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血液透析患者中 ChAd/BNT 异源疫苗与同源 BNT/BNT 和 ChAd/ChAd SARS-CoV-2 疫苗相比的体液免疫原性和耐受性：一项多中心前瞻性观察研究。

Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients : A multicenter prospective observational study.

机构信息

Diaverum Renal Care Center, Potsdam, Germany.

Diaverum AB, Hyllie Boulevard 39, 215 37, Malmö, Sweden.

出版信息

J Nephrol. 2022 Jun;35(5):1467-1478. doi: 10.1007/s40620-022-01247-7. Epub 2022 Jan 27.

DOI:10.1007/s40620-022-01247-7
PMID:35084719
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8792133/
Abstract

BACKGROUND: After the reports of severe adverse reactions to the AstraZeneca ChAdOx1-S-nCoV-19 vaccine, patients who had received one dose of ChAdOx1-S-nCoV-19 vaccine were recommended a second dose of Pfizer's BNT162b2 vaccine. In hemodialysis patients, we compared the humoral immunogenicity and tolerability of homologous vaccination with ChAdOx1-nCoV-19/ChAdOx1-nCoV-19 (ChAd/ChAd) and BNT162b2/BNT162b2 (BNT/BNT) with heterologous vaccination of first dose of ChAdOx1-nCoV-19 and a second dose with BNT162b2 (ChAd/BNT). METHODS: In a multicenter prospective observational study, SARS-CoV-2 spike-IgG antibody levels, Nucleocapsid-protein-IgG-antibodies, and vaccine tolerability were assessed 6 weeks after second SARS-CoV-2 vaccination in 137 hemodialysis patients and 24 immunocompetent medical personnel. RESULTS: In COVID-19-naïve hemodialysis patients, significantly higher median SARS-CoV-2-spike IgG levels were found after ChAd/BNT (N = 16) compared to BNT/BNT (N = 100) or ChAd/ChAd (N = 10) (1744 [25th-75th percentile 276-2840] BAU/mL versus 361 [25th-75th percentile 120-936] BAU/mL; p = 0.009; 1744 [25th-75th percentile 276-2840] BAU/mL versus 100 [25th-75th percentile 41-346] BAU/mL; p = 0.017, respectively). Vaccinated, COVID-19-naïve medical personnel had median SARS-CoV-2 spike-IgG levels of 650 (25th-75th percentile 217-1402) BAU/mL and vaccinated hemodialysis patients with prior COVID-19 7047 (25th-75th percentile 685-10,794) BAU/mL (N = 11). In multivariable regression analysis, heterologous vaccination (ChAd/BNT) of COVID-19-naïve hemodialysis patients was independently associated with SARS-CoV-2 spike-IgG levels. The first dose of ChAd and the second dose of BNT after the first vaccination with ChAd (heterologous vaccination, ChAd/BNT) were associated with more frequent but manageable side effects compared with homologous BNT. CONCLUSIONS: Within the limitations of this study, heterologous vaccination with ChAd/BNT appears to induce stronger humoral immunity and more frequent but manageable side effects than homologous vaccination with BNT/BNT or with ChAd/ChAd in COVID-19-naïve hemodialysis patients.

摘要

背景：在阿斯利康 ChAdOx1-S-nCoV-19 疫苗出现严重不良反应报告后，建议已接种一剂 ChAdOx1-S-nCoV-19 疫苗的患者接种第二剂辉瑞公司的 BNT162b2 疫苗。在血液透析患者中，我们比较了同源接种 ChAdOx1-nCoV-19/ChAdOx1-nCoV-19（ChAd/ChAd）和 BNT162b2/BNT162b2（BNT/BNT）与异源接种第一剂 ChAdOx1-nCoV-19 和第二剂 BNT162b2（ChAd/BNT）的免疫原性和耐受性。

方法：在一项多中心前瞻性观察性研究中，在 137 名血液透析患者和 24 名免疫功能正常的医务人员中，在第二次 SARS-CoV-2 接种后 6 周评估了 SARS-CoV-2 刺突 IgG 抗体水平、核衣壳蛋白 IgG 抗体和疫苗耐受性。

结果：在 COVID-19 初治的血液透析患者中，ChAd/BNT（N=16）组的 SARS-CoV-2 刺突 IgG 水平明显高于 BNT/BNT（N=100）或 ChAd/ChAd（N=10）组（1744[25th-75th 百分位数 276-2840]BAU/mL 比 361[25th-75th 百分位数 120-936]BAU/mL；p=0.009；1744[25th-75th 百分位数 276-2840]BAU/mL 比 100[25th-75th 百分位数 41-346]BAU/mL；p=0.017）。接种疫苗、COVID-19 初治的医务人员 SARS-CoV-2 刺突 IgG 水平中位数为 650（25th-75th 百分位数 217-1402）BAU/mL，COVID-19 既往感染的血液透析患者为 7047（25th-75th 百分位数 685-10794）BAU/mL（N=11）。在多变量回归分析中，COVID-19 初治血液透析患者的异源接种（ChAd/BNT）与 SARS-CoV-2 刺突 IgG 水平独立相关。与同源 BNT 相比，ChAd 的第一剂和 BNT 的第二剂（异源接种，ChAd/BNT）后接种 ChAd 后与更频繁但可管理的副作用相关。

结论：在本研究的限制范围内，与同源 BNT/BNT 或 ChAd/ChAd 接种相比，COVID-19 初治血液透析患者的 ChAd/BNT 异源接种似乎诱导更强的体液免疫和更频繁但可管理的副作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2735/9217895/6b8eaa5154b5/40620_2022_1247_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2735/9217895/f82a5bd3a807/40620_2022_1247_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2735/9217895/0054a475c518/40620_2022_1247_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2735/9217895/6b8eaa5154b5/40620_2022_1247_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2735/9217895/f82a5bd3a807/40620_2022_1247_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2735/9217895/0054a475c518/40620_2022_1247_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2735/9217895/6b8eaa5154b5/40620_2022_1247_Fig3_HTML.jpg

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Humoral immunogenicity and tolerability of heterologous ChAd/BNT compared with homologous BNT/BNT and ChAd/ChAd SARS-CoV-2 vaccination in hemodialysis patients : A multicenter prospective observational study.

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引用本文的文献

[1]
18-month longitudinal SARS COV-2 neutralizing antibody dynamics in haemodialysis patients receiving heterologous 3-dose vaccination (AZD-1222- AZD-1222- BNT162b2) in a lower middle income setting.

BMC Nephrol. 2024-5-22

[2]
Immunogenicity and safety of heterologous versus homologous prime-boost schedules with inactivated and adenoviral vectored SARS-CoV-2 vaccines - A prospective multi-center study.

Heliyon. 2023-12-3

[3]
Comparison of Humoral Response between Third and Fourth Doses of COVID-19 Vaccine in Hemodialysis Patients.

Vaccines (Basel). 2023-10-12

[4]
The prevention and treatment of COVID-19 in patients treated with hemodialysis.

Eur J Med Res. 2023-10-9

[5]
Immune response of heterologous versus homologous prime-boost regimens with adenoviral vectored and mRNA COVID-19 vaccines in immunocompromised patients.

Front Immunol. 2023

[6]
Outcomes of vaccinations against respiratory diseases in patients with end-stage renal disease undergoing hemodialysis: A systematic review and meta-analysis.

PLoS One. 2023

[7]
Immunogenicity Rates after SARS-CoV-2 Three-Dose Vaccination in Patients under Dialysis: A Systematic Review and Meta-Analysis.

Vaccines (Basel). 2022-12-2

[8]
[Not Available].

Nefrologia. 2022-12-16

[9]
ChAdOx1 nCoV-19 Immunogenicity and Immunological Response Following COVID-19 Infection in Patients Receiving Maintenance Hemodialysis.

Vaccines (Basel). 2022-6-16

[10]
A Qualitative Comparison of the Abbott SARS-CoV-2 IgG II Quant Assay against Commonly Used Canadian SARS-CoV-2 Enzyme Immunoassays in Blood Donor Retention Specimens, April 2020 to March 2021.

Microbiol Spectr. 2022-6-29

本文引用的文献

[1]
Humoral response to a third injection of BNT162b2 vaccine in patients on maintenance haemodialysis.

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