Superior Immune Response to Protein-Conjugate versus Free Pneumococcal Polysaccharide Vaccine in Chronic Obstructive Pulmonary Disease
Superior Immune Response to Protein-Conjugate versus Free Pneumococcal Polysaccharide Vaccine in Chronic Obstructive Pulmonary Disease
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DOI：
10.1164/rccm.200903-0488oc
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发表时间：
2009-09-15
影响因子：
24.7
通讯作者：
Bailey, William C.
中科院分区：
文献类型：
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作者：
Dransfield, Mark T.;Nahm, Moon H.;Bailey, William C.
基本原理：关于23价肺炎球菌多糖疫苗（PPSV 23）产生的抗体在慢性阻塞性肺疾病（COPD）中的免疫原性和保护效力存在争议。7价白喉结合的肺炎球菌多糖疫苗（PCV 7）诱导更强大的免疫应答比PPSV 23在健康的老年adult.Objectives：我们假设，与PPSV 23相比，PCV 7疫苗接种后，在中度至重度COPD中，亚型特异性IgG抗体浓度和功能性抗体活性将优于上级。我们还假设，年龄较大和以前的PPSV 23疫苗接种将与疫苗responsibility.Methods：120例COPD患者被随机分配到PPSV 23（63例）或PCV 7（57例）。通过ELISA测定IgG浓度;用标准化调理吞噬测定法测定功能性抗体活性，并报告为调理作用杀伤指数（OPK）。在疫苗接种后1个月，在疫苗组内和疫苗组之间比较了A型特异性IgG和OPK的增加。在每个研究组中，所有血清型的疫苗接种后IgG和OPK均高于基线（P < 0.01）。校正基线水平后，PCV 7组的所有7种血清型的接种后IgG均高于PPSV 23组，其中5种血清型的IgG达到统计学显著性（P < 0.05）。与PPSV 23相比，PCV 7导致7种血清型中6种的OPK更高（4种在统计学上更高）。在多变量分析中，年轻的年龄，疫苗的天真，并收到PCV 7与增加OPK responses.Conclusions：PCV 7诱导上级免疫反应，在1个月后接种COPD相比，PPSV 23。年龄较大和既往PPSV 23降低了疫苗反应性。
Rationale: Debate exists about the immunogenicity and protective efficacy of antibodies produced by the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in chronic obstructive pulmonary disease (COPD). The 7-valent diphtheria-conjugated pneumococcal polysaccharide vaccine (PCV7) induces a more robust immune response than PPSV23 in healthy elderly adults.Objectives: We hypothesized that serotype-specific IgG antibody concentration and functional antibody activity would be superior after PCV7 vaccination compared with PPSV23 in moderate to severe COPD. We also posited that older age and prior PPSV23 vaccination would be associated with reduced vaccine responsiveness.Methods: One hundred twenty patients with COPD were randomized to PPSV23 (63 subjects) or PCV7 (57 subjects). IgG concentrations were determined by ELISA; functional antibody activity was assayed with a standardized opsonophagocytosis assay and reported as an opsonization killing index (OPK). Increases in serotype-specific IgG and OPK at 1 month post vaccination were compared within and between vaccine groups.Measurements and Main Results: Both vaccines were well tolerated. Within each study group, postvaccination IgG and OPK were higher than baseline (P < 0.01) for all serotypes. Adjusted for baseline levels, postvaccination IgG was higher in the PCV7 group than the PPSV23 group for all seven serotypes, reaching statistical significance for five (P < 0.05). PCV7 resulted in a higher OPK for six of seven serotypes (statistically greater for four) compared with PPSV23. In multivariate analyses, younger age, vaccine naivety, and receipt of PCV7 were associated with increased OPK responses.Conclusions: PCV7 induces a superior immune response at 1 month post vaccination compared with PPSV23 in COPD. Older age and prior PPSV23 reduce vaccine responsiveness.