Clinical and Research Centre for Inflammatory Bowel Disease ISCARE and First Faculty of Medicine, Charles University, Prague, Czech Republic.
GENNET Prague, Czech Republic.
J Crohns Colitis. 2022 Sep 8;16(9):1347-1353. doi: 10.1093/ecco-jcc/jjac048.
Knowledge on the immunogenicity of anti-SARS-CoV-2 vaccines in inflammatory bowel disease [IBD] patients is limited. Therefore, SARS-CoV-2-specific T-cell responses and antibodies were analysed in 60 IBD vaccine recipients and 30 controls.
SARS-CoV-2 IgG antibodies against the viral spike protein were measured at baseline and at 8 and 26 weeks after the second vaccine dose. SARS-CoV-2 IgG antibodies against the nucleocapsid antigens were measured at week 26. A SARS-CoV-2 interferon-gamma released assay [IGRA] was performed in all vaccinees at week 26.
At weeks 0 and 8, no differences were found in anti-spike antibodies between cohorts. At week 26, the decrease in antibody levels was more significant in the IBD cohort compared to the healthy cohort, and anti-nucleocapsid antibodies were not detected in either group. At week 26, 16 of 90 [18%] vaccinated individuals had a negative IGRA test result, seven of 90 [8%] were borderline and 67 [74%] had a positive IGRA result; 22 of the 23 individuals with negative or borderline IGRA results belonged to the IBD cohort. However, the overall functional ability of T-lymphocytes to produce interferon-gamma after the unspecific mitogen stimulation was lower in IBD patients. In vaccinated individuals with low or borderline IGRA, treatment with tumour necrosis factor-alpha inhibitors was the most frequent. In individuals with a significant drop in anti-spike antibody levels, plasmatic interferon-gamma concentrations after the specific SARS-CoV-2 stimulation were also insufficient.
Simple humoral and cellular post-vaccination monitoring is advisable in IBD patients so that repeated vaccine doses may be scheduled.
目前对于炎症性肠病（IBD）患者接种抗 SARS-CoV-2 疫苗后的免疫原性知之甚少。因此，本研究分析了 60 例 IBD 疫苗接种者和 30 名对照者的 SARS-CoV-2 特异性 T 细胞反应和抗体。
在接种第 2 剂疫苗后 8 周和 26 周时，检测血清中针对病毒刺突蛋白的 SARS-CoV-2 IgG 抗体。在第 26 周时检测针对核衣壳抗原的 SARS-CoV-2 IgG 抗体。在所有接种者中，第 26 周时还进行了 SARS-CoV-2 干扰素-γ释放试验（IGRA）。
在第 0 周和第 8 周时，两组间针对刺突蛋白的抗体无差异。第 26 周时，与健康对照组相比，IBD 组的抗体水平下降更显著，且两组均未检测到针对核衣壳的抗体。第 26 周时，90 例接种者中有 16 例（18%）IGRA 检测结果为阴性，7 例（8%）为临界值，67 例（74%）为阳性；23 例 IGRA 检测结果为阴性或临界值的个体中，22 例来自 IBD 组。然而，IBD 患者外周血 T 淋巴细胞在非特异性丝裂原刺激下产生干扰素-γ的整体功能较低。在 IGRA 检测结果为阴性或临界值的接种者中，TNF-α 抑制剂的使用率最高。在抗刺突抗体水平显著下降的个体中，特异性 SARS-CoV-2 刺激后血浆中干扰素-γ的浓度也不足。
在 IBD 患者中，建议进行简单的体液和细胞免疫后监测，以便安排重复接种疫苗。
