Evaluation of SARS-CoV-2 IgG antibody reactivity in patients with systemic lupus erythematosus: analysis of a multi-racial and multi-ethnic cohort.
Evaluation of SARS-CoV-2 IgG antibody reactivity in patients with systemic lupus erythematosus: analysis of a multi-racial and multi-ethnic cohort.
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DOI：
10.1016/s2665-9913(21)00114-4
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发表时间：
2021-08
期刊：
影响因子：
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通讯作者：
NYU WARCOV Investigators
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文献类型：
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作者：
Saxena A;Guttmann A;Masson M;Kim MY;Haberman RH;Castillo R;Scher JU;Deonaraine KK;Engel AJ;Belmont HM;Blazer AD;Buyon JP;Fernandez-Ruiz R;Izmirly PM;NYU WARCOV Investigators
系统性红斑狼疮（SLE）患者由于潜在的免疫异常和定期使用免疫抑制剂药物，有发生COVID-19的风险。我们的目的是评估有或无既往COVID-19相关症状或RT-PCR证实的SARS-CoV-2感染的SLE患者中SARS-CoV-2 IgG抗体的存在。在这项分析中，我们纳入了来自纽约市两个队列的SLE患者：COVID-19大流行期间基于网络的自身免疫、免疫介导和风湿性患者评估（WARCOV）研究;以及纽约大学狼疮队列（NYU Langone Health和NYC Health + Hospitals/Bellevue的前瞻性患者登记研究）。两个队列中的患者通过医院或门诊实验室处理的市售免疫测定法检测SARS-CoV-2 IgG抗体。从纽约大学狼疮队列招募的患者，从附属提供者转介的患者，或因COVID-19入院的患者，在随访临床访视期间进行SARS-CoV-2 IgG抗体检测，作为常规监测的一部分。329名SLE患者被纳入这项分析，146名来自WARCOV研究，183名来自纽约大学狼疮队列，并在2020年4月29日至2021年2月9日期间进行了SARS-CoV-2抗体检测。309例（94%）为女性，91例（28%）为西班牙裔。329例患者中51例（16%）SARS-CoV-2 IgG抗体检测阳性。血清阳性患者比血清阴性患者更有可能是西班牙裔（51例中的24例[47%] vsz 278例中的67例[24%]）。其他人口统计学变量、SLE特异性因素和免疫抑制剂的使用与SARS-CoV-2阳性无关。在此前通过RT-PCR确诊的29名COVID-19患者中，18名（62%）正在服用免疫抑制剂; 29名患者中有24名（83%）SARS-CoV-2 IgG抗体检测呈阳性。在17名有COVID-19症状但同时进行的RT-PCR检测呈阴性的患者中，1名（6%）出现了抗体反应。在26名有COVID-19相关症状但没有接受RT-PCR检测的患者中，有6名（23%）出现了抗体反应。在83名没有COVID-19症状且没有进行RT-PCR检测的患者中，有4名（5%）出现了抗体反应。在36名最初为SARS-CoV-2 IgG阳性的患者中，大多数患者连续保持反应性（88%至10周，83%至20周，80%至30周）。在确诊的10名COVID-19患者中，有7名（70%）在发病后30周内出现抗体阳性。尽管使用了各种免疫抑制剂，但大多数确诊为COVID-19的SLE患者仍能够产生并维持血清学应答，这为体液免疫的有效性和持久性以及可能防止SARS-CoV-2再次感染提供了保证。美国国立关节炎、肌肉骨骼和皮肤病研究所、美国国立卫生研究院和彭博慈善机构COVID-19应对倡议拨款。
Patients with systemic lupus erythematosus (SLE) are at risk of developing COVID-19 due to underlying immune abnormalities and regular use of immunosuppressant medications. We aimed to evaluate the presence of SARS-CoV-2 IgG antibodies in patients with SLE with or without previous COVID-19-related symptoms or RT-PCR-confirmed SARS-CoV-2 infection. For this analysis, we included patients with SLE from two cohorts based in New York City: the Web-based Assessment of Autoimmune, Immune-Mediated and Rheumatic Patients during the COVID-19 pandemic (WARCOV) study; and the NYU Lupus Cohort (a prospective registry of patients at NYU Langone Health and NYC Health + Hospitals/Bellevue). Patients in both cohorts were tested for SARS-CoV-2 IgG antibodies via commercially available immunoassays, processed through hospital or outpatient laboratories. Patients recruited from the NYU Lupus Cohort, referred from affiliated providers, or admitted to hospital with COVID-19 were tested for SARS-CoV-2 IgG antibodies as part of routine surveillance during follow-up clinical visits. 329 patients with SLE were included in this analysis, 146 from the WARCOV study and 183 from the NYU Lupus Cohort, and were tested for SARS-CoV-2 antibodies between April 29, 2020, and Feb 9, 2021. 309 (94%) were women and 91 (28%) were of Hispanic ethnicity. 51 (16%) of 329 patients had a positive SARS-CoV-2 IgG antibody test. Seropositive patients were more likely than seronegative patients to be Hispanic (24 [47%] of 51 vsz 67 [24%] of 278). Other demographic variables, SLE-specific factors, and immunosuppressant use were not associated with SARS-CoV-2 positivity. Of the 29 patients with COVID-19 previously confirmed by RT-PCR, 18 (62%) were on immunosuppressants; 24 (83%) of 29 patients tested positive for SARS-CoV-2 IgG antibodies. Of 17 patients who had symptoms of COVID-19 but negative concurrent RT-PCR testing, one (6%) developed an antibody response. Of 26 patients who had COVID-19-related symptoms but did not undergo RT-PCR testing, six (23%) developed an antibody response. Of 83 patients who had no symptoms of COVID-19 and no RT-PCR testing, four (5%) developed an antibody response. Among 36 patients who were initially SARS-CoV-2 IgG positive, the majority maintained reactivity serially (88% up to 10 weeks, 83% up to 20 weeks, and 80% up to 30 weeks). Seven (70%) of ten patients with confirmed COVID-19 had antibody positivity beyond 30 weeks from disease onset. Most patients with SLE and confirmed COVID-19 were able to produce and maintain a serological response despite the use of a variety of immunosuppressants, providing reassurance about the efficacy and durability of humoral immunity and possible protection against re-infection with SARS-CoV-2. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, and Bloomberg Philanthropies COVID-19 Response Initiative Grant.