疫苗对重症和非重症COVID-19患者疫苗特异性T细胞的不同影响：一项363例病例的回顾性研究
Different effects of vaccine on VST in critical and non-critical COVID-19 patients: A retrospective study of 363 cases.
作者信息
Ying-Hao Pei, Rui-Han Li, Hai-Dong Zhang, Qiu-Hua Chen, Yuan-Yuan Gu, Yu-Shan Yang, Hai-Qi Zhou, Hua Jiang
机构信息
Department of Intensive Care Unit, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province, China.
Department of Endocrinology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province, China.
出版信息
Heliyon. 2023 May;9(5):e16017. doi: 10.1016/j.heliyon.2023.e16017. Epub 2023 May 1.
AIM
To explore the risk factors of prolonged viral shedding time (VST) in critical/non-critical COVID-19 patients during hospitalization.
METHODS
In this retrospective study, we enrolled 363 patients with SARS-CoV-2 infection admitted in a designated hospital during the COVID-19 outbreak in Nanjing Lukou International Airport. Patients were divided into critical (n = 54) and non-critical (n = 309) groups. We analyzed the relationship between the VST and demographics, clinical characteristics, medications, and vaccination histories, respectively.
RESULTS
The median duration of VST was 24 d (IQR, 20-29) of all patients. The VST of critical cases was longer than non-critical cases (27 d, IQR, 22.0-30.0 vs. 23 d, IQR 20-28, P < 0.05). Cox proportional hazards model showed that ALT (HR = 1.610, 95%CI 1.186-2.184, P = 0.002) and EO% (HR = 1.276, 95%CI 1.042-1.563, P = 0.018) were independent factors of prolonged VST in total cases; HGB (HR = 0.343, 95%CI 0.162-0.728, P = 0.005) and ALP (HR = 0.358, 95%CI 0.133-0.968, P = 0.043) were independent factors of prolonged VST in critical cases, while EO% (HR = 1.251, 95%CI 1.015-1.541, P = 0.036) was the independent factor of prolonged VST in non-critical cases. Vaccinated critical cases showed higher levels of SARS-CoV-2-IgG (1.725 S/CO, IQR 0.3975-28.7925 vs 0.07 S/CO, IQR 0.05-0.16, P < 0.001) and longer VSTs (32.5 d, IQR 20.0-35.25 vs 23 d, IQR 18.0-30.0, P = 0.011) compared with unvaccinated critical patients. Fully vaccinated non-critical cases, however, presented higher levels of SARS-CoV-2-IgG (8.09 S/CO, IQR 1.6975-55.7825 vs 0.13 S/CO IQR 0.06-0.41, P < 0.001) and shorter VSTs (21 d, IQR 19.0-28.0 vs 24 d, IQR 21.0-28.5, P = 0.013) compared with unvaccinated non-critical patients.
CONCLUSIONS
Our results suggested that risk factors of prolonged VST were different between critical and non-critical COVID-19 patients. Increased level of SARS-CoV-2-IgG and vaccination did not shorten the VST and hospital stay in critical COVID-19 patients.
目的
探讨新冠病毒感染住院患者（重症/非重症）病毒清除时间延长的危险因素。
方法
本回顾性研究纳入了南京禄口国际机场新冠疫情期间在某指定医院收治的363例新型冠状病毒感染患者。患者分为重症组（n = 54）和非重症组（n = 309）。我们分别分析了病毒清除时间与人口统计学、临床特征、用药情况及疫苗接种史之间的关系。
结果
所有患者病毒清除时间的中位数为24天（四分位间距，20 - 29天）。重症病例的病毒清除时间长于非重症病例（27天，四分位间距，22.0 - 30.0天 vs. 23天，四分位间距20 - 28天，P < 0.05）。Cox比例风险模型显示，谷丙转氨酶（HR = 1.610，95%置信区间1.186 - 2.184，P = 0.002）和嗜酸性粒细胞百分比（HR = 1.276，95%置信区间1.042 - 1.563，P = 0.018）是所有病例病毒清除时间延长的独立危险因素；血红蛋白（HR = 0.343，95%置信区间0.162 - 0.728，P = 0.005）和碱性磷酸酶（HR = 0.358，95%置信区间0.133 - 0.968，P = 0.043）是重症病例病毒清除时间延长的独立危险因素，而嗜酸性粒细胞百分比（HR = 1.251，95%置信区间1.015 - 1.541，P = 0.036）是非重症病例病毒清除时间延长的独立危险因素。与未接种疫苗的重症患者相比，接种疫苗的重症病例的新冠病毒IgG水平更高（1.725 S/CO，四分位间距0.3975 - 28.7925 vs 0.07 S/CO，四分位间距0.05 - 0.16，P < 0.001），病毒清除时间更长（32.5天，四分位间距20.0 - 35.25天 vs 23天，四分位间距18.0 - 30.0天，P = 0.011）。然而，与未接种疫苗的非重症患者相比，完全接种疫苗的非重症病例的新冠病毒IgG水平更高（8.09 S/CO，四分位间距1.6975 - 55.7825 vs 0.13 S/CO四分位间距0.06 - 0.41，P < 0.001），病毒清除时间更短（21天，四分位间距19.0 - 28.0天 vs 24天，四分位间距21.0 - 28.5天，P = 0.013）。
结论
我们的结果表明，重症和非重症新冠患者病毒清除时间延长的危险因素有所不同。新冠病毒IgG水平升高和接种疫苗并未缩短重症新冠患者的病毒清除时间和住院时间。
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