Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital, North Zealand, Copenhagen, Denmark
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
BMJ Open Respir Res. 2022 Jul;9(1). doi: 10.1136/bmjresp-2022-001268.
Responses to COVID-19 vaccination in patients with chronic pulmonary diseases are poorly characterised. We aimed to describe humoral responses following two doses of BNT162b2 mRNA COVID-19 vaccine and identify risk factors for impaired responses.
Prospective cohort study including adults with chronic pulmonary diseases and healthcare personnel as controls (1:1). Blood was sampled at inclusion, 3 weeks, 2 and 6 months after first vaccination. We reported antibody concentrations as geometric means with 95% CI of receptor binding domain (RBD)-IgG and neutralising antibody index of inhibition of ACE-2/RBD interaction (%). A low responder was defined as neutralising index in the lowest quartile (primary outcome) or RBD-IgG <225 AU/mL plus neutralising index <25% (secondary outcome), measured at 2 months. We tested associations using Poisson regression.
We included 593 patients and 593 controls, 75% of all had neutralising index ≥97% at 2 months. For the primary outcome, 34.7% of patients (n=157/453) and 12.9% of controls (n=46/359) were low responders (p<0.0001). For the secondary outcome, 8.6% of patients (n=39/453) and 1.4% of controls (n=5/359) were low responders (p<0.001). Risk factors associated with low responder included increasing age (per decade, adjusted risk ratio (aRR) 1.17, 95% CI 1.03 to 1.32), Charlson Comorbidity Index (per point) (aRR 1.15, 95% CI 1.05 to 1.26), use of prednisolone (aRR 2.08, 95% CI 1.55 to 2.77) and other immunosuppressives (aRR 2.21, 95% CI 1.65 to 2.97).
Patients with chronic pulmonary diseases established functional humoral responses to vaccination, however lower than controls. Age, comorbidities and immunosuppression were associated with poor immunological responses.
慢性肺部疾病患者对 COVID-19 疫苗的反应特征描述不佳。我们旨在描述 BNT162b2 mRNA COVID-19 疫苗接种两剂后的体液反应，并确定免疫反应受损的危险因素。
前瞻性队列研究包括慢性肺部疾病患者和医务人员作为对照组（1:1）。在第一次接种疫苗时、接种后 3 周、2 个月和 6 个月采集血样。我们以几何均数（95%置信区间）报告受体结合域（RBD）-IgG 和抑制 ACE-2/RBD 相互作用的中和抗体指数（%）。在 2 个月时，中和指数处于最低四分位数（主要结局）或 RBD-IgG<225 AU/mL 加上中和指数<25%（次要结局）的低应答者被定义为低应答者。我们使用泊松回归检验相关性。
我们纳入了 593 例患者和 593 例对照，其中 75%的患者在 2 个月时的中和指数≥97%。在主要结局方面，34.7%的患者（n=157/453）和 12.9%的对照（n=46/359）为低应答者（p<0.0001）。在次要结局方面，8.6%的患者（n=39/453）和 1.4%的对照（n=5/359）为低应答者（p<0.001）。与低应答相关的危险因素包括年龄增长（每十年，调整后的风险比（aRR）1.17，95%CI 1.03 至 1.32）、Charlson 合并症指数（每点）（aRR 1.15，95%CI 1.05 至 1.26）、使用泼尼松龙（aRR 2.08，95%CI 1.55 至 2.77）和其他免疫抑制剂（aRR 2.21，95%CI 1.65 至 2.97）。
慢性肺部疾病患者对疫苗接种产生了功能性体液反应，但低于对照组。年龄、合并症和免疫抑制与免疫反应受损有关。
