维持性血液透析患者接种新型冠状病毒肺炎疫苗的安全性及影响因素  

Safety and influencing factors of coronavirus disease 2019 vaccines in maintenance hemodialysis patients

作　　者：于海波[1] 王立华 王喆[1] 贾岚 王博[1] 李博[1] 姜埃利[1] Yu Haibo;Wang Lihua;Wang Zhe;Jia Lan;Wang Bo;Li Bo;Jiang Aili(Department of Kidney Disease and Blood Purification Treatment,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院肾脏病血液净化科,天津300211

出　　处：《中华肾脏病杂志》2023年第2期112-118,共7页Chinese Journal of Nephrology

基　　金：天津市科学技术协会重点决策咨询项目(TJSKXJCZXD202252)。

摘　　要：目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者接种新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫苗的现况、安全性及不良反应发生的影响因素。方法该研究为回顾性研究,以2020年1月至2022年7月天津市MHD患者接种COVID-19疫苗的人群为研究对象,收集患者的一般资料、接种疫苗情况、不良反应和接种疫苗前后实验室检查等资料。采用Logistic回归分析法分析患者接种疫苗后不良反应发生的危险因素。结果研究期间天津市登记接受血液透析治疗的患者7375例,其中53家血液透析中心共1036例接种COVID-19疫苗的患者被纳入本研究,COVID-19疫苗的接种率为14.05%,年龄(54.00±13.27)岁(17~88岁),男性676例(65.25%)。只接种1针疫苗171例(16.51%),接种2针疫苗464例(44.79%),接种3针疫苗401例(38.71%),出现不良反应67例(6.47%),无严重不良反应。与接种疫苗前相比,接种疫苗后患者中性粒细胞较低,淋巴细胞、谷丙转氨酶、谷草转氨酶及血白蛋白水平均较高(均P<0.05)。多因素Logistic回归分析结果显示,年龄(OR=0.967,95%CI 0.946~0.990,P=0.005)、既往有过敏史(OR=0.013,95%CI 0.001~0.151,P<0.001)、疫苗接种次数(OR=0.505,95%CI 0.330~0.774,P=0.002)、白细胞(OR=0.766,95%CI 0.628~0.935,P=0.009)、淋巴细胞(OR=0.082,95%CI 0.045~0.148,P<0.001)和血尿酸(OR=1.004,95%CI 1.001~1.008,P=0.020)与不良反应发生独立相关。结论MHD患者中COVID-19疫苗的接种率为14.05%,不良反应发生率为6.47%,未见严重不良事件。年龄、接种疫苗次数、既往有过敏史、淋巴细胞数量和血尿酸与MHD患者不良反应发生独立相关。Objective To explore the status of coronavirus disease 2019(COVID-19)vaccines,safety and the influencing factors of adverse reactions in maintenance hemodialysis(MHD)patients.Methods The study was a retrospective study.The MHD patients vaccinated with COVID-19 vaccines in Tianjin city from January 2020 to July 2022 were enrolled in the study.The data of general information,vaccination situation,adverse reactions,and laboratory tests before and after vaccination were collected.Logistic regression analysis was used to analyze the risk factors of adverse reactions after vaccination.Results A total of 7375 patients were registered to receive hemodialysis treatment in Tianjin city,of whom 1036 patients(14.05%)vaccinated with COVID-19 vaccines were enrolled from 53 hemodialysis centers in the study,with age of(54.00±13.27)years old(17-88 years old),and 676 males(65.25%).There were 171 patients(16.51%)receiving the first dose of vaccines only,464 patients(44.79%)receiving two doses of vaccines,401 patients(38.71%)receiving three doses of vaccines,and 67 patients(6.47%)had adverse reactions.No serious adverse reaction occurred.The number of neutrophils after vaccination was lower than that before vaccination(P<0.05),while the number of lymphocytes,alanine aminotransferase,glutamic oxaloacetic aminotransferase,and serum albumin after vaccination were higher than those before vaccination(all P<0.05).Logistic regression analysis showed that age(OR=0.967,95%CI 0.946-0.990,P=0.005),previous allergic history(OR=0.013,95%CI 0.001-0.151,P<0.001),serum uric acid(OR=1.004,95%CI 1.001-1.008,P=0.020),numbers of vaccinations administered(OR=0.505,95%CI 0.330-0.774,P=0.002),leukocytes(OR=0.766,95%CI 0.628-0.935,P=0.009)and lymphocytes(OR=0.082,95%CI 0.045-0.148,P<0.001)were independently correlated with the incidence of adverse reactions.Conclusions The proportion of MHD patients vaccinated with COVID-19 vaccines is 14.05%.The incidence of adverse reactions is 6.47%,and there is no serious adverse reaction.Age,previous allergic histo

关 键 词：肾透析 新型冠状病毒 COVID-19疫苗 危险因素 

分 类 号：R459.5[医药卫生—治疗学] R186[医药卫生—临床医学]