NPJ Vaccines:疫苗株对慢性阻塞性肺疾病患者和健康老年人流感疫苗免疫后血清阳转率的影响

2022-03-20 从医路漫漫 MedSci原创

慢性阻塞性肺疾病(COPD)是一种常见的、严重的肺部疾病,由吸烟和暴露在空气污染物中引起。

  

 慢性阻塞性肺疾病(COPD)是一种常见的、严重的肺部疾病,由吸烟和暴露在空气污染物中引起。慢性阻塞性肺病是全球第三大致死原因,全球疾病负担在未来几年可能大幅增加/鼻病毒和流感等常见呼吸道病毒经常引发慢性阻塞性肺疾病的加重,以及继发性细菌感染、住院和死亡。临床指南建议将流感疫苗接种作为COPD患者和其他高危人群(包括老年人和免疫受损人群)的优先事项。然而,在这些高危人群中,疫苗的效果可能不太理想,要么是因为与年龄相关的免疫功能障碍,称为免疫衰老,要么是因为抗病毒免疫方面的疾病特异性疾病。

   疫苗通过诱导抗体产生和持久记忆B细胞发挥作用,然而,流感疫苗的效果可能并不理想。接种疫苗后,流感抗体滴度下降相对较快,特别是在老年人,因此需要每年接种疫苗。此外,流感病毒血凝素(HA)和神经酰胺酶表面蛋白具有很高的抗原漂移和逃避宿主抗体的倾向,因此疫苗配方需要每年更新。每年疫苗的毒株选择通常基于对侧半球冬季传播的毒株的知识。

   尽管临床指南建议慢性阻塞性肺疾病(COPD)患者和其他高危人群接种流感疫苗,但目前尚不清楚当前的疫苗接种策略是否能诱导最佳抗体反应。这项研究的目的是确定与COPD患者和健康老年人的菌株特异性抗体反应相关的关键变量。

方法:76名慢性阻塞性肺病患者和72名健康参与者从澳大利亚的两个中心招募,接种了流感疫苗。免疫前后分别测定血清株特异性抗体效价。血清转换率是主要终点。不同疫苗株的抗体反应各不相同。

结果:新毒株的血清转换率最高(36-55%),连续一年以上对疫苗中包括的毒株的反应较小(27-33%)。COPD患者和健康参与者的疫苗反应相似。疫苗株、高血压和纬度是血清转换的独立预测因子。我们的发现让人放心,流感疫苗在COPD患者和健康的老年人中具有同等的免疫原性;然而,仍有改进的空间。

表1.研究人群的人口统计学和临床特征:COPD和老年健康参与者之间的比较。

图1血清转换的受试者比例(≥抗体滴度从D0上升4倍)。数据显示为比例±拟合标准误差。红色条:反复出现的菌株(出现在疫苗≥第二季中),蓝色条:疫苗季的新菌株。**对所有复发毒株(H1N1/加利福尼亚州、B/普吉岛和B/布里斯班)均有显著性差异(p<0.001);#仅对复发毒株H1N1/加利福尼亚州有显著性差异(p<0.05)。用叶茨卡方检验计算的比例间有显著性差异。

图2每株疫苗接种前(D0)和接种后(D28)的抗体反应。数据以GMT±95%置信区间表示。如果置信区间(CI)不重叠,则认为每个菌株的时间差异显著。虚线水平线代表格林威治时间1:40,表示血清保护。GMT:几何平均滴度。

表2.疫苗接种前(D0)和接种后(D28)的疫苗反应:每种疫苗株的血清保护率、血清转换率和GMT

结论:可能需要使每年的流感疫苗个人化,包括考虑先前存在的抗体滴度,以便针对单个抗体库中的空白并加强保护。

原文出处:Snape N,  Anderson GP,  Irving LB, et al.Vaccine strain affects seroconversion after influenza vaccination in COPD patients and healthy older people.NPJ Vaccines 2022 Jan 24;7(1)

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    2022-12-22 heli0118
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    2022-10-24 tomyang96
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