SARS-CoV-2 疫苗接种与自身免疫性肝炎患者 COVID-19 重症结局风险的关系。
SARS-CoV-2 vaccination and risk of severe COVID-19 outcomes in patients with autoimmune hepatitis.
机构信息
Department of Gastroenterology, Harran University Hospital, Şanlıurfa, Turkey.
Department of Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
出版信息
J Autoimmun. 2022 Oct;132:102906. doi: 10.1016/j.jaut.2022.102906. Epub 2022 Sep 7.
BACKGROUND
Data regarding outcome of Coronavirus disease 2019 (COVID-19) in vaccinated patients with autoimmune hepatitis (AIH) are lacking. We evaluated the outcome of COVID-19 in AIH patients who received at least one dose of Pfizer- BioNTech (BNT162b2), Moderna (mRNA-1273) or AstraZeneca (ChAdOx1-S) vaccine.
PATIENTS AND METHODS
We performed a retrospective study on AIH patients with COVID-19. The outcomes of AIH patients who had acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection after at least one dose of COVID-19 vaccine were compared to unvaccinated patients with AIH. COVID-19 outcome was classified according to clinical state during the disease course as: (i) no hospitalization, (ii) hospitalization without oxygen supplementation, (iii) hospitalization with oxygen supplementation by nasal cannula or mask, (iv) intensive care unit (ICU) admission with non-invasive mechanical ventilation, (v) ICU admission with invasive mechanical ventilation or (vi) death, and data was analyzed using ordinal logistic regression.
RESULTS
We included 413 (258 unvaccinated and 155 vaccinated) patients (81%, female) with a median age of 52 (range: 17-85) years at COVID-19 diagnosis. The rates of hospitalization were (36.4% vs. 14.2%), need for any supplemental oxygen (29.5% vs. 9%) and mortality (7% vs. 0.6%) in unvaccinated and vaccinated AIH patients with COVID-19. Having received at least one dose of SARS-CoV-2 vaccine was associated with a significantly lower risk of worse COVID-19 severity, after adjusting for age, sex, comorbidities and presence of cirrhosis (adjusted odds ratio [aOR] 0.18, 95% confidence interval [CI], 0.10-0.31). Overall, vaccination against SARS-CoV-2 was associated with a significantly lower risk of mortality from COVID-19 (aOR 0.20, 95% CI 0.11-0.35).
CONCLUSIONS
SARS-CoV-2 vaccination significantly reduced the risk of COVID-19 severity and mortality in patients with AIH.
背景
关于接种疫苗的自身免疫性肝炎 (AIH) 患者感染 2019 年冠状病毒病 (COVID-19) 的结果数据尚缺乏。我们评估了至少接种过辉瑞-生物科技（BNT162b2）、莫德纳（mRNA-1273）或阿斯利康（ChAdOx1-S）疫苗的 AIH 患者 COVID-19 的结果。
患者和方法
我们对 COVID-19 合并 AIH 的患者进行了回顾性研究。比较了至少接种一剂 COVID-19 疫苗后发生急性严重呼吸综合征冠状病毒 2 (SARS-CoV-2) 突破性感染的 AIH 患者与未接种疫苗的 AIH 患者的结果。根据疾病过程中的临床状态，将 COVID-19 结果分为以下几类：（i）无住院，（ii）无吸氧住院，（iii）经鼻导管或面罩吸氧住院，（iv）无创机械通气 ICU 入院，（v）有创机械通气 ICU 入院或（vi）死亡，并使用有序逻辑回归分析数据。
结果
我们纳入了 413 名（258 名未接种和 155 名接种）COVID-19 诊断时中位年龄为 52 岁（范围：17-85 岁）的患者（81%为女性）。COVID-19 合并 AIH 的未接种和接种疫苗患者的住院率分别为（36.4% vs. 14.2%）、需要任何补充氧气的比例分别为（29.5% vs. 9%）和死亡率分别为（7% vs. 0.6%）。在调整年龄、性别、合并症和肝硬化存在后，至少接种一剂 SARS-CoV-2 疫苗与 COVID-19 严重程度显著降低相关（调整比值比 [aOR] 0.18，95%置信区间 [CI]，0.10-0.31）。总体而言，接种 SARS-CoV-2 疫苗与 COVID-19 死亡率显著降低相关（aOR 0.20，95%CI 0.11-0.35）。
结论
SARS-CoV-2 疫苗接种显著降低了 AIH 患者 COVID-19 严重程度和死亡率的风险。
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