本文選題：終末期腎臟病　切入點(diǎn)：維持性血液透析　出處：《蚌埠醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:通過觀察維持性血液透析(MHD)患者對(duì)20μg國產(chǎn)重組乙型肝炎疫苗的應(yīng)答情況,探討影響免疫應(yīng)答的相關(guān)因素,以期更好地指導(dǎo)乙型肝炎疫苗在MHD患者中的應(yīng)用。方法:選取我院血液凈化中心病情穩(wěn)定,免疫過篩八項(xiàng)均為陰性,肝功能正常,從未接種過乙型肝炎疫苗的維持性血液透析患者30例作為實(shí)驗(yàn)組;同時(shí)選取我院健康體檢中心健康成年人42例接受注射乙型肝炎疫苗作為對(duì)照組。兩組研究對(duì)象均按0,1,6月肌肉注射20μg乙型肝炎疫苗共三次,每次疫苗注射后觀察30分鐘有無不良反應(yīng)發(fā)生,完成3次疫苗接種的研究對(duì)象在接受最后一次疫苗注射后2個(gè)月左右測(cè)定乙型肝炎表面抗體(Hbs Ab)的滴度值,以≥l0m IU/ml認(rèn)定為保護(hù)性血清轉(zhuǎn)換,計(jì)算保護(hù)性血清轉(zhuǎn)換率。比較實(shí)驗(yàn)組與對(duì)照組的陽轉(zhuǎn)率、抗體滴度值及免疫指標(biāo)的組間差異。以MHD患者中發(fā)生保護(hù)性血清轉(zhuǎn)換的患者為陽轉(zhuǎn)組,未發(fā)生保護(hù)性血清轉(zhuǎn)換的MHD患者為未陽轉(zhuǎn)組,運(yùn)用統(tǒng)計(jì)學(xué)檢驗(yàn)方法,比較兩組在年齡、血紅蛋白、血白蛋白、血清Fe蛋白、血PTH水平方面是否有差異。結(jié)果:實(shí)驗(yàn)組30名MHD患者均按0,1,6月三針免疫接種程序完成了乙肝疫苗的接種,無一例發(fā)生寒戰(zhàn)、發(fā)熱、皮疹等不良反應(yīng)。在最后一針疫苗接種后2個(gè)月復(fù)查免疫過篩八項(xiàng),其中有23名MHD患者產(chǎn)生的抗體滴度≥l0m IU/ml,保護(hù)性血清轉(zhuǎn)換率為76.67%,抗體滴度值為161.47±148.93m IU/ml。對(duì)照組42名健康成人中有一人未完成三針免疫接種,其余41人均按0,1,6月三針免疫接種程序完成了乙肝疫苗的接種,無一例出現(xiàn)不良反應(yīng),最后一針疫苗接種后2月復(fù)查免疫過篩八項(xiàng),其中有40人產(chǎn)生的抗體滴度≥l0m IU/ml,保護(hù)性血清轉(zhuǎn)換率為97.56%,抗體滴度值387.93±146.97m IU/ml。兩組研究對(duì)象抗體陽轉(zhuǎn)率及抗體滴度值差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。兩組外周血T細(xì)胞亞群:CD3+(%)67.59±10.06VS 70.12±7.45,P0.05;CD4+T(%)32.92±10.33 VS 39.51±6.19,P0.05;CD8+T(%)30.53±8.89 VS 24.76±6.22,P0.05;CD4+/CD8+1.22±0.67 VS 1.72±0.66,P0.05。陽轉(zhuǎn)組與未陽轉(zhuǎn)組在年齡(55.22±12.49 VS 51.43±13.82)、血紅蛋白(103.48±17.70VS 97.71±17.77)、血清Fe蛋白(884±632.17 VS 1112.99±913.22)、血PTH(263.52±164.20 VS 336.30±214.06)方面差異均無統(tǒng)計(jì)學(xué)意義(P0.05),在血白蛋白(39.28±3.20 VS 33.65±4.91)方面差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.MHD患者對(duì)20μg國產(chǎn)重組乙型病毒性肝炎疫苗應(yīng)答較好,但在抗體滴度值及抗體陽轉(zhuǎn)率方面均較健康成年人差。2.MHD患者對(duì)乙肝疫苗的反應(yīng)與外周血T細(xì)胞亞群CD4+T及CD4+/CD8+呈正相關(guān),與CD8+T呈負(fù)相關(guān),與CD3+不相關(guān)。3.MHD患者對(duì)乙肝疫苗的反應(yīng)與年齡、血紅蛋白、Fe蛋白、血PTH等因素不相關(guān),與白蛋白水平中等程度正相關(guān)。
[Abstract]:Objective: to observe the response of maintenance hemodialysis (HD) patients to 20 渭 g domestic recombinant hepatitis B vaccine (RHBV), and to explore the related factors affecting the immune response in order to better guide the application of hepatitis B vaccine in patients with MHD.Methods: 30 patients with maintenance hemodialysis who had never been vaccinated with hepatitis B vaccine were selected as experimental group.At the same time, 42 healthy adults received hepatitis B vaccine as control group.The two groups were given intramuscular injection of 20 渭 g hepatitis B vaccine for three times in 6 months. The adverse reactions were observed 30 minutes after each injection.The titers of hepatitis B surface antibody (HBS) were determined about 2 months after the last vaccination, and the protective serum conversion was determined by 鈮，

本文編號(hào)：1719300