新型冠状病毒肺炎疫苗对慢性肾脏病透析患者保护作用的Meta分析

Protective effect of COVID-19 vaccines on dialysis patients with chronic kidney disease:a meta-analysis

目的对慢性肾脏病(chronic kidney disease,CKD)透析患者接种新型冠状病毒(2019 novel coronavirus,2019-nCoV,国际病毒分类委员会命名为SARS-CoV-2)肺炎(coronavirus disease 2019,COVID-19)疫苗的有效性及安全性进行评估。方法系统检索Pubmed、Medline、Embase英文数据库和中国知网、维普、万方中文数据库,截止时间为2022年4月25日,检索词包括:“haemodialysis”、“peritoneal dialysis”、“vaccine”、“seroresponse”、“COVID-19”、“SARS-CoV-2”、“慢性肾脏病”、“血液透析”、“腹膜透析”、“新冠疫苗”。提取有效数据后使用Stata进行数据分析,主要结局指标包括接种COVID-19疫苗后阳性率、抗体滴度、随访中抗体变化、SARS-CoV-2感染率、住院率及病死率。结果总共纳入26篇文献共154195例患者进行分析,Meta分析结果显示,CKD患者接种第一剂疫苗后血清IgG抗体阳性率为48%,第二剂后89%,第三剂后为96%。接种疫苗后血液透析和腹膜透析患者之间血清抗体及滴度差异均无统计学意义,但和健康对照组相比,透析患者接种疫苗后抗体阳性率及抗体滴度更低(均P<0.05)。在随访中,透析患者接种疫苗后第3个月较第1个月抗体阳性率降低12%,第6个月较第3个月降低15%,第6个月较第1个月降低20%。第三剂疫苗注射后血清抗体阳性率较注射前增加38%(RR=1.38,95%CI 1.12~1.70,P<0.001),抗体滴度水平显著增加(SMD=1.46,95%CI 0.31~2.61,P<0.001),尽管COVID-19疫苗不能降低透析患者的SARS-CoV-2感染率,但可以显著降低感染后住院率及病死率。结论CKD透析患者接种COVID-19疫苗后可产生较强的血清抗体,降低SARS-CoV-2感染后住院率及病死率,但抗体持续时间较短,滴度较低,有必要及时接种加强针,以获得更强的免疫保护效应。

Objective To evaluate the effectiveness and safety of coronavirus disease 2019(COVID-19)vaccines for dialysis patients with chronic kidney disease.Methods PubMed,Medline,Embase databases and CNKI,VIP,Wanfang databases were searched systematically.The deadline was April 25,2022.The search terms included haemodialysis,peritoneal dialysis,vaccine,seroresponse,COVID-19,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).The main outcome included the positive rate after vaccination,antibody titer,antibody changes during follow-up,infection rate of SARS-CoV-2,hospitalization rate and mortality.Results A total of 154195 patients were analyzed in 26 studies.The results of meta-analysis showed that the positive rate of serum IgG antibody in patients with chronic kidney disease was 48%after the first dose of vaccine,89%and 96%after the second dose and third dose,respectively.After vaccination with COVID-19 vaccines,there was no significant difference in serum antibody and titer between hemodialysis patients and peritoneal dialysis patients.However,compared with the healthy control group,the antibody positive rate and antibody titer of dialysis patients after vaccination were lower(both P<0.05).In the follow-up,the antibody positive rate at the third month decreased by 12%compared with at the first month,at the sixth month decreased by 15%compared with at the third month,and at the sixth month decreased by 20%compared with at the first month.The serum antibody positive rate after the third dose of vaccine increased by 38%(RR=1.38,95%CI 1.12-1.70,P<0.001),and the antibody titer increased significantly(SMD=1.46,95%CI 0.31-2.61,P<0.001).Although the vaccines could not reduce the infection rate of SARS-CoV-2 in dialysis patients,it could significantly reduce the hospitalization rate and mortality after infection.Conclusions After vaccination with COVID-19 vaccines,dialysis patients can produce strong serum antibodies,which can reduce the hospitalization rate and mortality after SARS-CoV-2 infection.However,the duration of antibody is short and the titer level is low,so it is necessary to timely vaccinate booster vaccine dose to obtain stronger immunogenicity.