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北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (6): 1041-1046. doi: 10.19723/j.issn.1671-167X.2024.06.015

• 论著 • 上一篇    下一篇

系统性硬化症患者新型冠状病毒感染特点及疫苗接种效果：一项单中心队列研究

潘苇1,2, 李云1, 罗俊佳3, 李春1, 叶华1, 李雪1,*(), 贾园1,*()   

  1. 1. 北京大学人民医院风湿免疫科，北京 100044
    2. 中国人民解放军联勤保障部队第九二三医院检验科，南宁 530004
    3. 深圳市龙华区人民医院风湿免疫科，广东深圳 518110
  • 收稿日期:2024-08-01 出版日期:2024-12-18 发布日期:2024-12-18
  • 通讯作者: 李雪,贾园 E-mail:lx_bjmu@aliyun.com;jiayuan1023@sina.com
  • 作者简介:第一联系人：

    *These authors contributed equally to this work

  • 基金资助:
    国家自然科学基金(81871281);北京大学人民医院研究与发展基金(RDX2022-02)

COVID-19 vaccines efficacy and infection features in patients with systemic sclerosis: A single-center cohort study

Wei PAN1,2, Yun LI1, Junjia LUO3, Chun LI1, Hua YE1, Xue LI1,*(), Yuan JIA1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University People' s Hospital, Beijing 100044, China
    2. Department of Clinical Laboratory, 923 Hospital of the Chinese People' s Liberation Army Joint Logistic Support Force, Nanning 530021, China
    3. Department of Rheumatism and Immunology, Longhua District People' s Hospital, Shenzhen 518110, Guangdong, China
  • Received:2024-08-01 Online:2024-12-18 Published:2024-12-18
  • Contact: Xue LI, Yuan JIA E-mail:lx_bjmu@aliyun.com;jiayuan1023@sina.com
  • Supported by:
    National Natural Science Foundation of China(81871281);Peking University People's Hospital Scientific Research Development Funds(RDX2022-02)

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摘要：

目的: 了解系统性硬化症(systemic sclerosis，SSc)患者COVID-19疫苗接种及新型冠状(简称新冠)病毒感染情况。方法: 选取2016年1月至2023年3月于北京大学人民医院风湿免疫科住院，明确诊断为SSc的患者，通过住院病历检索和电话随访的形式，收集患者的临床特征、COVID-19疫苗接种及新冠病毒感染情况。结果: 236例SSc患者中有99例接受了电话随访及问卷调查，其中局限型SSc 41例、弥漫型SSc 28例、重叠综合征30例；患者接受了糖皮质激素(57.58%)、免疫抑制剂(56.57%)、生物制剂(7.07%)和小分子靶向药(6.06%)治疗。共49例患者接种过COVID-19疫苗，2022年11月至2023年3月期间共81例患者感染新冠病毒，接种三针及以上疫苗患者的感染率(19/29，65.5%)较未接种患者(45/50，90.0%)明显降低(P=0.007)。14例患者因新冠病毒感染住院治疗，26例患者感染后SSc症状有所加重，包括雷诺现象(Raynaud phenomenon)、皮肤病变、指端溃疡、肺动脉高压和肺间质病变等。与健康同居者相比较，SSc患者新冠病毒感染后发热(36.71%)、乏力(35.44%)等症状更严重。多因素回归分析显示，皮下钙质沉积(OR=7.713，95%CI：1.142~45.051)和抗着丝点抗体阳性(OR=9.210，95%CI：1.211~70.028)是SSc患者因新冠病毒感染入院治疗的独立危险因素。结论: 对于SSc患者，接种COVID-19疫苗对预防新冠病毒感染有效且安全；SSc患者新冠病毒感染后原发病加重，且感染症状也较无基础病人群加重。预防和早期合理治疗新冠病毒感染，对SSc患者具有重要意义。

关键词: 系统性硬化症, 新型冠状病毒感染, COVID-19疫苗

Abstract:

Objective: To comprehensively understand the COVID-19 vaccination and infection status among patients with systemic sclerosis (SSc). Methods: We conducted a retrospective analysis of patients diagnosed with SSc who were hospitalized in the Rheumatology and Immunology Department of Peking University People' s Hospital from January 2016 to March 2023. We collected detailed clinical cha-racteristics, vaccination status, and infection details through a systematic review of medical records and telephone follow-ups with the SSc patients. Results: Out of 236 identified patients, 99 SSc patients participated in the follow-up. This cohort included 41 patients with limited SSc, 28 with diffuse SSc, and 30 with SSc overlap syndromes. Treatments varied, with glucocorticoids administered to 57.58% of patients, immunosuppressants to 56.57%, biologic agents to 7.07%, and small molecule targeted therapies to 6.06%. Notably, 49 patients had received the COVID-19 vaccine. Between November 2022 and March 2023, a total of 81 patients contracted COVID-19. The infection rate among those who received three doses or more (19/29, 65.5%) was significantly lower compared with unvaccinated patients (45/50, 90.0%, P=0.007). Fourteen of these patients required hospitalization due to COVID-19. Furthermore, 26 patients reported exacerbation of SSc symptoms post-infection, which included severe manifestations, such as Raynaud phenomenon, skin lesions, fingertip ulcers, pulmonary hypertension, and interstitial lung disease. Compared with healthy cohabitants, the SSc patients exhibited more severe symptoms following COVID-19, including fever (36.71%) and fatigue (35.44%). Multivariate regression analysis identified subcutaneous calcinosis (OR=7.713, 95%CI: 1.142-45.051) and positivity for anti-centromere antibodies (OR=9.210, 95%CI: 1.211-70.028) as independent risk factors for hospitalization due to COVID-19. Conclusion: Vaccination is both effective and safe in preventing COVID-19 among SSc patients. Additionally, it underscores that these patients experience exacerbation of their underlying disease and more severe COVID-19 symptoms compared with individuals without underlying conditions. Thus, proactive prevention, continuous monitoring, and early treatment of COVID-19 are of significant importance for the health and well-being of SSc patients. Timely interventions can help mitigate the impact of infections and improve overall patient outcomes.

Key words: Systemic sclerosis, COVID-19, COVID-19 vaccines

中图分类号: 

  • R593.2

表1

系统性硬化症患者一般资料(n=99)"

Items Data Items Data
Age/years, $\bar x \pm s$ 54.92±14.30 Results of laboratory tests, n (%)
Female, n (%) 93 (93.94)   ANA+ 64 (64.65)
BMI/(kg/m2), $\bar x \pm s$ 22.54±4.02   Anti-Scl-70+ 25 (25.25)
Localized SSc, n(%) 41 (41.41)   ACA+ 10 (10.10)
Diffuse SSc, n (%) 28 (28.28)   Anti Ro-52+ 18 (18.18)
Overlap syndrome, n (%) 30 (30.30)   Anti-ku+ 4 (4.04)
  RA 8 (8.08)   Anti-RP11+ 2 (2.02)
  SLE 9 (9.09)   Anti-RP155+ 2 (2.02)
  Other 13 (13.13)   Anti PM-Scl100+ 1 (1.01)
Clinical manifestations, n (%)   Anti-Th/To+ 2 (2.02)
  Raynaud phenomenon 85 (85.85) Use medication before infection, n (%)
  Arthritis 26 (26.26)   Glucocorticoid 57 (57.58)
  Myositis 7 (7.07)   Hydroxychloroquine 34 (34.34)
  Subcutaneous calcareous deposition 8 (8.08)   Immunosuppressants 56 (56.57)
  Digestive tract involvement 23 (23.23)   Tocilizumab 6 (6.06)
  Heart involvement 11 (11.11)   JAK inhibitors 6 (6.06)
  Interstitial lung disease 50 (50.51)   Rituximab 1 (1.01)
  Kidney crisis 4 (4.04)

表2

系统性硬化症患者的COVID-19疫苗接种情况(n=99)"

Items n(%)
Number of COVID-19 vaccine recipients 49 (49.50)
  One dose 7 (14.29)
  Two doses 13 (26.53)
  Three doses 28 (57.14)
  Four doses 1 (2.04)
Developed symptoms after vaccination
  Muscle soreness 10 (20.41)
  Injection site inflamed and swollen ≥3 d 4 (8.16)
  Fatigue 4 (8.16)
  Joint pain 3 (6.12)
  Nausea and vomiting 2 (4.08)
  Fever 1 (2.04)
  Dyspnea or hospitalization 0

图1

接种不同针数COVID-19疫苗的系统性硬化症患者新冠病毒感染率"

表3

系统性硬化症患者新冠病毒感染及治疗情况(n=81)"

Items Data
Diagnostic methods, n(%)
  COVID-19 antigens positive 48 (59.26)
  COVID-19 nucleic acid positive 12 (14.81)
  Developed similar symptoms following exposure 18 (22.22)
No symptoms, n(%) 3 (3.70)
Duration of symptoms/d, $\bar x \pm s$ 25.53±24.62
Therapy, n(%)
  Chinese traditional medicine 30 (37.04)
  Antipyretic analgesics 21 (25.93)
  Glucocorticoid 19 (23.46)
  Nirmatrelvir 2 (2.47)
  Other antivirals (interferon alpha, oseltamivir) 3 (3.70)
Measures taken during infection, n(%)
  Oxygen 5 (6.17)
  Inpatient care 14 (17.28)

图2

与同居者相比系统性硬化症患者的表现"

表4

新冠病毒感染期间系统性硬化症患者病情变化情况"

Items n(%)
Patients feeling worsened 26 (32.10)
New or exacerbated manifestations
  Raynaud phenomenon 22 (27.16)
  Skin swelling and hardening 16 (19.75)
  Skin ulcers 8 (9.88)
  Heart involvement 3 (3.70)
  Pulmonary hypertension 3 (3.70)
  Interstitial lung disease 15 (18.52)

表5

系统性硬化症患者因新冠病毒感染住院组与非住院组一般资料比较"

Clinical data Hospitalized treatment (n=14) Non-hospitalized treatment (n=67) t/χ2 P
Age/years, $\bar x \pm s$ 58.57±11.17 52.67±14.75 -1.312 0.189
Female, n (%) 14(100.00) 62(92.54) 1.100 0.294
BMI/(kg/m2), $\bar x \pm s$ 21.79±3.64 23.06±5.27 -0.631 0.528
Localized SSc, n(%) 6(42.86) 30(44.78) 0.017 0.895
Diffuse SSc, n (%) 2(14.29) 17(25.37) 0.867 0.352
Overlap syndrome, n (%) 4(28.57) 20(29.85) 0.009 0.924
  RA 1(7.14) 7(10.45) 0.153 0.696
  SLE 1(7.14) 8(11.94) 0.298 0.585
  Other 3(21.43) 7(10.44) 1.125 0.287
Clinical manifestations
  Raynaud phenomenon 14(100.00) 55(82.09) 4.972 0.026
  Arthritis 3(21.43) 17(25.37) 0.099 0.753
  Myositis 1(7.14) 5(7.46) 0.002 0.967
  Subcutaneous calcareous deposition 4(28.57) 4(5.97) 5.168 0.023
  Digestive tract involvement 7(50.00) 14(20.90) 2.741 0.193
  Heart involvement 4(28.57) 5(7.46) 4.189 0.041
  Interstitial lung disease 8(57.14) 35(52.24) 0.112 0.738
  Kidney crisis 1(7.14) 2(2.99) 0.554 0.457
Results of laboratory tests
  ANA+ 12(85.71) 49(73.13) 1.085 0.298
  Anti-Scl-70+ 4(28.57) 21(31.34) 0.009 0.837
  ACA+ 4(28.57) 3(4.48) 6.405 0.011
  Anti Ro-52+ 3(21.43) 12(17.91) 0.095 0.758
  Anti-ku+ 0 3(4.48) 0.651 0.420
  Anti-RP11+ 1(7.14) 1(1.49) 1.535 0.215
  Anti-RP155+ 1(7.14) 1(1.49) 1.535 0.215
  Anti PM-Scl100+ 0 1(1.49) 0.212 0.646
  Anti-Th/To+ 0 2(2.99) 0.428 0.513
Use medication before infection
  Glucocorticoid 6(42.86) 40(59.70) 1.339 0.247
  Hydroxychloroquine 8(57.14) 22(32.84) 2.934 0.087
  Immunosuppressants 10(71.43) 37(55.22) 1.249 0.264
  Tocilizumab 0 5 (7.46) 1.233 0.294
  JAK inhibitors 1(7.14) 3 (4.48) 0.173 0.677
  Rituximab 0 1 (1.49) 0.209 0.648
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ISSN 1671-167X
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