Cossiga Valentina, Capasso Mario, Guarino Maria, Loperto Ilaria, Brusa Stefano, Cutolo Francesco Maria, Attanasio Maria Rosaria, Lieto Raffaele, Portella Giuseppe, Morisco Filomena
Diseases of the Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples "Federico II", 80131 Naples, Italy.
UOC Epidemiologia e Prevenzione e Registro Tumori, ASL Napoli 1 Centro, 80148 Naples, Italy.
J Clin Med. 2023 Mar 15;12(6):2281. doi: 10.3390/jcm12062281.
The low response to vaccines is a well-known problem in cirrhosis. We evaluated the safety and immunogenicity of booster doses in patients with chronic liver disease (CLD), comparing the humoral response in cirrhotic vs. non-cirrhotic patients, and the impact of different factors on immune response. From September 2021 to April 2022, outpatients with CLD who completed the primary vaccination course and the booster dose against SARS-CoV-2 were enrolled. Blood samples were collected after second and third doses for detecting anti-spike protein IgG. We enrolled 340 patients; among them, 91 subjects were cirrhotic. After primary vaccination course, 60 (17.6%) patients did not develop a positive antibody titer, without significant differences between cirrhotic and non-cirrhotic patients ( = 0.076); most of them (88.3%) developed it after booster dose. At multivariable analysis, factors associated with higher humoral response after booster dose were only porto-sinusoidal vascular disorder ( = 0.007) as an etiology of CLD and the use of the mRNA-1273 vaccine ( = 0.001). In conclusion, in patients with CLD, a booster dose against SARS-CoV-2 induces an excellent immunogenicity and leads to an adequate antibody response. Cirrhosis is not associated with a worse humoral response, compared to patients with non-cirrhotic CLD.
疫苗低应答是肝硬化中一个众所周知的问题。我们评估了慢性肝病（CLD）患者加强剂量疫苗的安全性和免疫原性，比较了肝硬化患者与非肝硬化患者的体液免疫应答，以及不同因素对免疫应答的影响。2021年9月至2022年4月，纳入完成针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的基础疫苗接种疗程和加强剂量的CLD门诊患者。在接种第二剂和第三剂疫苗后采集血样，以检测抗刺突蛋白免疫球蛋白G（IgG）。我们纳入了340例患者；其中91例为肝硬化患者。在基础疫苗接种疗程后，60例（17.6%）患者未产生阳性抗体滴度，肝硬化患者与非肝硬化患者之间无显著差异（P = 0.076）；其中大多数患者（88.3%）在接种加强剂量疫苗后产生了阳性抗体滴度。在多变量分析中，加强剂量疫苗接种后体液免疫应答较高的相关因素仅为作为CLD病因的门静脉-肝窦血管紊乱（P = 0.007）和使用mRNA-1273疫苗（P = 0.001）。总之，在CLD患者中，针对SARS-CoV-2的加强剂量疫苗诱导了良好的免疫原性，并导致了充分的抗体应答。与非肝硬化CLD患者相比，肝硬化与较差的体液免疫应答无关。
