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

doi:10.11958/20231791

Abstract

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

CLC Number:

R593.2

Figures/Tables 4

References 18

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组别	n		年龄/岁		女性		病程/年		吸烟状态						ILD类型				糖尿病
组别	n		年龄/岁		女性		病程/年		正在		既往		从不		UIP		NSIP		糖尿病
未接种疫苗组	11		69.55±7.67		5（45.5）		5.0（1.0，8.0）		1（9.1）		3（27.3）		7（63.6）		5（45.5）		3（27.3）		2（18.2）
接种疫苗组	26		66.31±5.61		9（34.6）		3.0（1.0，7.3）		7（26.9）		8（30.8）		11（42.3）		10（38.5）		11（42.3）		2（7.7）
t、Z或P			1.436		0.711^▲		0.552				0.391^▲				0.675				0.573^▲
组别		高血压		BMI/（kg/m²）		MPA病情缓解		免疫抑制治疗
组别		高血压		BMI/（kg/m²）		MPA病情缓解		CTX		MMF		他克莫司		雷公藤多苷		RTX		来氟米特		无
未接种疫苗组		5（45.5）		23.63±3.98		10（90.9）		6（54.5）		3（27.3）		0		0		0		0		2（18.2）
接种疫苗组		7（26.9）		22.71±2.81		22（84.6）		15（57.7）		2（7.7）		1（3.8）		1（3.8）		2（7.7）		1（3.8）		4（15.4）
t、Z或P		0.442^▲		0.796		1.000^▲								0.628

组别	n		年龄/岁		女性		病程/年		吸烟状态						ILD类型				糖尿病
组别	n		年龄/岁		女性		病程/年		正在		既往		从不		UIP		NSIP		糖尿病
未接种疫苗组	11		69.55±7.67		5（45.5）		5.0（1.0，8.0）		1（9.1）		3（27.3）		7（63.6）		5（45.5）		3（27.3）		2（18.2）
接种疫苗组	26		66.31±5.61		9（34.6）		3.0（1.0，7.3）		7（26.9）		8（30.8）		11（42.3）		10（38.5）		11（42.3）		2（7.7）
t、Z或P			1.436		0.711^▲		0.552				0.391^▲				0.675				0.573^▲
组别		高血压		BMI/（kg/m²）		MPA病情缓解		免疫抑制治疗
组别		高血压		BMI/（kg/m²）		MPA病情缓解		CTX		MMF		他克莫司		雷公藤多苷		RTX		来氟米特		无
未接种疫苗组		5（45.5）		23.63±3.98		10（90.9）		6（54.5）		3（27.3）		0		0		0		0		2（18.2）
接种疫苗组		7（26.9）		22.71±2.81		22（84.6）		15（57.7）		2（7.7）		1（3.8）		1（3.8）		2（7.7）		1（3.8）		4（15.4）
t、Z或P		0.442^▲		0.796		1.000^▲								0.628

组别	COVID-19分型		因COVID-19 住院	COVID-19 相关死亡
组别	轻症	非轻症	因COVID-19 住院	COVID-19 相关死亡
未接种疫苗组	5（45.5）	6（54.6）	6（54.6）	3（27.3）
接种疫苗组	22（84.6）	4（15.4）	3（11.5）	2（7.7）
P	0.038		0.011	0.140

组别	COVID-19分型		因COVID-19 住院	COVID-19 相关死亡
组别	轻症	非轻症	因COVID-19 住院	COVID-19 相关死亡
未接种疫苗组	5（45.5）	6（54.6）	6（54.6）	3（27.3）
接种疫苗组	22（84.6）	4（15.4）	3（11.5）	2（7.7）
P	0.038		0.011	0.140

变量	β	SE	Wald χ2	P	OR（95%CI）
疫苗	-3.106	1.202	6.679	0.010	0.045（0.004~0.472）
MPA缓解	-2.793	1.474	3.592	0.058	0.061（0.003~1.100）
ILD类型	-0.037	1.057	0.001	0.972	0.964（0.121~7.655）
免疫抑制	-1.199	1.210	0.982	0.322	0.302（0.028~3.230）
常数项	3.809	1.976	3.716	0.054	45.127