Joo Yoosun, Kim Dae Kyu, Jeon Yun Gi, Kim Ah-Ra, Do Hyeon Nam, Yoon Soo-Young, Kim Jin Sug, Jung Su Woong, Hwang Hyeon Seok, Moon Ju-Young, Jeong Kyung Hwang, Lee Sang-Ho, Kang So-Young, Kim Yang Gyun
Division of Nephrology, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea.
Division of Nephrology, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul 02447, Republic of Korea.
Vaccines (Basel). 2023 Oct 12;11(10):1584. doi: 10.3390/vaccines11101584.
Dialysis patients are more likely to die or become hospitalized from coronavirus disease 2019 (COVID-19). Currently, only a few studies have evaluated the efficacy of a fourth booster vaccination in hemodialysis (HD) patients and there is not enough evidence to recommend for or against a fourth booster vaccination. This study compared the humoral response and disease severity of patients on HD who received either three or four doses of COVID-19 vaccine. A total of 88 patients were enrolled. Humoral response to vaccination was measured by quantifying immunoglobulin G levels against the receptor binding domain of SARS-CoV-2 (anti-RBD IgG) at five different times and plaque reduction neutralization tests (PRNT) at two different times after vaccination over a period of 18 months. Antibody levels were measured at approximately two-month intervals after the first and second dose, then four months after the third dose, and then one to six months after the fourth dose of vaccine. PRNT was performed two months after the second and four months after the third dose of vaccine. We classified patients into four groups according to the number of vaccine doses and presence of COVID-19 infection. Severe infection was defined as hospital admission for greater than or equal to two weeks or death. There was no difference in antibody levels between naïve and infected patients except after a fourth vaccination, which was effective for increasing antibodies in infection-naïve patients. Age, sex, body mass index (BMI), dialysis vintage, and presence of diabetes mellitus (DM) did not show a significant correlation with antibody levels. Four patients who experienced severe COVID-19 disease tended to have lower antibody levels prior to infection. A fourth dose of SARS-CoV-2 vaccine significantly elevated antibodies in infection-naïve HD patients and may be beneficial for HD patients who have not been previously infected with SARS-CoV-2 for protection against severe infection.
透析患者因2019冠状病毒病（COVID-19）死亡或住院的可能性更高。目前，仅有少数研究评估了血液透析（HD）患者接种第四剂加强疫苗的效果，尚无足够证据支持或反对接种第四剂加强疫苗。本研究比较了接受三剂或四剂COVID-19疫苗的HD患者的体液反应和疾病严重程度。共纳入88例患者。在18个月的时间里，通过在五个不同时间点定量检测针对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）受体结合域的免疫球蛋白G水平（抗RBD IgG）以及在接种疫苗后的两个不同时间点进行空斑减少中和试验（PRNT）来测量对疫苗的体液反应。在第一剂和第二剂疫苗接种后大约每隔两个月测量抗体水平，然后在第三剂疫苗接种后四个月测量，接着在第四剂疫苗接种后一至六个月测量。PRNT在第二剂疫苗接种后两个月和第三剂疫苗接种后四个月进行。我们根据疫苗接种剂量数和是否感染COVID-19将患者分为四组。严重感染定义为住院时间大于或等于两周或死亡。除了在接种第四剂疫苗后，未感染和感染患者之间的抗体水平没有差异，第四剂疫苗对未感染患者增加抗体有效。年龄、性别、体重指数（BMI）、透析龄和糖尿病（DM）的存在与抗体水平均无显著相关性。4例经历严重COVID-19疾病的患者在感染前抗体水平往往较低。第四剂SARS-CoV-2疫苗显著提高了未感染HD患者的抗体水平，可能对先前未感染SARS-CoV-2的HD患者预防严重感染有益。
