系统性硬化症患者的肺炎球菌疫苗免疫原性和安全性。
Immunogenicity and safety of pneumococcal vaccination in patients with systemic sclerosis.
机构信息
Department of Clinical Sciences, Lund, Section for Rheumatology, Lund University and Skåne University Hospital, Lund, Sweden.
Department of Laboratory Medicine, Section of Microbiology, Immunology and Glycobiology, Lund University, Lund, Sweden.
出版信息
Rheumatology (Oxford). 2018 Apr 1;57(4):625-630. doi: 10.1093/rheumatology/kex471.
OBJECTIVE
To study the impact of disease and treatment with DMARDs on antibody response elicited by either pneumococcal conjugate vaccine (PCV13) or pneumococcal polysaccharide vaccine (PPV23) in patients with SSc.
METHODS
Forty-four SSc patients and 49 controls received a dose of either PCV13 or PPV23. Twelve patients were treated with DMARDs. Antibody levels to pneumococcal polysaccharides 6B and 23 F were measured before and 4-6 weeks after vaccination using ELISA. Antibody functionality was studied using opsonophagocytic assay performed on serotype 23 F.
RESULTS
Number of patients, percentage female and mean age (years) at vaccination were: 32, 94%, 57.5 years in SSc without DMARDs; 12, 100%, 55.5 years in SSc on DMARDs and 49, 63% and 50.6 years in controls. Post-vaccination antibody levels for both serotypes increased significantly in SSc without DMARDs and controls (P < 0.001), but in SSc on DMARDs only for 6B (P = 0.041). Compared with the other groups, patients with SSc receiving DMARDs had lower post-vaccination antibody levels for both serotypes. Opsonophagocytic assay increased significantly in all three groups. No significant difference in immunogenicity between PCV13 and PPV23 was seen.
CONCLUSION
Pneumococcal vaccination using either PCV13 or PPV23 yielded satisfactory antibody response in SSc patients without DMARD treatment, but a lower response in patients treated with synthetic DMARDs. Type of pneumococcal vaccine (conjugate or polysaccharide) did not significantly influence antibody response.
TRIAL REGISTRATION
ClinicalTrials.gov, http://clinicaltrials.gov, NCT02240888.
目的
研究疾病和 DMARDs 治疗对 SSc 患者接种肺炎球菌结合疫苗（PCV13）或肺炎球菌多糖疫苗（PPV23）后产生的抗体反应的影响。
方法
44 例 SSc 患者和 49 例对照者分别接种一剂 PCV13 或 PPV23。12 例患者接受 DMARDs 治疗。使用 ELISA 法在接种前和接种后 4-6 周测量肺炎球菌多糖 6B 和 23F 的抗体水平。使用 23F 血清型的调理吞噬试验研究抗体功能。
结果
接种时患者数量、女性百分比和平均年龄（岁）为：无 DMARDs 的 SSc 患者 32 例，94%，57.5 岁；DMARDs 的 SSc 患者 12 例，100%，55.5 岁；对照组 49 例，63%，50.6 岁。无 DMARDs 的 SSc 患者和对照组接种后两种血清型的抗体水平均显著升高（P < 0.001），但 DMARDs 的 SSc 患者仅 6B 升高（P = 0.041）。与其他组相比，接受 DMARDs 的 SSc 患者两种血清型的接种后抗体水平较低。所有三组调理吞噬试验均显著增加。PCV13 和 PPV23 的免疫原性无显著差异。
结论
无 DMARD 治疗的 SSc 患者接种 PCV13 或 PPV23 均可获得满意的抗体反应，但接受合成 DMARDs 治疗的患者反应较低。肺炎球菌疫苗类型（结合疫苗或多糖疫苗）对抗体反应无显著影响。
试验注册
ClinicalTrials.gov，http://clinicaltrials.gov，NCT02240888。
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