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KRONİK HEMODİYALİZ HASTALARINDA HEPATİT- B AŞI UYGULAMASI VE İMMÜN CEVABIN DEĞERLENDİRİLMESİ

HEPATITIS-B VACCINATION AND DETERMINATION OF IMMUN RESPONSE IN CHRONIC HEMODIALYSIS PATIENTS

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 1995

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Hepatitis-B is stili a problem in dialysis units and the number of nonresponders to hepatitis-B vaccinati¬on is relatively high in patients on regular hemodialy-sis treatment. The reason for low seroconversion rates in hemodialyzed patients is poorly understood. Fifteen dialysis patients; 6 females, 9 males aged between 12 to 60 years underwent the following schedule of vac¬cination: a 40 jig dose of recombinant vaccine (Gen Hevac B Pasteur) at 0, 1, 2 and 6 months. The T lymphocyte subsets and stimulation indices, total IgG levels and major HLA-Class I and II antigens were evaluated, for the changes of immune response at Is', 2nd, 6th and 12th months. The seroconversion (Anti-HBs >10mIU/L) was 20%, 67%, 64% and 63.7% at the 1st, 2nd, 6th and 12th months respectively. There was no statistically significant difference between the basal values of T lymphocyte subsets of the patients and the control group (p>0.05). T4IT8 ratio at 2th month, CD8 levels at 6th and 12th months, CD4 levels at 12nd month were lower when compared with the basal values for T4IT8 ratio, the levels at 1st and 2nd months for CD8, and the levels at Td month for CD4 (p 0.05 andp<0.05). The difference between the im¬mune parameters of the nonresponders and respon-ders were not statistically significant (p>0.05). The lymphocyte stimulation indices of two nonresponder patients were low,. In addition, all nonresponder pati¬ents had HLA-Ai and three of them had HLA-DR2. In conclusion, we have shown that low seroconversion rates to HBV vaccine in hemodialyzed patients can be associated with several immune defects.
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Abstract (Original Language): 
Hepatit-B virus (HBV) infeksiyonu re güler hemodiyaliz tedavisinin (RHT) hala önemli infeksiyöz kompli-kasyonlarından biri olup; kronik hemodiyaliz hastalarında standart HBV aşısına karsı serokonversiyon oranı düşüktür. Bu hastalarda serokonversiyon oranı düşüklüğüne yol açan immün defektin tipi tam olarak bilinmemektedir. Bu çalışmada yaşları 12-60 yıl arasında olan 6'ı kadın, 9u erkek 15 kronik hemodiyaliz hastasına 0,1,2 ve 6. aylarda 40 ıg rekombinant HBV aşısı yapılarak oluşan anti-HBs cevabı ile T lenfositlerin sayısı ve fonksiyonları ile major hislo-kompatibilite antijenleri arasındaki ilişki araştırıldı. Anti-HBs litreleri, T lenfosit subgrupları ve total IgG düzeyleri aşılama ile eş zamanlı olarak belirlenirken; lenfosit stimülasyon indeksleri ve HLA-Klas I ve II an¬tijenleri 12. ayda değerlendirildi. İlk aşıyı takiben 1, 2, 6 ve 12. aylarda serokonversiyon (Anti-HBs >10mIUIml) oranları sırasıyla %20, %67, %64 ve %63.7olup; kadınlarda serokonversiyon oranları da¬ha yüksek idi. Hastaların bazal T hücre subgrup sayı¬ları kontrollerin değerlerinden farklı değildi (p>0.05). ikinci aydaki T4IT8 oranı bazal değerler¬den, 6. ve 12. aydaki CD8 değerleri 1. ve 2. aydaki değerlerden ve 12. aydaki CD4 değerleri 2. aydaki değerlerden düşük bulundu (p<0.05). Seropozitif ve seronegatif hastaların immün parametreleri arasında ise istatistiksel olarak fark yoktu (p>0.05). Cevapsız olan iki hastanın lenfosit stimülasyon indeksleri dü¬şük bulunurken; cevapsız hastaların hepsinde HLA-A2, üçünde HLA-DR2 tesbit edildi. Sonuç olarak kro¬nik hemodiyaliz hastalarında HBV aşısına karşı olu¬şan düşük immün cevaplan birden fazla immün defek-tin sorumlu olabileceği düşünüldü.
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  • 1
25-32
  • Turkish

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