Spike and neutralizing antibodies response to COVID-19 vaccination in haemodialysis patients.
Spike and neutralizing antibodies response to COVID-19 vaccination in haemodialysis patients.
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血液透析患者中对COVID-19的抗体反应的尖峰和中和抗体反应。
DOI：
10.1093/ckj/sfab128
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发表时间：
2021-10
影响因子：
4.6
通讯作者：
Robert T
中科院分区：
文献类型：
--
作者：
Giot M;Fourié T;Lano G;Villarroel PMS;de Lamballeri X;Gully M;Samson L;Farault J;Bouchouareb D;Jehel O;Brunet P;Jourde-Chiche N;Ninove L;Robert T
需要在接受维持性血液透析（HD）的脆弱人群中评估对严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫苗的体液反应。我们分析了来自单个透析中心的患者在每次剂量的信使RNA（mRNA）Comirnaty疫苗（BNT162b2; BioNTech & Pfizer）之前和之后对SARS-CoV-2的刺突（S）抗原的抗体应答，并检测了中和抗体（Nabs）的存在。在90名接种疫苗的HD患者（平均年龄69岁，61%为男性）中，19名（21%）有SARS-CoV-2感染史。在第一剂（早期应答者）和第二剂后，分别有20%和77%的患者记录了抗S免疫球蛋白G抗体（Sabs）的血清转换，而23%的患者为无应答者。心脏病、肝硬化和丙种球蛋白水平是无血清转换的独立预测因素。首次给药后，在15.4%的早期应答者中检测到Nab，第二次给药后，在84.6%的早期应答者和57.9%的晚期应答者中检测到Nab。第二次给药后，有Nab的患者的Sab滴度高于无Nab的患者{598 [四分位距（IQR）246 - 882]）vs 134 [IQR 61 - 390]; P <0.0001}。所有有SARS-CoV-2感染史的患者均发生了Sabs和Nabs，其Sabs和Nabs滴度高于晚期应答者。大多数HD患者在mRNA疫苗接种后产生了针对SARS-CoV2的实质性体液应答，其中Nabs。这种免疫力是否会随着时间的推移而持续，并能够有效地保护患者免受2019年冠状病毒病的影响，仍有待确定。
Humoral response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines needs to be evaluated in the fragile population of patients on maintenance haemodialysis (HD). We analysed the antibody response to the spike (S) antigen of SARS-CoV-2 before and after each dose of the messenger RNA (mRNA) Comirnaty vaccine (BNT162b2; BioNTech & Pfizer) in patients from a single dialysis centre and detected the presence of neutralizing antibodies (Nabs). Among the 90 vaccinated HD patients (mean age 69 years, 61% male), 19 (21%) had a history of SARS-CoV-2 infection. A seroconversion with anti-S immunoglobulin G antibodies (Sabs) was documented in 20% of patients after the first dose (early responders) and in 77% after the second dose, while 23% were non-responders. Cardiac disease, cirrhosis and gamma globulin levels were independently predictive of the absence of seroconversion. Nabs were detected in 15.4% of early responders after the first dose and in 84.6% of early responders and 57.9% of late responders after the second dose. Sab titres after the second dose were higher in patients with Nab than without Nab {598 [interquartile range (IQR) 246–882]) versus 134 [IQR 61–390]; P < 0.0001}. All patients with a history of SARS-CoV-2 infection developed both Sabs and Nabs and their titres for Sabs and Nabs were higher than in late responders. Most HD patients develop a substantial humoral response against SARS-CoV2, with Nabs, following the mRNA vaccine. Whether this immunity persists over time and is able to efficiently protect patients from coronavirus disease 2019 remains to be determined.
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