天津医药

天津医药 ›› 2024, Vol. 52 ›› Issue (7): 683-686.doi: 10.11958/20231791

• 专题研究·结缔组织病-间质性肺病/肺动脉高压（主编 魏蔚） • 上一篇    下一篇

显微镜下多血管炎相关间质性肺病合并COVID-19患者疫苗保护作用初探

祁福敏(), 苏睿, 郝剑, 苏丽, 范倩, 李昕, 魏蔚∆()   

  1. 天津医科大学总医院风湿免疫科（邮编300052）
  • 收稿日期:2023-11-19 修回日期:2024-01-09 出版日期:2024-07-15 发布日期:2024-07-11
  • 通讯作者: ∆E-mail：tjweiwei2003@163.com
  • 作者简介:祁福敏（1996），女，医师，主要从事ANCA相关性血管炎方面研究。E-mail：qifumin0607@163.com

Study on the protective effect of vaccine in patients with microscopic polyangiitis-interstitial lung disease complicated with COVID-19 infection

QI Fumin(), SU Rui, HAO Jian, SU Li, FAN Qian, LI Xin, WEI Wei∆()   

  1. Department of Rheumatology and Immunology, Tianjin Medical University General Hospital, Tianjin 300052, China
  • Received:2023-11-19 Revised:2024-01-09 Published:2024-07-15 Online:2024-07-11
  • Contact: ∆E-mail: tjweiwei2003@163.com

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摘要：

目的 分析显微镜下多血管炎（MPA）相关间质性肺病（ILD）患者合并新型冠状病毒肺炎（COVID-19）的临床特征，初步探究新型冠状病毒（SARS-CoV-2）疫苗的保护作用。方法 纳入确诊的MPA-ILD患者，同时符合《新型冠状病毒感染诊疗方案（第十版）》制定的COVID-19诊断标准，且均有明确SARS-CoV-2抗原或核酸检测阳性证据。收集并分析患者临床资料，ILD影像学分型，SARS-CoV-2疫苗接种情况、临床分型及预后。结果 共纳入37例MPA-ILD患者，女14例，男23例。32例在并发COVID-19时MPA病情处于缓解期，31例同时维持免疫抑制剂或生物制剂治疗。ILD的影像学类型以寻常型间质性肺炎（15例）和非特异性间质性肺炎（14例）为主，剩余8例分型不确定。COVID-19分型中，27例为轻症，5例因COVID-19死亡。11例未接种疫苗，26例接种SARS-CoV-2灭活疫苗，其中11例完成3剂次加强免疫。接种疫苗患者COVID-19轻症比例高于未接种疫苗组（P=0.038）。多因素分析显示接种疫苗为MPA-ILD患者合并COVID-19住院（OR=0.045，95%CI：0.004~0.472，P=0.010）及非轻症感染（OR=0.049，95%CI：0.005~0.517，P=0.012）的独立保护因素。同时MPA处于缓解期为COVID-19非轻症感染的保护因素（OR=0.021，95%CI：0.001~0.459，P=0.014）。结论 接种SARS-CoV-2疫苗及MPA病情处于缓解期有可能减轻MPA患者合并COVID-19的严重程度。

关键词: 显微镜下多血管炎, 新型冠状病毒肺炎, COVID-19疫苗

Abstract:

Objective To analyze the clinical features of microscopic polyangiitis (MPA)-associated interstitial lung disease (ILD) patients infected with coronavirus disease-2019 (COVID-19)，and investigate the protective effect of SARS-CoV-2 vaccine. Methods Patients with MPA-ILD in the General Hospital of Tianjin Medical University were included, and patients also met the diagnostic criteria for COVID-19 in accordance with the COVID-19's diagnosis and treatment plan (10th Edition). All of patients had positive evidence of coronavirus antigens or positive nucleic acid tests. Clinical data of patients, ILD imaging typing, COVID-19 vaccination, clinical typing and prognostic results were collected and analyzed. Results Thirty-seven patients with MPA-ILD were included, including 14 females and 23 males. Thirty-two patients with MPA were in remission at the time of infection with COVID-19, and 31 were maintained on concurrent immunosuppressive/biologic therapy. The original imaging type of MPA-ILD was predominantly usual interstitial pneumonia (UIP, 15 cases) and nonspecific interstitial pneumonia (NSIP, 14 cases). The typing of the remaining 8 cases was inconclusive. Of the COVID-19 subtypes, 27 patients were mild infection, and 5 dead due to COVID-19. Eleven patients were unvaccinated, and 26 received inactivated vaccine. Among them, 11 completed 3-dose of booster immunization. The proportion of patients with mild COVID-19 was significantly higher in MPA-ILD patients with vaccinated patient group than that in the unvaccinated patient group (P=0.038). Multifactorial analysis showed that vaccines were an independent protective factor for MPA-ILD patients with COVID-19 infection (OR=0.045, 95%CI: 0.004-0.472, P=0.010) and non-mild infection (OR=0.049, 95%CI: 0.005-0.517, P=0.012). Moreover, MPA in remission was a protective factor for COVID-19 non-mild infections (OR=0.021, 95%CI: 0.001-0.459, P=0.014). Conclusion Vaccination and MPA in remission may reduce the severity of COVID-19 infection in patients with MPA.

Key words: microscopic polyangiitis, COVID-19, COVID-19 vaccines

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