Ulus Travma Acil Cerrahi Derg. 2006; 12(4): 277-281

Splenektomi yapýlan hastalarda Pnemo-23 ve Act-HIB’nin etkinliði ve immünojenitesi

Adam Uslu, Halit Yetiþ, Ahmet Aykas, Arif Karagöz, Murat Doðan, Cenk Þimþek, Ahmet Nart, Mehmet Fatih Yüzbaþýoðlu
T.C.S.B. ÝZMÝR EÐÝTÝM HASTANESÝ 3. GENEL CERRAHÝ KLÝNÝÐÝ ve ORGAN NAKLÝ MERKEZÝ, BOZYAKA,ÝZMÝR.

AMAÇ: Bu prospektif çalýþmada, splenektomili olgularda opsonizasyon yetisinin devamlýlýðýný ve serum immünglobulin düzeylerinin dönüþümünü ortaya koyarak, Streptococcus pneumoniae ve Haemophilus influenzae tip B aþýlarýnýn etkinliði gösterildi. GEREÇ-YÖNTEM: Ýyi ve kötü huylu hematolojik hastalýðý olan, splenik travma veya splenik kitle nedeniyle elektif ya da acil splenektomi uygulanmý þ 32 eriþkin hasta (18 erkek, 14 kadýn; ort. yaþ 46.1; daðýlým 18-79) incelendi. Tüm hastalara rutin olarak Pneumo- 23 ve Act-HIB aþýlarý uygulandý. Aþýlama sonrasý immün sistemde opsonizasyon kapasitesinin devamlýlýðý ve immünglobulin düzey dönüþümlerini ortaya koymak amacýyla, serum IgG, IgM, C3 ve C4 düzeyleri kantitatif olarak tayin edildi. BULGULAR: Serimizde cerrahi mortalite ve morbidite sýrasýyla %16 ve %9 olup, erken ameliyat sonu ölüm gözlenmedi. Farklý malin hastalý klý 5 olgu primer tümörün sistemik yayýlýmý nedeniyle kaybedildi. Benin hematolojik hastalýk ve splenik travma nedeniyle splenektomi uygulanan hiçbir olguda, 427 günlük ortalama izlem süresince ölüm saptanmadý. Ayrýca, serimizdeki hiçbir hastada splenektomi sonrasý þiddetli enfeksiyona baðlý ölüm geliþmedi. Malin olgular dahil tüm hastalarýn çýkýþ ve son kontrol kan örneklerinde IgG ve IgM düzeyleri normal olup, ortalama deðerler sýrasýyla 1383.1 mg/dL ve 80.9 mg/dL idi. Splenik travma, splenik kitle ve benin hematolojik hastalýk grubunda C3 ve C4 düzeyleri tümüyle normal sýnýrlarda olup, ortalama de- ðerler sýrasýyla 108.8 mg/dL. ve 21.4 mg/dL idi. SONUÇ: Bu öncül çalýþmada, aþýlama sonrasý splenektomiyi takiben tüm olgularda immünglobulin düzeylerinin, selim hematolojik hastalýk ya da splenik travmalý olgularda ise ek olarak C3 ve C4 düzeylerinin normal sýnýrlarda korunduðu gösterildi. Bunun ötesinde, son grupta yer alan olgularýn hiçbirinde takip süresince sepsise baðlý ölüm ve H. influenzae veya S. pneu - moniae enfeksiyonu geliþmedi. Bu immünolojik yanýtlarýn devamlýlýðýnýn ve rapel gereksiniminin ortaya konmasý için uzun dönem takipler gerekmektedir.

Anahtar Kelimeler: Act-HIB, H. influenzae; pnömokok aþý; Pneumo 23; splenektomi; S. pneumoniae.

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The efficacy and immunogenecity of Pneumo-23 and ACT-HIB in patients undergoing splenectomy

Adam Uslu, Halit Yetiþ, Ahmet Aykas, Arif Karagöz, Murat Doðan, Cenk Þimþek, Ahmet Nart, Mehmet Fatih Yüzbaþýoðlu
Department of General Surgery and Organ Transplantation Center, Izmir Teaching Hospital of The Ministry of Health- Turkey.

BACKGROUND: The objective of this prospective study is to validate the efficiency of Streptococcus pneumoniae and Haemophilus influenzae vaccines in splenectomized patients via the demonstration of seroconversion and uninterrupted ability for opsonization. METHODS: Thirty-two adult patients (18 males, 14 females; mean age 46.1 years; range 18 to 79 years) who underwent elective or urgent splenectomy for various benign and malignant hematological disorders, splenic trauma and splenic masses were reviewed. Pneumo-23 and Act-HIB were administered to all patients on routine basis. In order to demonstrate the ongoing opsonizing capacity of the immune system and the seroconversion of immunoglobulins after vaccination, antibody titers of IgG and IgM and plasma C3 and C4 levels were quantitatively measured. RESULTS: The operative morbidity was 9% and overall mortality was 16%, with no early postoperative death in this series. Five patients with various malignant disorders died due to dissemination of their primary tumor. None of the patients with benign hematological disorders or those with splenic trauma died during the mean follow-up of 427 days. Furthermore, death from overwhelming postsplenectomy infection was nil in our clinical survey. All of the patients including those with malignancy had normal IgG (mean: 1383.1 mg/dL) and IgM levels (mean: 80.9 mg/dL) during discharge and at the last follow-up. Among the patients with benign hematological disorders, splenic trauma and splenic masses necessitating splenectomy, C3 and C4 levels were entirely within normal limits with a mean of 108.8 mg/dL and 21.4 mg/dL, respectively. CONCLUSION: This preliminary study reveals adequate seroconversion of immunoglobulins in all patients and normal C3 and C4 levels in patients with benign hematological disorders and splenic trauma. Moreover, none of the patients in the latter group had S. pneumoniae or H. influenzae infection nor did they expire due to overwhelming sepsis during the follow-up period. Long-term follow-up is required to determine the continuation of this immunologic response and the necessity of repeated vaccination..

Keywords: Act-HIB, H. influenzae; pneumococcal vaccines; Pneumo 23; splenectomy; S. pneumoniae.

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