免疫抑制治疗的炎症性肠病患者接种 SARS-CoV-2 疫苗后的体液免疫原性：我们是否应该优先考虑额外加强注射？
Humoral Immunogenicity After Vaccination Against SARS-CoV-2 Infection in Inflammatory Bowel Disease Patients Under Immunosuppressive Therapy: Should We Prioritize an Additional Booster Injection?
机构信息
Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.
Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.
出版信息
Inflamm Bowel Dis. 2023 Feb 1;29(2):268-273. doi: 10.1093/ibd/izac187.
BACKGROUND
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to the development of the novel coronavirus disease (coronavirus disease 2019 [COVID-19]). Scarce data are available regarding safety and efficacy of SARS-CoV-2 vaccination in inflammatory bowel disease (IBD) patients, which may present differences between subgroups. Lower humoral immunological response could require additional booster injections.
METHODS
This is a prospective study including adult patients with IBD after complete vaccination against SARS-CoV-2 infection with BioNTech vaccine. Patients with previous SARS-CoV-2 infection were excluded. A control group with healthy individuals matched for age and sex was also analyzed. Blood samples were collected 30 days after complete vaccination to quantify immunoglobulin G (IgG) antibody titers against SARS-CoV-2 in both groups.
RESULTS
The final sample included 81 IBD and 32 non-IBD patients, 55 (48.7%) of them women, with a mean age of 40.2 ± 13.0 years. From IBD patients, 58 (71.6%) had Crohn's disease and 23 (28.4%) had ulcerative colitis. IBD patients had significantly lower median anti-SARS-CoV-2 IgG levels when compared with the control group (6479 [interquartile range (IQR) 1830-11883, 10 053] AU/mL vs 13 061 [IQR 2826-21427, 15 539] AU/mL; P = .003). Regarding IBD medication, significant lower levels of SARS-CoV-2 IgG antibodies when compared with control subjects were observed in patients treated with thiopurines (5423 [IQR 3109-13369, 10 260] AU/mL; P = .011), methotrexate (834 [IQR 507-3467, 4155] AU/mL; P = .002), anti-tumor necrosis factor α agents (5065 [IQR 1033-11669, 10 636] AU/mL; P = .001), and corticosteroids (548 AU/mL; P = .001). The incidence of SARS-CoV-2 infection after vaccination was also significantly higher in patients treated with these agents.
CONCLUSIONS
IBD patients treated with immunomodulators, anti-tumor necrosis factor α agents and corticosteroids presented significantly lower anti-SARS-CoV-2 IgG levels following complete vaccination when compared with healthy control subjects. These findings support the benefit of additional booster injections in this population.
背景
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染可能导致新型冠状病毒病（COVID-19）的发生。炎性肠病（IBD）患者接种 SARS-CoV-2 疫苗的安全性和有效性的数据很少，这可能在亚组之间存在差异。较低的体液免疫反应可能需要额外的加强注射。
方法
这是一项前瞻性研究，纳入了已完成 BioNTech 疫苗接种的 IBD 成年患者。排除了有 SARS-CoV-2 既往感染的患者。还分析了一组与年龄和性别相匹配的健康个体作为对照组。两组均在完成疫苗接种 30 天后采集血样，以定量检测 SARS-CoV-2 免疫球蛋白 G（IgG）抗体滴度。
结果
最终样本纳入 81 例 IBD 患者和 32 例非 IBD 患者，其中 55 例（48.7%）为女性，平均年龄为 40.2±13.0 岁。IBD 患者中，58 例（71.6%）为克罗恩病，23 例（28.4%）为溃疡性结肠炎。与对照组相比，IBD 患者的 SARS-CoV-2 IgG 水平中位数明显较低（6479[四分位距（IQR）1830-11883，10053]AU/mL 比 13061[IQR 2826-21427，15539]AU/mL；P=.003）。在 IBD 药物方面，与对照组相比，接受硫嘌呤（5423[IQR 3109-13369，10260]AU/mL；P=.011）、甲氨蝶呤（834[IQR 507-3467，4155]AU/mL；P=.002）、抗肿瘤坏死因子α（5065[IQR 1033-11669，10636]AU/mL；P=.001）和皮质类固醇（548AU/mL；P=.001）治疗的患者 SARS-CoV-2 IgG 抗体水平明显较低。接种疫苗后 SARS-CoV-2 感染的发生率也明显更高。
结论
与健康对照组相比，接受免疫调节剂、抗肿瘤坏死因子α药物和皮质类固醇治疗的 IBD 患者在完成疫苗接种后 SARS-CoV-2 IgG 水平明显较低。这些发现支持在该人群中进行额外加强注射的益处。
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