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.
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 pa-tients diagnosed with SSc who were hospitalized in the Rheumatology and Immunology Department of Pe-king 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 par-ticipated 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 pa-tients,immunosuppressants to 56.57％,biologic agents to 7.07％,and small molecule targeted thera-pies 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.Further-more,26 patients reported exacerbation of SSc symptoms post-infection,which included severe manifesta-tions,such as Raynaud phenomenon,skin lesions,fingertip ulcers,pulmonary hypertension,and inter-stitial 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 analy-sis 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 hospitali-zation 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 un-derlying disease and more severe COVID-19 symptoms compared with individuals without underlying con-ditions.Thus,proactive prevention,continuous monitoring,and early treatment of COVID-19 are of sig-nificant importance for the health and well-being of SSc patients.Timely interventions can help mitigate the impact of infections and improve overall patient outcomes.
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