الفهرس 
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Abstract
Hepatitis B infection may be largely preventable by vaccination.
Administration of hepatitis B recombinant vaccines leads to the
development of protective antibodies to HBV (anti – HBs) in responders.
Antibody test after vaccination is not required for healthy people,
however, it should be tested after vaccination in HD patients, HIV
positive people, those at occupational risk of infection, babies born to
HBsAg positive mothers, and those with family history of HBV carriers.
Lack of the development of anti-HBs means susceptibility to HBV
infection .
This study was conducted on 50 patients with CRF on HD aimed to
assess immune response to hepatitis B vaccine in these patients. They
were selected from attendants to dialysis unit of Menouf Fever Hospital,
Menoufia Governorate ;during the period from May 2014 to May 2015 .
In addition, 30 healthy persons of matched age and sex were selected as
control group. Patients and controls were classified into: GI(HD
group):- Included 50 patients with CRF on HD. They were 24 males (48
%) and 26 females (52%). Their ages ranged between 35 and 59 years
with mean value of 48.54 ± 5.91 years. Etiology of CRF was primary
renal diseases (21patients), DM (20 patients) and systemic hypertension
(9 patients) . GII (Control group):- Included 30 healthy persons. They
were 13 males (43.3 %) and 17 females (56.7 %). Their ages ranged
between 35 and 58 years with mean value of 47.27 ± 6.88 years. For this
purpose, all patients and controls were subjected to thorough history
taking, complete clinical examination, laboratory investigations including
(complete blood count, liver function tests , renal function tests , serum
Na , K , and Ca ) , imagining study (abdominal and pelvic ultra sound ) ,
serological study (HBsAg ,anti-HBs, anti-HBc , HCV-Ab by ELISA ) .
Statistical analysis of the presenting data revealed the
following :
•No statistically significant difference between studied groups as
regard age and sex distribution.
•Non of HD group patients had clinical evidences of chronic
infection , hepatic ,cardiopulmonary or endocrine disease .
•Anemia and decrease serum albumin were present in various
proportion while elevated serum creatinine and blood urea levels
were present in all patients on HD .
•In HD group ,CRF was due to primary renal diseases (42%) , DM
(40%) and systemic hypertension (18%) .
•Highly significant increase in the number of patients on HD with
inadequate immune response to HB vaccine (anti-HBs Ab between
10 and 100 IU/l) when compared with control group (32 out of 50
(64%) vs. 8 out 30 (26.7%) ) ,while the number of controls with
adequate immune response ( anti-HBs titer > 100 IU/l) was highly
significant when compared with HD group (22 out of 30 (73.3%)
vs.18 out of 50 (36%)). Non of studied groups members had anti-
HBs titer < 10 Iu/l .
•Highly significant decrease in the mean value of anti- HBs titer in
HD group when compared with control group. Also, there was
highly significant decrease in the mean value of inadequate anti-
HBs titer & significant decrease in the mean value of adequate
anti- HBs titer in HD group when compared with control group. Non-significant difference between diabetic & non-diabetic HD
subgroups as regard number of patients with HB vaccine immune
response ( χ 2 =10.47 & P value 0.27 ). Response to HB vaccine
was inadequate in 13 out of 20 (65%) diabetic HD patients versus
19 out of 30 (63.3%) non diabetic HD patients & while the
response was adequate in 7 out of 20 (35%) diabetic HD patients
versus 11out of 30 (36.7%) non diabetic HD patients .
Highly significant increase in the mean value of anti- HBs titer in
control group when compared with diabetic HD subgroup, while
this increase was significant when compared with non-diabetic HD
subgroup. On the other hand, there was no significant difference
between diabetic &non diabetic sub groups as regard mean values
of serum anti-HBs titer.
No significant correlation between anti- HBs titer and each of the
following: sex (P value 0.90) , Hb % (r 0.18 – P value 0.19) ,
serum Na (r 0.05 –P value 0.69) , K(r 0.08 –P value 0.57) , Ca (r
0.04 –P value 0.72) , ALT(r 0.08–P value 0.57) or AST(r 0.09 –P
value 0.49) .
Significant negative correlation between anti-HBs titer and Age (r -
0.61 and P-value <0.001).
Highly significant negative correlation between anti-HBs titer and
serum creatinine levels & blood urea(r -0.82 and P-value <0.001),
( r -0.61 and P-value <0.001) respectively .
Significant positive correlation between anti-HBs titer and serum
albumin levels (r -0.33 and P-value 0.02 )