利用来自完全接种疫苗的成年人的新冠疫苗诱导的适应性免疫反应，确定骨科患者金属超敏反应具有临床意义的范围。
Establishing clinically meaningful ranges of metal hypersensitivity in orthopaedic patients using COVID-19 vaccine-induced adaptive immune responses from fully vaccinated adults.
作者信息
Caicedo Marco S, Flores Vianey, Siapno Rochelle, Crosby Michael, Samelko Lauryn A, Jacobs Joshua J, Hallab Nadim J
机构信息
Orthopedic Analysis, LLC, Chicago, IL, 60612, USA.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA.
出版信息
J Orthop. 2023 Nov 19;48:89-95. doi: 10.1016/j.jor.2023.11.041. eCollection 2024 Feb.
BACKGROUND
This study aimed to assess metal sensitization ranges among orthopaedic patients by comparing adaptive immune responses in all-comer pre- and post-operative orthopaedic adults who were COVID-19 unvaccinated or vaccinated vs patients with a painful aseptic implant by lymphocyte transformation test (LTT) to SARS-CoV-2-Spike-Protein (SP) and implant metal(s), respectively.
METHODS
Data were retrospectively reviewed from three independent groups: unvaccinated COVID-19 adults (n = 23); fully COVID-19 vaccinated adults (n = 35); unvaccinated, painful aseptic implant patients with history of metal allergy (n = 98). Standard in vitro LTT for SP and implant metal(s) (nickel, cobalt) were performed and rated as negative (stimulation index [SI]<2), mild (SI ≥ 2), positive (SI ≥ 4-15), and high sensitization (SI > 15) adaptive immune responses to tested antigen.
RESULTS
Overall, 17/23 (74%) of unvaccinated adults showed negative to mild LTT ranges, and 35/35 (100%) of vaccinated showed mild to positive LTT ranges to SP. Vaccinated individuals showed significantly higher median SI (16.1) to SP than unvaccinated (median SI, 1.7; < 0.0001). Most vaccinated adults (94%) showed a lymphocyte SI > 4 to SP, establishing LTT SI ≥ 4 with >90% sensitivity for diagnosing effective COVID-19 adaptive immune responses. Significantly fewer painful orthopaedic patients (41%) showed comparable elevated levels of lymphocyte metal sensitivity at SI ≥ 4 compared to vaccinated group ( < 0.0001).
CONCLUSIONS
Vaccinated adults showed significantly higher lymphocyte SI to SP than unvaccinated indicating that SI ranges ≥4 should be set as unequivocally diagnostic of LTT-positive adaptive immune responses to tested antigen. This analysis supports using higher LTT SI ranges (SI ≥ 4) in diagnosing clinical orthopaedic-related Type IV metal-hypersensitivity responses among orthopaedic patients.
背景
本研究旨在通过淋巴细胞转化试验（LTT）分别比较未接种或接种新冠疫苗的骨科成年患者术前和术后针对严重急性呼吸综合征冠状病毒2刺突蛋白（SP）的适应性免疫反应，以及与有疼痛性无菌植入物的患者针对植入金属的适应性免疫反应，以评估骨科患者的金属致敏范围。
方法
回顾性分析三个独立组的数据：未接种新冠疫苗的成年人（n = 23）；全程接种新冠疫苗的成年人（n = 35）；有金属过敏史、未接种疫苗且有疼痛性无菌植入物的患者（n = 98）。对SP和植入金属（镍、钴）进行标准体外LTT，并将其评定为阴性（刺激指数[SI]<2）、轻度（SI≥2）、阳性（SI≥4 - 15）和高敏（SI>15）的针对测试抗原的适应性免疫反应。
结果
总体而言，17/23（74%）未接种疫苗的成年人LTT范围为阴性至轻度，35/35（100%）接种疫苗的成年人对SP的LTT范围为轻度至阳性。接种疫苗的个体对SP的中位SI（16.1）显著高于未接种疫苗的个体（中位SI，1.7；<0.0001）。大多数接种疫苗的成年人（94%）对SP的淋巴细胞SI>4，建立了LTT SI≥4且诊断有效新冠适应性免疫反应的敏感性>90%。与接种疫苗组相比，疼痛性骨科患者中淋巴细胞金属敏感性SI≥4的水平明显较低（41%）（<0.0001）。
结论
接种疫苗的成年人对SP的淋巴细胞SI显著高于未接种疫苗的成年人，表明应将SI范围≥4明确设定为对测试抗原LTT阳性适应性免疫反应的诊断标准。该分析支持在诊断骨科患者临床骨科相关IV型金属超敏反应时使用更高的LTT SI范围（SI≥4）。
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