疫苗接种对感染 SARS-CoV-2 德尔塔变异株（B.1.617.1）的住院患者症状的影响。
Impact of vaccination on the symptoms of hospitalised patients with SARS-CoV-2 Delta variant (B.1.617.1) infection.
机构信息
Infectious Diseases, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC, 1406, Inserm-CHUGA-UGA, Grenoble, France; Groupe Vaccination-Prévention de La Société de Pathologie Infectieuse de Langue Française (SPILF), France.
Groupe Vaccination-Prévention de La Société de Pathologie Infectieuse de Langue Française (SPILF), France; APHP, Hôpital Antoine Béclère, Service de Médecine Interne, Clamart, Université Paris-Saclay, UVSQ, INSERM U1018, CESP, Le Kremlin-Bicêtre, France.
出版信息
Clin Microbiol Infect. 2022 Dec;28(12):1629-1635. doi: 10.1016/j.cmi.2022.06.019. Epub 2022 Jun 30.
OBJECTIVES
The diffusion of the SARS-CoV-2 Delta (B.1.617.2) variant and the waning of immune response after primary Covid-19 vaccination favoured the breakthrough SARS-CoV-2 infections in vaccinated subjects. To assess the impact of vaccination, we determined the severity of infection in hospitalised patients according to vaccine status.
METHODS
We performed a retrospective observational study on patients hospitalised in 10 centres with a SARS-CoV-2 infection (Delta variant) from July to November 2021 by including all patients who had completed their primary vaccination at least 14 days before hospital admission and the same number of completely unvaccinated patients. We assessed the impact of vaccination and other risk factors through logistic regression.
RESULTS
We included 955 patients (474 vaccinated and 481 unvaccinated). Vaccinated patients were significantly older (75.0 [63.25-84.0] vs. 55.0 [38.0-73.0]; p < 0.001), more frequently males (55.1% (261/474) vs. 46.4% (223/481); p = 0.009), and had more comorbidities (2.0 [1.0-3.0] vs. 1.0 [0.0-2.0]; p < 0.001). Vaccinated patients were less often admitted for Covid-19 (59.3% (281/474) vs. 75.1% (361/481); p < 0.001), had less extended lung lesions (≤25%: 64.3% (117/182) vs. 38.4% (88/229); p < 0.001), required oxygen less frequently (57.5% (229/398) vs. 73.0% (270/370); p < 0.001), at a lower flow (3.0 [0.0-8.7] vs. 6.0 [2.0-50.0] L/min, p < 0.001), and for a shorter duration (3 [0.0-8.0] vs. 6 [2.0-12.0] days, p < 0.001)., and required less frequently intensive care unit admission (16.2% (60/370) vs. 36.0% (133/369); p < 0.001) but had comparable mortality in bivariate analysis (16.7% (74/443) vs. 12.2% (53/433); p = 0.075). Multivariate logistic regression showed that vaccination significantly decreased the risk of death (0.38 [0.20-0.70](p = 0.002), ICU admission (0.31 [0.21-0.47](p < 0.001) and oxygen requirement (0.16 [0.10-0.26](p < 0.001), even among older patients or with comorbidities.
CONCLUSIONS
Among patients hospitalised with a delta variant SARS-CoV-2 infection, vaccination was associated with less severe forms, even in the presence of comorbidities.
目的
SARS-CoV-2 德尔塔（B.1.617.2）变异株的传播和初次 COVID-19 疫苗接种后免疫反应的减弱，使接种疫苗的个体更容易发生突破性 SARS-CoV-2 感染。为了评估疫苗接种的影响，我们根据疫苗接种情况确定了住院患者感染的严重程度。
方法
我们对 2021 年 7 月至 11 月期间在 10 个中心因 SARS-CoV-2 感染（德尔塔变异株）住院的患者进行了回顾性观察性研究，纳入了所有至少在住院前 14 天完成初级疫苗接种的患者和相同数量的完全未接种疫苗的患者。我们通过逻辑回归评估了疫苗接种和其他危险因素的影响。
结果
我们纳入了 955 例患者（474 例接种疫苗，481 例未接种疫苗）。接种疫苗的患者年龄明显更大（75.0[63.25-84.0] vs. 55.0[38.0-73.0]；p<0.001），更多为男性（55.1%（261/474）vs. 46.4%（223/481）；p=0.009），合并症更多（2.0[1.0-3.0] vs. 1.0[0.0-2.0]；p<0.001）。接种疫苗的患者因 COVID-19 住院的比例较低（59.3%（281/474）vs. 75.1%（361/481）；p<0.001），肺部受累范围较小（≤25%：64.3%（117/182）vs. 38.4%（88/229）；p<0.001），需要吸氧的频率较低（57.5%（229/398）vs. 73.0%（270/370）；p<0.001），吸氧流量较低（3.0[0.0-8.7] vs. 6.0[2.0-50.0] L/min，p<0.001），吸氧时间较短（3[0.0-8.0] vs. 6[2.0-12.0]天，p<0.001），需要入住重症监护病房的比例较低（16.2%（60/370）vs. 36.0%（133/369）；p<0.001），但在二元分析中死亡率无差异（16.7%（74/443）vs. 12.2%（53/433）；p=0.075）。多变量逻辑回归显示，接种疫苗显著降低了死亡风险（0.38[0.20-0.70]（p=0.002）、入住重症监护病房的风险（0.31[0.21-0.47]（p<0.001）和吸氧的需求（0.16[0.10-0.26]（p<0.001），即使在合并症患者或老年患者中也是如此。
结论
在因 delta 变异 SARS-CoV-2 感染住院的患者中，即使存在合并症，疫苗接种也与病情较轻有关。
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