Study on the protective effect of vaccine in patients with microscopic polyangiitis-interstitial lung disease complicated with COVID-19 infection
Objective To analyze the clinical features of microscopic polyangiitis(MPA)-associated interstitial lung disease(ILD)patients infected with coronavirus disease-2019(COVID-19),and investigate the protective effect of SARS-CoV-2 vaccine.Methods Patients with MPA-ILD in the General Hospital of Tianjin Medical University were included,and patients also met the diagnostic criteria for COVID-19 in accordance with the COVID-19′s diagnosis and treatment plan(10th Edition).All of patients had positive evidence of coronavirus antigens or positive nucleic acid tests.Clinical data of patients,ILD imaging typing,COVID-19 vaccination,clinical typing and prognostic results were collected and analyzed.Results Thirty-seven patients with MPA-ILD were included,including 14 females and 23 males.Thirty-two patients with MPA were in remission at the time of infection with COVID-19,and 31 were maintained on concurrent immunosuppressive/biologic therapy.The original imaging type of MPA-ILD was predominantly usual interstitial pneumonia(UIP,15 cases)and nonspecific interstitial pneumonia(NSIP,14 cases).The typing of the remaining 8 cases was inconclusive.Of the COVID-19 subtypes,27 patients were mild infection,and 5 dead due to COVID-19.Eleven patients were unvaccinated,and 26 received inactivated vaccine.Among them,11 completed 3-dose of booster immunization.The proportion of patients with mild COVID-19 was significantly higher in MPA-ILD patients with vaccinated patient group than that in the unvaccinated patient group(P=0.038).Multifactorial analysis showed that vaccines were an independent protective factor for MPA-ILD patients with COVID-19 infection(OR=0.045,95%CI:0.004-0.472,P=0.010)and non-mild infection(OR=0.049,95%CI:0.005-0.517,P=0.012).Moreover,MPA in remission was a protective factor for COVID-19 non-mild infections(OR=0.021,95%CI:0.001-0.459,P=0.014).Conclusion Vaccination and MPA in remission may reduce the severity of COVID-19 infection in patients with MPA.
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