新型冠状病毒原型株有症状感染者中和抗体水平对奥密克戎亚型BA.1、BA.4和BA.5的保护概率预测  

Prediction of protection probability against Omicron BA.1, BA.4 and BA.5 variants in symptomatic infections with prototype strain based on neutralization antibody levels

作　　者：陆婉莹 陈鑫华 郑楠 余宏杰[1] Lu Wanying;Chen Xinhua;Zheng Nan;Yu Hongjie(School of Public Health/Key Laboratory of Public Health Safety,Ministry of Education,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学公共卫生学院流行病学教研室,公共卫生安全教育部重点实验室,上海200032

出　　处：《中华医学杂志》2023年第18期1429-1434,共6页National Medical Journal of China

基　　金：国家自然科学基金(82130093)

摘　　要：目的预测既往未接种疫苗的新型冠状病毒原型株有症状感染者再次感染奥密克戎变异株后发生不同临床结局的保护概率。方法数据来源于一项系统综述与荟萃分析。此项综述系统检索了PubMed、Embase、Web of Science和Europe PMC等数据库,纳入自2020年1月1日至2022年10月2日期间发表或上传的新型冠状病毒原型株有症状感染者体内中和抗体动态变化的研究,并提取文献学信息、研究设计、血清学实验信息和抗体结果。根据所提取的抗体滴度数据的散点分布特征,使用基于高斯分布的广义加性模型,对基于对数转换后的中和抗体滴度值进行拟合,得到新型冠状病毒原型株有症状感染者体内中和抗体随时间动态变化的数据。本研究选取了该综述结果中第28、51、261天自然感染者的抗体滴度用于预测分析。结果既往未接种疫苗的新型冠状病毒原型株有症状感染者体内产生的中和抗体可对其再次感染奥密克戎变异株提供一定的保护,保护概率随时间逐渐减弱。患者在出现症状后第28天的中和抗体水平能提供针对再次感染奥密克戎变异株BA.5的保护概率为30.3%(95%CI:20.0%~45.5%),针对有症状感染的保护概率为51.5%(95%CI:33.4%~75.9%),针对重症感染的保护概率为91.2%(95%CI:77.1%~97.7%)。再次感染奥密克戎BA.1、BA.4和BA.5变异株的保护概率在出现症状后第261天时下降明显,针对三种临床结局的保护概率分别为9.6%~12.9%、18.4%~23.9%和63.1%~70.3%。在同一时间点、针对同一临床结局,BA.1亚型的保护概率最高,BA.4其次,而BA.5最低。结论既往感染新型冠状病毒原型株且未接种疫苗的有症状患者体内诱导产生的中和抗体,对免于再次感染目前全球主导流行的奥密克戎BA.5亚型以及感染后出现症状的保护概率有限,在出现症状第28天时的保护概率为30.3%,第261天时降至10%左右。但对再感染后免于重症的保护概率�Objective To predict the protection probability of different clinical outcomes after reinfection with Omicron variant in symptomatic and unvaccinated COVID-19 patients who infected with prototype strain.Methods The data used in this study were derived from a systematic review and meta-analysis which systematically searched PubMed,Embase,Web of Science,and Europe PMC databases,included published and uploaded studies of dynamic changes of neutralizing antibodies in symptomatic COVID-19 patients from 1 January 2020 to 2 October 2022 and extracted the literature information,study design,serological experiment information and antibody results.According to the scatter distribution characteristics of antibody titer data,a generalized additive model based on Gaussian distribution was used to fit the titer value of neutralizing antibody based on logarithmic conversion and the dynamic change pattern of neutralizing antibody in symptomatic and unvaccinated COVID-19 patients infected with prototype strain over time was obtained.In this study,the fitted antibody titers of patients on the 28th,51st,and 261st day after symptom onset was selected to predict the protection probability.Results Neutralizing antibodies produced in symptomatic and unvaccinated patients infected with prototype strain could provide protection against Omicron reinfection,and the probability of protection gradually decreased with time.Neutralizing antibody level on day 28 after symptom onset provided protection probability of 30.3%(95%CI:20.0%-45.5%)against reinfection,51.5%(95%CI:33.4%-75.9%)against symptomatic reinfection,and 91.2%(95%CI:77.1%-97.7%)against severe reinfection caused by Omicron BA.5.The protection probability against Omicron BA.1,BA.4 and BA.5 reinfections decreased significantly 261 days after symptom onset,showing 9.6%-12.9%,18.4%-23.9%and 63.1%-70.3%against three clinical outcomes,respectively.At the same time point and against the same clinical outcome,the protection probability of BA.1 was the highest,followed by BA.4 and BA.5.Conc

关 键 词：病毒 新型冠状病毒感染 中和抗体 自然感染 保护概率 

分 类 号：R563.1[医药卫生—呼吸系统]