BMJ:免疫缺陷人群接种新冠肺炎疫苗后效果研究

2022-03-07 MedSci原创 MedSci原创

免疫功能低下人群接种Covid-19疫苗后的血清转换率显著低于常人,尤其是器官移植受者。在所有患者组中,接种第二剂量与血清转化增加相关,接种第三针可实现先前无应答人群的血清转化。

SARS-CoV-2的传播以及全球范围内Covid-19的大流行仍在继续。截至2021年11月,全球已有超过2.5亿新冠肺炎患者,超过400多万人死亡。Covid-19疫情加速了疫苗的研发,已有多个灭活、mRNA疫苗以及病毒载体疫苗上市。免疫缺陷人群是新冠肺炎的高危人群,近日研究人员考察了新冠肺炎疫苗在免疫系统缺陷人群的效果。


本次研究为系统回顾和荟萃分析,收集PubMed、Embase以及Central Register of Controlled Trials数据库中相关研究,比较在免疫缺陷和免疫功能正常人群中接种新冠肺炎疫苗后的效果差异。研究的主要终点为完成第一剂、第二剂以及第三剂covid-19疫苗后血清转化的相对和绝对差异。
收集82项研究数据,其中77个(94%)研究使用了mRNA疫苗,16个(20%)使用了病毒载体疫苗,4个(5%)使用了灭活全病毒疫苗。63项研究被评估为低偏倚风险,19项研究为中度偏倚风险。在完成一次疫苗接种后,血液系统肿瘤(风险比0.40,I2=80%;绝对风险0.29, I2=89%)、免疫介导的炎症性疾病(0.53,I2=89%;0.29,I2=97%)和实体瘤(0.55,0.46-0.65,I2=78%;0.44,0.36-0.53,I2=84%)患者的血清转化率约为对照组的一半,而器官移植受者的血清转化率则低16倍(0.06,I2=0%;0.06,I2=0%)。第二次注射后,移植受者的血清转化仍然最小(0.39,I2=92%),只有三分之一人群实现了血清转化。血液系统肿瘤(0.63,I2=88%;0.62,I2=90%)、免疫介导的炎症性疾病(0.75,I2=92%;0.77,I2=93%)和实体瘤(0.90,I2=51%;0.89,I2=49%)患者血清转化率在完成2次接种计划后增加。HIV患者与对照组之间的血清转换率相似(1.00,I2=0%;I2=89%)。11项研究显示,接种第三针COVID-19 mRNA疫苗可实现先前无应答的实体瘤、血液肿瘤和免疫介导的炎症性疾病患者的血清转化率。

第一次接种后各组人群血清转化率

研究发现,疫功能低下人群接种Covid-19疫苗后的血清转换率显著低于常人,尤其是器官移植受者。在所有患者组中,接种第二剂量与血清转化增加相关,接种第三针可实现先前无应答人群的血清转化。
原始出处:
Ainsley Ryan Yan Bin Lee et al. Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis. BMJ,02 March 2022。

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    2022-12-03 gaoxiaoe
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    2022-03-16 ms3000000876072209

    很棒

    0

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