Giambra Vincenzo, Piazzolla Annarita Valeria, Cocomazzi Giovanna, Squillante Maria Maddalena, De Santis Elisabetta, Totti Beatrice, Cavorsi Chiara, Giuliani Francesco, Serra Nicola, Mangia Alessandra
Institute for Stem Cell Biology, Regenerative Medicine and Innovative Therapies, Fondazione IRCCS "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy.
Liver Unit, Fondazione IRCCS Ospedale "Casa Sollievo della Sofferenza", 71013 San Giovanni Rotondo, Italy.
Vaccines (Basel). 2022 Aug 8;10(8):1281. doi: 10.3390/vaccines10081281.
Background: LC has been associated with hyporesponsiveness to several vaccines. Nonetheless, no data on complete serological and B- and T-cell immune response are currently available. Aims: To assess, in comparison with healthy controls of the same age and gender, both humoral and cellular immunoresponses of patients with LC after two or three doses of the mRNA Pfizer-BioNTech vaccine against SARS-CoV-2 and to investigate clinical features associated with non-response. Material and methods: 179 patients with LC of CTP class A in 93.3% and viral etiology in 70.1% of cases were longitudinally evaluated starting from the day before the first dose to 4 weeks after the booster dose. Their antibody responses were compared to those of healthcare workers without co-morbidities. In a subgroup of 40 patients, B- and T-cell responses were also compared to controls. Results: At d31, d90 and d180 after BNT162b2 vaccine, no detectable SARS-CoV-2 IgG response was observed in 5.9%, 3.9% and 7.2% of LC patients as compared to 0 controls (p < 0.03). A delay in B-cell and lack of prompt T-cell response compared to healthcare workers was also registered. A significant correlation between antibody titers and cellular response was observed. A MELD score > 8 was the only independent predictor of poor d31 response (p = 0.028). Conclusions: Our results suggest that cirrhotic patients have a slower and in <10% suboptimal immune response to SARS-CoV-2 vaccination. Rates of breakthrough infections were comparable between cirrhotics and controls. The booster dose was critical in inducing both humoral and cellular responses comparable to controls.
肝硬化（LC）与对多种疫苗的低反应性有关。然而，目前尚无关于完整血清学以及B细胞和T细胞免疫反应的数据。目的：与年龄和性别相同的健康对照相比，评估两剂或三剂辉瑞 - 生物科技公司的SARS-CoV-2 mRNA疫苗接种后肝硬化患者的体液免疫和细胞免疫反应，并研究与无反应相关的临床特征。材料和方法：从第一剂接种前一天开始至加强剂量接种后4周，对179例CTP A级肝硬化患者进行纵向评估，其中93.3%的病例为病毒病因。将他们的抗体反应与无合并症的医护人员的反应进行比较。在40例患者的亚组中，还将B细胞和T细胞反应与对照组进行了比较。结果：在BNT162b2疫苗接种后的第31天、第90天和第180天，分别有5.9%、3.9%和7.2%的肝硬化患者未检测到SARS-CoV-2 IgG反应，而对照组为0（p<0.03）。与医护人员相比，还发现肝硬化患者的B细胞反应延迟且缺乏迅速的T细胞反应。观察到抗体滴度与细胞反应之间存在显著相关性。终末期肝病模型（MELD）评分>8是第31天反应不佳的唯一独立预测因素（p = 0.028）。结论：我们的结果表明，肝硬化患者对SARS-CoV-2疫苗的免疫反应较慢，且<10%的患者反应欠佳。肝硬化患者和对照组之间的突破性感染率相当。加强剂量对于诱导与对照组相当的体液免疫和细胞免疫反应至关重要。
