对 SARS-CoV-2 疫苗的犹豫和接种疫苗后系统性红斑狼疮患者的发作。
Hesitancy for SARS-CoV-2 vaccines and post-vaccination flares in patients with systemic lupus erythematosus.
机构信息
Department of Medicine, Tuen Mun Hospital, Hong Kong.
Department of Medicine, Tuen Mun Hospital, Hong Kong.
出版信息
Vaccine. 2022 Sep 29;40(41):5959-5964. doi: 10.1016/j.vaccine.2022.08.068. Epub 2022 Sep 6.
OBJECTIVES
To study the rate of SARS-CoV-2 vaccination and post-vaccination disease flares in patients with systemic lupus erythematosus (SLE).
METHODS
Patients who fulfilled ≥ 4 of the ACR criteria for SLE were identified and their SARS-CoV-2 vaccination status was traced. Flares of SLE at 6-week post-vaccination were reviewed retrospectively. Clinical characteristics of patients with and without vaccination, and those who did or did not experience post-vaccination flares were compared by statistical analyses.
RESULTS
914 adult patients with SLE were studied (92.5 % women, age 48.6 ± 14.0 years; SLE duration 14.5 ± 8.6 years). Two doses of the SARS-Cov-2 vaccines (61.5 % BioNTech; 38.5 % CoronaVac) were received by 449 (49.1 %) patients. The vaccination rate in SLE was significantly lower than that of the adult general population (77.8 %; p < 0.001) at the time of data analysis. Patients who were hesitant for vaccination were more likely to be hypertensive, have a history of neuromuscular manifestations, and a significantly higher organ damage score (1.10 ± 1.45 vs 0.74 ± 1.15; p < 0.001). However, none of these factors were significantly associated with vaccine hesitancy on multivariate analysis. Among 449 vaccinated patients, 37(8.2 %) experienced SLE flares: mild/moderate in 34; severe in 3. In an equal number of unvaccinated SLE controls randomly matched for the post-vaccination observation period, 28(6.2 %) had SLE flares: mild/moderate in 17; severe in 11 (odds ratio [OR] for flare in vaccinated patients 1.40[0.81-2.43]; p = 0.23, adjusted for age, sex, active serology, SLE duration and prednisolone use). In vaccinated patients, logistic regression revealed that active lupus serology before vaccination (OR 2.63[1.05-6.62]; p = 0.04) and a history of arthritis (OR 2.71[1.05-7.00]; p = 0.04) or discoid skin lesion (OR 4.73[1.90-11.8]; p = 0.001) were associated with SLE flares following vaccination, adjusted for confounders.
CONCLUSION
Hesitancy for COVID-19 vaccination is common in SLE patients. Vaccination against SARS-CoV-2 is not significantly associated with increased SLE flares. Patients with active SLE serology or a history of arthritis/discoid lesion are more likely to flare after vaccination.
目的
研究系统性红斑狼疮（SLE）患者的 SARS-CoV-2 疫苗接种率和接种后疾病发作情况。
方法
确定符合 ≥ 4 项 ACR SLE 标准的患者，并追踪其 SARS-CoV-2 疫苗接种情况。回顾性分析接种后 6 周内 SLE 发作情况。通过统计学分析比较接种和未接种患者、接种后未发作和发作患者的临床特征。
结果
共研究了 914 例成人 SLE 患者（92.5%女性，年龄 48.6±14.0 岁；SLE 病程 14.5±8.6 年）。449 例（49.1%）患者接受了两剂 SARS-CoV-2 疫苗（61.5%BioNTech；38.5%CoronaVac）。在数据分析时，SLE 患者的疫苗接种率明显低于成人普通人群（77.8%；p<0.001）。犹豫不决接种疫苗的患者更有可能患有高血压、有神经肌肉表现史，且器官损伤评分明显更高（1.10±1.45 比 0.74±1.15；p<0.001）。然而，在多变量分析中，这些因素均与疫苗犹豫无显著相关性。在 449 例接种疫苗的患者中，37 例（8.2%）出现 SLE 发作：轻度/中度 34 例；严重 3 例。在随机匹配的相同数量未接种疫苗的 SLE 对照组中，28 例（6.2%）出现 SLE 发作：轻度/中度 17 例；严重 11 例（接种患者发作的优势比[OR]1.40[0.81-2.43]；p=0.23，调整年龄、性别、活跃的血清学、SLE 病程和泼尼松龙使用）。在接种疫苗的患者中，logistic 回归显示接种前存在活跃的狼疮血清学（OR 2.63[1.05-6.62]；p=0.04）和关节炎（OR 2.71[1.05-7.00]；p=0.04）或盘状皮肤病变（OR 4.73[1.90-11.8]；p=0.001）病史与接种后 SLE 发作相关，经混杂因素调整。
结论
SLE 患者对接种 COVID-19 疫苗犹豫不决很常见。接种 SARS-CoV-2 疫苗与 SLE 发作增加无显著相关性。有活跃的狼疮血清学或关节炎/盘状皮损病史的患者在接种后更有可能发作。
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