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Lancet Rheumatol: 免疫介导的炎症性疾病和其治疗对COVID-19结局和疫苗反应的影响

2021-09-09 MedSci原创 MedSci原创

Lancet Rheumatology
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免疫介导炎症性疾病患者感染COVID-19风险未增加，对疫苗耐受性良好。

在 COVID-19 大流行之初，免疫介导的炎症性疾病患者被认为是感染 SARS-CoV-2且会发展成严重COVID-19的高风险人群。然而Filippo Fagni等人整理过去一年收集的数据表明炎性关节炎、银屑病或炎性肠病患者感染 SARS-CoV-2 或发展成严重 COVID-19的风险与没有这些疾病的人相比风险并未增加。

多个研究表明使用糖皮质激素增加免疫介导炎症性疾病患者感染COVID-19、感染后入院和死亡的风险。糖皮质激素不仅广泛地抑制先天免疫系统的功能，也极大地抑制适应性免疫细胞，例如T细胞。一个调查了来自40个国家600名患者的大型横断面研究表明每日摄入10 mg或更多的强的松与两倍入院风险相关（OR 2.05,95% CI 1.06-3.96）。COVID-19登记数据和结缔组织疾病患者队列数据表明接受B细胞耗竭疗法的患者长期存在SARS-CoV-2病毒血症、体液免疫反应延迟、高住院率、严重COVID-19反应和高死亡率。整体上看，糖皮质激素和B 细胞耗竭治疗似乎会恶化COVID-19的结果。

此外，大量数据表明免疫介导的炎症患者经常使用的某些药物，尤其是细胞因子抑制剂，甚至可能降低患严重COVID-19的风险。比如，一项欧洲多中心研究调查了3028 名患有多种免疫介导炎症性疾病（主要是炎症性关节炎）患者的SARS-CoV-2临床和血清学流行情况，发现细胞因子抑制剂减少了近50%有症状的 COVID-19（OR 0.51,0.32–0.82）中，提示细胞因子抑制剂（如 TNF 抑制剂）可以缓解 COVID-19感染的进程。

最后，第一批对这些疾病的患者进行SARS-CoV-2疫苗接种的数据显示耐受性良好，但是对疫苗接种的免疫反应可能有所降低，尤其是服用甲氨蝶呤或进行CD20靶向治疗的患者。

Reference:

Fagni F, Simon D, Tascilar K, Schoenau V, Sticherling M, Neurath MF, Schett G. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. Lancet Rheumatol. 2021 Aug 27. doi: 10.1016/S2665-9913(21)00247-2. Epub ahead of print. PMID: 34485930; PMCID: PMC8397302.

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    2022-07-04 howi

    #Lancet#

    0

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    2021-11-13 ms9651749636653578

    #炎症性疾病#

    0

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    2021-12-30 yangcx0915

    #疫苗反应#

    0

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    2021-09-10 12498dd9m15暂无昵称

    #炎症性#

    0

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    2021-09-10 爆笑小医

    #免疫介导的炎症性疾病#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1831291, encodeId=7a5d18312913f, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Mon Jul 04 04:56:13 CST 2022, time=2022-07-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1736830, encodeId=05081e3683098, content=<a href='/topic/show?id=56bf6e024d4' target=_blank style='color:#2F92EE;'>#炎症性疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67024, encryptionId=56bf6e024d4, topicName=炎症性疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9d7334182962, createdName=ms9651749636653578, createdTime=Sat Nov 13 15:56:13 CST 2021, time=2021-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798801, encodeId=89a51e988017c, content=<a href='/topic/show?id=0bade0496eb' target=_blank style='color:#2F92EE;'>#疫苗反应#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70496, encryptionId=0bade0496eb, topicName=疫苗反应)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4723380, createdName=yangcx0915, createdTime=Thu Dec 30 10:56:13 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1547470, encodeId=5bbc154e47074, content=<a href='/topic/show?id=4ef26e01766' target=_blank style='color:#2F92EE;'>#炎症性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=67017, encryptionId=4ef26e01766, topicName=炎症性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=09e813968720, createdName=12498dd9m15暂无昵称, createdTime=Fri Sep 10 00:56:13 CST 2021, time=2021-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1622889, encodeId=17241622889d3, content=<a href='/topic/show?id=b6052895168' target=_blank style='color:#2F92EE;'>#免疫介导的炎症性疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28951, encryptionId=b6052895168, topicName=免疫介导的炎症性疾病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Fri Sep 10 00:56:13 CST 2021, time=2021-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1016004, encodeId=97b010160047a, content=学习了<a href='/topic/show?id=23e3454e353' target=_blank style='color:#2F92EE;'>#学习#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45473, encryptionId=23e3454e353, topicName=学习)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3fc25474426, createdName=ms1000001651821510, createdTime=Thu Sep 09 11:12:10 CST 2021, time=2021-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1015703, encodeId=e7361015e037d, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=08531974177, createdName=凤梨酥茄子泥, createdTime=Wed Sep 08 15:15:09 CST 2021, time=2021-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034444, encodeId=acb91034444f7, content=顶刊就是不一样，质量很高，内容精彩！学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Wed Sep 08 12:56:13 CST 2021, time=2021-09-08, status=1, ipAttribution=)]
    2021-09-09 ms1000001651821510

    学习了#学习#

    0

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    2021-09-08 凤梨酥茄子泥

    学习了

    0

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    2021-09-08 goodbing

    顶刊就是不一样，质量很高，内容精彩！学到很多

    0