Inflamatuvar barsak hastaliginda Hepatitis-B asilamasinin etkinligi
The effectiviness of hepatitis-B vaccination in inflammatory bowel disease
Özet
Giris ve amaç: Sik hospitalizasyon, kan transfüzyonu ve endoskopik girisimler nedeniyle, inflamatuar barsak hastalari Hepatitis- B virüsü infeksiyonu açisindan risk grubundadir. Bu çalismanin amaci, inflamatuvar barsak hastalari hastalarinin Hepatitis- B virüsü asilamasina yanitinin degerlendirilmesidir. Gereç ve yöntem: Toplam 41 hasta (24 ülseratif kolit, 17 Crohn hastaligi) ve 28 kontrol, 3 doz (0,1 ve 6.aylarda) rekombinant Hepatitis- B virüsü asisi ile asilandi. Gruplar serokonversiyon orani, efektif immünite (antiHBs ≥ 100mIU/mL) ve antiHBs antikoru titrasyon ortalamalari yönünden karsilastirildi. Bulgular: Serokonversiyon orani açisindan inflamatuvar barsak hastalari (%75.6) ile kontrol grubu (%92.8) arasinda istatiksel olarak anlamli bir fark saptanmadi (p=0.06). Efektif immün yanit inflamatuvar barsak hastalarinda (%34.1), kontrol grubundan (%82.1) daha düsüktü (p<0.01). Inflamatuvar barsak hastalari, kontrol grubuna göre daha düsük antiHBs titrasyon ortalamalarina sahipti. (176.9 mIU/mL x 350.3mIU/mL) (p<0.01). Yasin kirkdan büyük olmasi, aktif veya degisken gidis (asilama sirasinda en az bir kez aktiflesme), ülseratif kolit de sol kolon, Crohn hastaligi’da kolonik yerlesim ve immün supresif tedavi alma inflamatuvar barsak hastalarinda kontrol grubuna göre daha düsük serokonversiyon orani ve antiHBs titrasyon düzeylerine neden olan faktörler olarak bulundu. Inflamatuar barsak hastaliklari varliginda asiya yanitsizlik riski 3.42, düsük immün yanit riski ise 3.37 kat artmaktadir. Sonuç: Inflamatuvar barsak hastalarinda Hepatitis- B virüsü asisina yanit kötüdür. Asilama remisyon periodunda yapilmali ve yanit izlenmelidir.
Abstract
Background and aim: Inflammatory bowel disease patients are at high risk for hepatitis- B Virus infection due to the frequent need for hospitalisation, blood transfusion and endoscopic examination. The aim of this study was to evaluate the responsiveness of inflammatory bowel disease patients to hepatitis- B Virus vaccination. Material and methods: A total of 41 patients (24 ulcerative colitis and 17 Crohn’s disease) and 28 healthy controls were vaccinated with a recombinant hepatitis- B virus vaccine (at months zero, one and six). Groups were compared for seroconversion rate, effective immunity (antiHBs ≥ 100mIU/ml) and mean titers of antiHBs Ab. Results: There was no significant difference in the seroconversion rate between inflammatory bowel disease patients (75.6% ) and controls (92.8%) (p=0.06). However, the effective immunity response rate was lower in inflammatory bowel disease patients (34.1%) than controls (82.1%) (p= 0.01<0.05). Inflammatory bowel disease patients also had lower anti HBs Ab titers than controls (176.9 vs 350.3mIU/mL), (p<0.01). Age over 40, an active or fluctuating (sometimes active) clinical course during the vaccination period, left sided disease in ulcerative colitis, colon location in Crohn’s disease and immunosuppressive therapy during the vaccination period caused significantly lower seroconversion rates and mean AntiHBs Ab titers in inflammatory bowel disease patients than controls. The relative risk for lack of response was 3.42 and for low immunity was 3.37 in the presence of inflammatory bowel disease. Conclusion: Response to Hepatitis- B Virus vaccination is low in inflammatory bowel disease patients. Vaccination should administered during a remission period and the response monitored.
