-) olan hastalara 0, 1, 2 ve 6. aylarda olmak üzere 40 |jg aşı (Hepavax - Gene-inj (R) rekombinant 20 |jg/ml, Green Cross Vaccine Corp, Kore) uygulandı; Grup B'deki, daha önce aşılanıp, antikor titresi 10 mIU/mL'nin altına düşmüş olan hastalara ise 40 |jg rapel doz aşı intramüsküler uygulandı. Antikor titresi 10 mIU/ml'nin üzerinde olanlar, antikor yanıtı pozitif kabul edildi. Grup A, daha sonra antikor yanıtına göre iki altgruba (Grup A1 ve Grup A2) ayrıldı.Bulgular: Çalışmayı 28 hasta tamamladı (Grup A: n=21, yaş ortalaması 41±11 yıl, ortalama HD süresi 15.1±14.7 ay, ortalama URR 68.7±7.4, ortalama Kt/V 1.45± 0.23; Grup B: n=7, ortalama yaş 55±16 yıl, ortalama HD süresi 22.2±26.8 ay, ortalama URR 68.2±8.1, ortalama Kt/V 1.4±0.34). Grup A'da hepatit B aşılamasına karşı pozitif antikor yanıtı %71.4, negatif antikor yanıtı ise %28.6 oranında gerçekleşti. Rapel doz uygulanan Grup B'de ise tüm olgularda (%100) pozitif antikor yanıtı gerçekleşti. Aşı programının başında ve sonunda Grup A'da pozitif antikor yanıtı oluşturan (15/21) hastalarla (Grup A1), antikor yanıtı negatif olan (6/21) hastaların (Grup A2) ve rapel doz aşı grubunun demografik ve hematolojik özellikleriyle beslenme duru¬ mu parametrelerinde anlamlı bir farklılık saptanmadı (p>0.05). Grup A1'de TNF-a yüksekliğinin dışında diğer inflamasyon göstergeleri, Grup A2 ile benzer iken, Grup B'de daha yüksek saptandı. Çalışma sürecince en sık infeksiyonun Grup A1'de geliştiği saptandı. Sonuç: HD tedavisine başlarken HBV serolojik göstergesi negatif olan hastalar önerilen aşı şemasıyla aşılanmalı, aşılanmış hastalardan antiHBs antikor titresi 10 mIU/mL'nin altına düşmüş olanlara da rapel doz aşı uygulanmalıdır. Bu süre zarfında gelişen akut infeksiyonların ve inflamasyonun antikor yanıtını negatif yönde et¬ kilemediği ve akut faz yanıt göstergelerinin, negatif antikor yanıtı¬ nın bir göstergesi olamayacağı düşünülmektedir.
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  • 4
188-194
  • Turkish

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