Longevity Of SARS-CoV-2 (COVID-19) immune Responses in Hemodialysis Patients And Protection Against Reinfection
Mar 07, 2022
Hu rau: emily.li@wecistanche.com
Cov neeg mob thaum kawgmob raumtau txais in-center hemodialysis (ICHD) tau muaj tus nqi siab ntawm SARS-CoV-2(COVID-19) kab mob. Tom qab kis kab mob, cov neeg mob tau txais ICHD nquag tsim cov tshuaj tiv thaiv kab mob rau SARS-CoV-2, txawm tias muaj tus kab mob asymptomatic. Ntawm no, peb tau tshawb xyuas qhov ua haujlwm ntev thiab ua haujlwm ntawm lub cev tiv thaiv kab mob rau SARS-CoV-2 (COVID-19) kis kab mob hauv cov neeg mob tau txais ICHD. Peb puas thiab tsib caug-rau cov neeg mob no tau soj ntsuam ntev rau SARS-CoV-2(COVID-19) Cov tshuaj tiv thaiv kab mob thiab tau ua raws li niaj hnub PCR-test rau cov tsos mob thiab asymptomatic kab mob. Cov neeg mob tau kuaj xyuas tsis tu ncua rau nucleocapsid protein (anti-NP) thiab receptor binding domain (anti-RBD) cov tshuaj tiv thaiv, thiab cov neeg uas dhau los ua neeg tsis zoo nyob rau lub hlis tau kuaj rau SARS-CoV-2 cov lus teb tshwj xeeb T-cell. Ib puas thiab nees nkaum cuaj (36.2 feem pua) cov neeg mob tau kuaj pom cov tshuaj tiv thaiv anti-NP thaum lub sijhawm xoom, ntawm 127 kuj tau kuaj pom cov tshuaj tiv thaiv RBD. Qhov tseem ceeb, ntawm rau lub hlis, 71/111 (64.0 feem pua ) thiab 99/116 (85.3 feem pua) tseem yog anti SNP thiab anti-RBD seropositive, feem. Rau cov neeg mob uas khaws cov tshuaj tiv thaiv kab mob, ob qho tib si anti-NP thiab anti-RBD qib tau txo qis tom qab rau lub hlis. Kaum ib tus neeg mob uas tau tiv thaiv NP seropositive thaum lub sijhawm xoom tsis muaj tshuaj tiv thaiv kab mob ntawm rau lub hlis; ntawm yim leej tau pom tias muaj SARS-CoV-2(COVID-19) Antigen tshwj xeeb T cell teb. Kev ywj pheej ntawm cov tshuaj tiv thaiv ntawm rau lub hlis, cov neeg mob uas muaj tus kab mob zoo SARS-CoV-2 serology tsis tshua muaj peev xwm muaj PCR paub tseeb tias kis tau rau lub hlis tom ntej. Yog li, cov neeg mob tau txais ICHD mount lub cev tiv thaiv kab mob rau lub hlis tom qab SARS-CoV-2(COVID-19) kab mob, nrog tsawg dua 3 feem pua ntawm cov neeg mob uas tsis pom muaj pov thawj ntawm kev humoral lossis cellulartiv thaiv kab mob.
KEYWORDS: COVID-19; hemodialysis; SARS-CoV-2; serology
Cistanche yog qhov zoo rau kev txhim kho kev tiv thaiv
Qhov kev ua tau zoo tau tshwm sim los ntawm ntau qhov mob hnyav ua pa nyuaj ua rau tus mob coronavirus 2 (SARS-CoV-2) kev sim tshuaj tiv thaiv tau muab cov xov xwm zoo siab tos txais thaum kawg ntawm xyoo 2020, raws li kev nthuav tawm ntawm cov kev pab cuam txhaj tshuaj zoo tau teeb tsa los cim qhov pib ntawm qhov kawg ntawm kev sib kis. .1–3 Cov tshuaj tiv thaiv Moderna (mRNA-1273), Pfizer/BioNTech (BNT162b2 mRNA), thiab Oxford/AstraZeneca (ChAdOx1 nCoV-19) cov tshuaj tiv thaiv tau pom tias yuav ua rau muaj kev lom zem thiab lub cev tiv thaiv kab mob cov protein ntau ntawm SARS-CoV-2, uas tseem ceeb tiv thaiv tib neeg los ntawm kev pheej hmoo ntawm kev kis kab mob tom ntej.4,5 Txawm li cas los xij, muab cov teeb meem logistical cuam tshuam nrog kev muab khoom, kev faib tawm, thiab kev tswj hwm cov tshuaj tiv thaiv thoob ntiaj teb, ntxiv kev tiv thaiv thiab tswj kev ntsuas. yuav tsum tau txuas ntxiv rau lub hlis tom ntej.
Cov neeg mob uas muaj kab mob hauv lub raum kawg (ESKD) tau raug txheeb xyuas tias muaj cov tsos mob tsis zoo tom qab SARS-CoV-2 kab mob.6–8 Tsis tas li ntawd, nws tau lees paub tias cov neeg mob tau txais kev kho mob hauv nruab nrab hemodialysis (ICHD) nyob ntawm Kev pheej hmoo siab dua ntawm kev kis tus kab mob vim qhov tsis muaj peev xwm tiv thaiv tau zoo.8 Siv cov txheej txheem serological, yav dhau los peb tau pom tias cov neeg mob ESKD nkag mus rau seroconvert tom qab paub tseeb tias SAR-CoV-2 kab mob; peb kuj tau qhia tias asymptomatic seroconversion muaj tshwm sim nyob rau hauv qhov chaw raug mob siab ntawm ICHD units.7 Dab tsi tsis paub tam sim no hauv cov pej xeem no yog qhov ua tau ntev ntawm cov tshuaj tiv thaiv kab mob thiab seb puas muaj SARS-CoV-2 cov tshuaj tiv thaiv tiv thaiv kab mob. tus neeg uas muaj ESKD los ntawm kev rov ua dua tshiab.
Hauv qhov kev tshawb fawb no, peb tshaj tawm cov xwm txheej ntev serological ntawm ib pawg loj ntawm cov neeg mob tau txais ICHD. Lub hom phiaj ntawm peb txoj kev tshawb fawb yog los sib piv qhov ntev ntawm cov tshuaj tiv thaiv kab mob rau qhov sib txawv SARS-CoV-2 antigenic lub hom phiaj, uas yog, nucleocapsid thiab receptor-binding domain ntawm spike protein. Peb tshawb xyuas cov tshuaj tiv thaiv kab mob ntawm tes hauv cov neeg mob uas cov tshuaj tiv thaiv kab mob tau ploj mus, thiab thaum kawg, peb ntsuas seb puas muaj cov tshuaj tiv thaiv kab mob tiv thaiv kab mob SARS-CoV-2 tiv thaiv cov neeg mob tau txais kev lim ntshav los ntawm kev rov ua dua tshiab.
Txoj kev
Kev xaiv tus neeg mob
Peb puas tsib caug-rau tus neeg mob tau txais ICHD nyob rau hauv 2 units koom nrog Imperial College Renal thiab Transplant Center raws li tau tshaj tawm yav dhau los suav nrog.7 Cov neeg mob tau taug qab txij li 24 Lub Ob Hlis 2020 mus txog rau 1 Lub Ib Hlis 2{ {24}}21. Txhua tus neeg mob kuaj (n ¼ 356) ntawm lub sijhawm 0 raug kuaj rau nucleocapsid protein (anti-NP) thiab RBD (anti-RBD) cov tshuaj tiv thaiv. Thaum 6 lub hlis, tag nrho cov qauv muaj (n ¼ 301) tau rov kuaj dua rau kev tiv thaiv NP (Ntxiv daim duab S1). Tsis tas li ntawd, cov qauv raug kuaj rau kev tiv thaiv RBD yog tias ib qho ntawm cov qauv hauv qab no tau ntsib: cov neeg mob tau tiv thaiv NPþ ntawm 6 lub hlis lossis cov neeg mob muaj qhov sib npaug ntawm cov tshuaj tiv thaiv NP (piv txwv li, qhov txiav tawm index [S / C] ntawm 0.25– 1.39) los yog anti-NP (piv txwv li, ib qho S / C ntawm # 0.24) ntawm 6 lub hlis tab sis yog los tiv thaiv NPþ thiab / los yog anti-RBDþ ntawm lub hauv paus.
Cov txiaj ntsig ntawm tus neeg mob, suav nrog tag nrho cov tshiab SARS-CoV-2(COVID-19) Cov kab mob tau lees paub los ntawm kev kuaj pom tus kab mob, tau sau tseg txog thaum Lub Ib Hlis 1, uas suav nrog cov ntaub ntawv los ntawm nthwv dej thib ob ntawm kev kis mob hauv tebchaws Askiv. Daim duab qhia txog qhov tshwm sim ntawm cov neeg moblos ntawm serological thiab symptomatic xwm txheej yog qhia nyob rau hauvDaim duab 1. Txoj kev tshawb fawb no tau pom zoo los ntawm Pawg Saib Xyuas Kev Tshawb Fawb Kev Noj Qab Haus Huv Kev Tshawb Fawb Txog Kev Ncaj Ncees (Reference: 20/WA/0123 - Qhov cuam tshuam ntawmCOVID-19rau cov neeg mob uas muaj kab mob raum thiab Immunosuppressed Patients).
SARS-CoV-2 antibody detection
Baseline serum los ntawm txhua tus neeg mob tau sim rau ob qho tib si anti-NP thiab anti-RBD cov tshuaj tiv thaiv. Lub xub ntiag ntawm cov tshuaj tiv thaiv NP raug soj ntsuam siv cov khoom lag luam muag Abbott Architect SARS-CoV-2(COVID-19) IgG II kauj ruam chemiluminescent immunoassay raws li cov chaw tsim khoom cov lus qhia. Rau qhov kev tshawb fawb no, cov qauv raug txhais tias yog qhov zoo lossis qhov tsis zoo raws li cov chaw tsim khoom cov lus qhia nrog tus nqi txiav tawm ntawm 1.4.9 Anti-RBD tau kuaj pom siv ib qho hauv tsev ob-antigen binding enzyme-txuas immunoassay (Imperial SARS-CoV{{ 8}}(COVID-19) Hybrid DABA, Imperial College London, London, UK), which detects total RBD antibodies.10 The in-house assay cutoff was calculated from receiver operating characteristic curve analysis, and serum reactivity was normalized by using the signal-to-cutoff ratio. For this study, a sample was considered antibody positive if the signal-to-cutoff ratio was >1.2. Ib qho kev ntsuam xyuas RBD tau siv ntxiv rau qhov kev ntsuam xyuas los tiv thaiv NP, raws li kev tiv thaiv RBD tau pom tias muaj kev cuam tshuam nrog cov tshuaj tiv thaiv tsis zoo.11
Detection of SARS-CoV-2 T-cell responses
T-cell cov lus teb tau raug tshawb xyuas nyob rau hauv cov ntaub ntawv uas serological pov thawj ntawm tus kab mob, ob qho tib si anti-NP, thiab anti-RBD, tau waned ntawm 6 lub hlis.
SARS-CoV-2–specific T-cell responses were detected using T-SPOT Discovery SARS-CoV-2(COVID-19) (Oxford Immunotec) raws li cov chaw tsim khoom cov lus qhia. Hauv luv luv, peripheral ntshav mononuclear hlwb raug cais los ntawm tag nrho cov ntshav kuaj siv T-Cell Select (Oxford Immunotec) qhov twg qhia. Tag nrho ntawm 250,000 peripheral blood mononuclear cells raug plated hauv ib lub qhov dej ntawm T-SPOT Discovery SARS-CoV-2(COVID-19) plate. The assay measures immune responses to 5 different overlapping SARS-CoV-2 structural peptide pools: spike protein, nucleocapsid protein, membrane protein, and a mix of structural proteins, as well as positive and negative controls. Cells were incubated, and interferon-g–secreting T cells were detected. The sum of T-SPOT immune responses to SARS-CoV-2 structural peptides was calculated. Counts >12 qhov chaw ntawm 250,000 peripheral ntshav mononuclear hlwb tau tshaj tawm tias zoo.12
Diagnosis of SARS-CoV-2 infection
Kev kis tus kab mob SARS-CoV-2 tau lees paub los ntawm kev rov qab transcriptase-polymerase chain reaction (PCR) kev soj ntsuam ntawm nasopharyngeal swab specimens, tom qab kev tshuaj ntsuam niaj hnub lossis tom qab kev nthuav qhia mob. Rov qab transcriptase PCR tau ua raws li Public Health England cov lus qhia los ntawm kev siv cov ntawv pov thawj kos npe nrog cov primers qhia tawm tsam ntau lub hom phiaj ntawm SARS-CoV-2 genes.13 Lub Peb Hlis thiab Lub Rau Hli 2020, cov neeg mob tau rov qab transcriptase PCR kuaj ntawm nasopharyngeal swabs thaum lawv nthuav qhia rau kev lim ntshav nrog cov tsos mob. Thaum Lub Rau Hli, txhua tus neeg mob hauv peb lub chaw tau tshuaj xyuas tsis hais cov tsos mob, ua ib feem ntawm kev soj ntsuam ib leeg kom paub tseeb tias muaj tus kab mob. Txij li thaum pib ntawm nthwv dej thib ob thaum lub Kaum Ib Hlis 2020, txhua tus neeg mob tau txais ICHD tau ua txhua lub limtiam rov qab transcriptase PCR kuaj ntawm nasopharyngeal swabs.
Kev txheeb cais
Statistical and graphical analyses were performed with MedCalc v19.2.1 (STATA Corporation). The 2-sided level of significance was set at P < 0.05. The chi-square test was used for proportional assessments. Nonparametric data were compared using the Mann-Whitney test. The Wilcoxon test was used to compare antibody levels of paired samples. Using the log-rank test, Kaplan-Meier analyses were used to estimate and compare the risk of infection (or reinfection) by serological status. We recorded any positive PCR test at >60 days after a positive serological test at time 0 to prevent the capture of persistent viral detection of the primary infection.14 As we were not routinely PCR swabbing all asymptomatic cases at the time of first serological sampling, we also used only the PCR results taken >60 hnub tom qab kuaj serological hauv pawg tshuaj tiv thaiv-tsis zoo. Tom qab PCR-zoo pub dawb muaj sia nyob tau raug censored rau kev tuag thaum tsis muaj PCR kev pom zoo thiab hloov pauv.
TSEEM CEEB
Thaum lub sij hawm {{0}}, 129 ntawm 356 tus neeg mob (36.2 feem pua) tau kuaj pom anti-NP thiab 134 ntawm 356 (37.6 feem pua) tau kuaj pom cov tshuaj tiv thaiv RBD. Kev tsis sib haum xeeb ntawm anti-NP thiab anti-RBD nrhiav pom tau pom hauv 9 ntawm 356 tus neeg mob nkaus xwb (0.3 feem pua). Cov yam ntxwv kho mob ntawm cov neeg mob los ntawm kev tiv thaiv NP cov xwm txheej tau piav qhia yav dhau los thiab tau sau tseg hauv Table 1.7
Serostatus thiab antibody qib ntawm 6 lub hlis
Peb puas ib tus neeg mob muaj cov qauv muaj nyob rau 6 lub hlis tom qab qhov kev kuaj thawj zaug. Ntawm 190 cov neeg mob uas tau tawm tsam SNP thaum lub sijhawm 0, 6 (3.2 feem pua) tau kuaj pom cov tshuaj tiv thaiv NP los ntawm lub hli 6, ntawm 3 tus muaj tus kab mob PCR-pov thawj hauv lub sijhawm cuam tshuam. Hauv cov neeg mob uas tau tawm tsam NPþ lub sijhawm 0; S / C tau nce siab dua hauv cov neeg mob cov tsos mob ntau dua li cov neeg mob asymptomatic, nrog tus nqi nruab nrab ntawm 7.3 (interquartile range [IQR] 6 .1–8.5) thiab 6.2 (IQR 3.2–7.1), ntsig txog (P ¼ 0 } 0006). Ib puas kaum ib ntawm 129 tus neeg mob uas tau tawm tsam NPþat lub sijhawm 0 muaj cov qauv muaj nyob ntawm 6 lub hlis. Plaub caug ntawm 111 (36. Hauv cov neeg mob uas tau antiNPþ ob lub sijhawm 0 thiab 6 lub hlis, qhov nruab nrab S / C tau qis dua ntawm 6 lub hlis dua li ntawm 0 ntawm 2.3 (IQR 0.9–4.3) thiab 6.9 (IQR 5.2–8.2) raws li (P < 0.0001)="" (daim="" duab="">
Ntawm 129 tus neeg mob uas tau tawm tsam NPþ lub sijhawm 0, 127 tus neeg mob (98.4 feem pua) tau tawm tsam RBDþ. Ntawm 227 tus neeg mob uas tau tawm tsam NP thaum lub sijhawm 0, 7 (3.1 feem pua) tau tawm tsam RBDþ. Hauv cov neeg mob antiRBDþ, cov tshuaj tiv thaiv kab mob nyob rau lub sijhawm 0 kuj tseem muaj txiaj ntsig ntau dua hauv cov neeg mob cov tsos mob ntau dua li cov neeg mob asymptomatic, nrog qhov nruab nrab ntawm cov teeb liab-rau-txiav piv ntawm 23.9 (IQR 23.4–26.1) thiab 23.4 (IQR 11. {26}}–24.1), ntsig txog (P ¼.{39}}011). Ntawm 116 tus neeg mob uas muaj kev tiv thaiv RBD ntawm lub hauv paus nrog cov qauv muaj rau kev sim ntawm 6 lub hlis, 99 cov neeg mob (85.3 feem pua) tseem tiv thaiv RBDþ. Anti-RBD durability tau ntev dua li anti-NP durability (P ¼ 0.0002); thiab ntawm 40 tus neeg mob uas tau los ua cov tshuaj tiv thaiv NP, 28 (70.0 feem pua) tseem tiv thaiv RBDþ ntawm 6 lub hlis. Ib yam li cov tshuaj tiv thaiv NP, rau cov neeg mob khaws cov tshuaj tiv thaiv kab mob, cov tshuaj tiv thaiv-RBD qhov Performance index tau siab dua thaum lub sij hawm 0 tshaj li ntawm 6 lub hlis, nrog rau qhov nruab nrab lub teeb liab-rau txiav tawm piv ntawm 23.8 (IQR 23.3-25.4) thiab 14.7 (IQR 5.7). -21.7), ntsig txog (P <>
T-cell teb ntawm 6 lub hlis
Kaum ob tus neeg mob uas tau tawm tsam NPþ thaum lub sijhawm 0 tau ua haujlwm rau ob qho tib si anti-NP thiab anti-RBD ntawm 6 lub hlis. Ib ntawm cov neeg mob no tau txais kev hloov pauv hauv lub sijhawm cuam tshuam, thiab yog li cov lus teb T-cell tau tshawb xyuas hauv 11 tus neeg mob ntxiv. Ntawm 11 tus neeg mob no, 8 tus neeg tau txais cov enzyme-linked immune absorbent spots (ELISpot) readouts, raws li qhia hauv Table 2. Peb cov neeg mob tau pom tias muaj cov lus teb tsis muaj tshuaj tiv thaiv kab mob T-cell; tag nrho cov laus dua 70 xyoo; 1 tau muaj keeb kwm mob qog noj ntshav zais zis, tab sis tsis muaj iatrogenically immunosuppressed. Tag nrho 3 tus neeg mob tau kis tus mob asymptomatic dhau los; 2 ntawm 3 muaj ob qho tib si kuaj tau anti-NP thiab anti-RBD ntawm kev kuaj mob, whereas 1 ntawm 3 muaj anti-NP tab sis yog anti-RBD. T-cell cov lus teb tsis muaj nyob rau hauv cov neeg mob uas yog anti-NP tab sis anti-RBD ntxiv rau lub sij hawm 0.
Ua ke cov txiaj ntsig ntawm kev ntsuas kev tiv thaiv kab mob saum toj no, ntawm thawj 129 tus neeg mob uas tau tiv thaiv NP ntxiv, 126 (97.7 feem pua) muaj pov thawj ntawm kev pheej hmoo ntawm kev tiv thaiv kab mob serological lossis cellular tiv thaiv SARS-CoV-2 ntawm 6 lub hlis.
Cov txiaj ntsig kho mob cuam tshuam nrog seroconversion
Finally, we investigated the clinical relevance of these immune responses in terms of the risk of a subsequent diagnosis of SARS-CoV-2 infection. Within the first 60 days of the time 0 serological tests, 4 anti-NP, and 1 anti-NPþ patient died and 3 anti-NP and 3 anti-NPþ patients had a positive PCR test. From >60 hnub tom qab thawj zaug kuaj serological, anti-NP ntxiv rau cov neeg mob tau txais kev pheej hmoo tsawg dua ntawm kev kuaj mob SARS-CoV-2(COVID-19) compared with anti-NP patients (log-rank, P ¼ 0.0005), as shown in Figure 3. The 2 patients who were anti-NP+ at baseline who went on to have subsequent PCR-confirmed infection both had a prior asymptomatic infection; one of the patients had subsequent asymptomatic infection diagnosed by surveillance swabbing, whereas the other patient had an asymptomatic infection and died 28 days postdiagnosis. Of the remaining 27 patients who had a positive PCR test at >60 days after the first serological test, 11 (40.7%) had follow-up for >28 hnub tom qab kuaj PCR, ntawm cov neeg 2 (18.2 feem pua) tau tuag. Anti-RBD plus cov neeg mob kuj tseem muaj kev pheej hmoo tsawg dua ntawm kev kuaj mob SARS-CoV-2(COVID-19) by PCR testing compared with anti-RBD patients (log-rank, P ¼ 0.0051), as shown in Figure 3. Of the 7 anti-RBD+ patients who were anti-NP at time 0, 2 subsequently went on to have a PCR-positive test at >60 hnub; thawj zaug tau kuaj pom nyob rau hnub 74 tom qab kuaj serological, thiab qhov no tuaj yeem sawv cev rau cov kab mob sib kis tsis tu ncua tsis yog rov ua dua tshiab. Qhov thib ob yog tus txiv neej tus neeg mob hauv nws lub hnub nyoog 70 xyoo uas tau kuaj pom thaum hnub 112 tom qab tus kab mob asymptomatic uas tau ua rau rov zoo tag nrho.
Kev sib tham
Peb tau pom tias cov tshuaj tiv thaiv kab mob rau SARS-CoV-2(COVID-19) Kev kis kab mob hauv cov neeg mob uas tau txais ICHD tuaj yeem siv tau ntev txog 6 lub hlis, txawm tias cov neeg mob uas muaj tus kab mob me lossis asymptomatic. Tsis tas li ntawd, peb tau muab cov ntaub ntawv uas qhia tau hais tias kev tiv thaiv kab mob tiv thaiv kab mob SARS-CoV-2 tuaj yeem pab muab kev tiv thaiv "kev kis kab mob" lossis rov ua dua tshiab hauv cov neeg mob tau lim ntshav hauv lub sijhawm nruab nrab. Kev siv cov txheej txheem serological los txiav txim siab dhau los ntawm cov neeg tau txais ICHD tuaj yeem pab txheeb xyuas cov neeg mob uas muaj kev pheej hmoo siab ntawm tus kab mob thawj zaug thaum tos cov tshuaj tiv thaiv.
Kev tshawb fawb ntev ntev ntawm cov neeg ua haujlwm saib xyuas kev noj qab haus huv tsis ntev los no tau pom tias muaj cov tshuaj tiv thaiv kab mob los yog cov tshuaj tiv thaiv NP tau cuam tshuam nrog kev txo qis kev pheej hmoo ntawm kev rov ua dua tshiab nyob rau lub sijhawm 6-hli lub sijhawm.14,15 Cov ntaub ntawv no zoo ib yam nrog txheeb ze ntawm cov ntaub ntawv qhia txog kev rov ua dua tshiab hauv cov ntaub ntawv.16,17 Txawm li cas los xij, muab qhov kev tshawb fawb no suav nrog cov neeg ua haujlwm kho mob, uas yuav muaj hnub nyoog qis dua thiab tsis muaj kev sib haum xeeb, txhais cov kev tshawb pom no rau cov neeg mob ESKD hauv qhov tsis muaj cov ntaub ntawv yuav yog qhov tsis ncaj ncees. Txawm li cas los xij, ib daim ntawv tshaj tawm cais, uas tau tshawb xyuas qhov nruab nrab lub sij hawm humoral thiab cellular teb nyob rau hauv cov neeg mob nrog SARS-CoV-2 thiab ib tug ntau yam ntawm comorbidities, kuj qhia tau hais tias muaj zog tiv thaiv kab mob tej zaum yuav nyob twj ywm rau yam tsawg kawg yog 8 lub hlis postinfection.18 Txawm hais tias qhov no yuav yog cov ntaub ntawv sib piv ntau dua rau cov neeg mob tau txais kev lim ntshav, ib qho kev tshawb fawb ntxiv los ntawm tib pawg kev tshawb fawb no tau pom tias muaj qhov tsis sib xws ntawm kev tiv thaiv kev tiv thaiv kab mob hauv cov neeg laus.19 Qhov no yog kev txhawj xeeb rau cov neeg mob nephrology, raws li cov neeg mob tau lim ntshav kuj paub. kom muaj kev puas tsuaj ntawm ob qho tib si hauv lub cev thiab kev hloov pauv lub cev tiv thaiv kab mob uas cuam tshuam nrog kev laus ntxov ntxov.20
Peb txoj kev tshawb fawb, uas yog thawj zaug tshawb nrhiav qhov ntev ntawm SARS-CoV-2(COVID-19) Cov tshuaj tiv thaiv kab mob hauv cov neeg mob tau txais kev lim ntshav, yog li qhov tseem ceeb ntawm kev kho mob. Ib yam li lwm tus, peb tau pom tias cov tshuaj tiv thaiv kab mob qis zuj zus mus rau lub sijhawm thiab tus nqi ntawm kev lwj cuam tshuam nrog kev kis mob hnyav.21 Peb pom tias cov tsos mob tshwm sim cuam tshuam nrog cov tshuaj tiv thaiv ntau dua "titers," thiab nws tau lees paub tias qhov kev faib tawm ntawm S / C. Cov txiaj ntsig hauv cov neeg mob tau txais kev lim ntshav tom qab kis kab mob yog piv nrog rau cov neeg ua haujlwm kho mob raws li tau tshaj tawm hauv lwm cov kev tshawb fawb siv tib yam kev soj ntsuam serological.22 Tsis tas li ntawd, raws li cov ntaub ntawv hauv cov neeg ua haujlwm saib xyuas kev noj qab haus huv, peb tau pom tias cov tshuaj tiv thaiv RBD tiv thaiv kab mob ntau dua. ib qho lus teb los tiv thaiv NP.22 Txawm li cas los xij, peb lees paub tias kev siv seroprevalence ib leeg tuaj yeem kwv yees tsis tu ncuativ thaiv kab mobto SARS-CoV-2(COVID-19), nrog cov ntaub ntawv qhia tias cov lus teb T-cell muaj zog tuaj yeem kuaj pom hauv cov neeg mob uas muaj tus kab mob me lossis asymptomatic, txawm tias tsis muaj tshuaj tiv thaiv kab mob.23 Hauv peb pawg neeg mob tau txais kev lim ntshav, peb tau qhia tias<3% of="" patients="" lacked="" evidence="" of="" either="" serological="" or="" t-cell="" responses="" at="" 6="" months="" postinfection.="" of="" utmost="" clinical="" relevance,="" we="" have="" also="" shown="" that="" a="" detectable="" serological="" response="" to="" sars-cov-2="">(COVID-19) Kev kis kab mob zoo li tiv thaiv kev rov ua dua tshiab hauv cov neeg mob tau txais kev lim ntshav, txawm tias tom qab 6 lub hlis tom qab kis kab mob. Cov ntaub ntawv no tau txhawb nqa vim tias muaj tus kab mob loj heev uas pom thaum ntxov ntawm tus kabmob kis thoob ntiaj teb, raws li, txawm hais tias cov neeg mob tau txais kev lim ntshav tos txhaj tshuaj tiv thaiv, kev kis tus kabmob yav dhau los tuaj yeem muaj kev tiv thaiv. Hauv peb pawg neeg, kev tshuaj ntsuam xyuas serological yeej ua rau muaj kev txheeb xyuas cov neeg mob uas muaj tus kab mob ua ntej, uas tej zaum yuav muaj kev kwv yees tsis zoo, vim tias peb tsis niaj hnub kuaj rau PCR-zoo kab mob hauv cov mob asymptomatic thaum thawj nthwv dej.
Nws yog ib qho tsim nyog sau cia tias ntawm 2 tus neeg mob uas muaj pov thawj serological ntawm anti-NP uas tau kuaj pom tus kab mob tom qab los ntawm kev rov qab transcriptase PCR ntawm hnub 142 thiab 205 tom qab kuaj pom thawj zaug ntawm seroconversion, ib tus neeg mob HIV thiab lwm tus neeg mob yav dhau los tau hloov lub raum. (Table Ntxiv S1). Tsis tas li ntawd, 3 cov neeg mob uas tsis muaj serological lossis cellular pov thawj ntawmtiv thaiv kab mobntawm 6 lub hlis, tag nrho cov laus dua 70 xyoo. Yog li ntawd, txawm hais tias peb tau pom tias cov neeg mob tau txais kev lim ntshav ib zaug pom tshwm sim los tiv thaiv cov lus teb rau SARS-CoV-2(COVID-19), tej zaum yuav muaj lwm yam kev paub txog kev kho mob uas yuav ua rau tsis zootiv thaiv kab mobthiab cuam tshuam cov txiaj ntsig hauv cov neeg mob tau txais kev lim ntshav, uas yuav tsum tau kawm ntxiv.
Kev ua tau zoo ntawm SARS-CoV-2 cov tshuaj tiv thaiv hauv cov neeg mob ESKD tam sim no tsis paub tias cov neeg mob no raug cais tawm ntawm qhov ua ntej SARS-CoV-2(COVID-19) kev sim tshuaj tiv thaiv. Cov neeg mob tau txais kev lim ntshav tau lees paub tias muaj qis dua ntawm seroprotection rau cov tshuaj tiv thaiv piv nrog kev tswj hwm kev noj qab haus huv, uas ib feem yog vim muaj cov nyhuv uremic toxins ntawm lub cev tiv thaiv kab mob.24 Qhov kev tiv thaiv kab mob tsis txaus no zoo li muaj feem xyuam rau cov lus teb rau cov kab mob tshiab antigenic, uas. Nws yog ib qho tseem ceeb ntawm qhov tshwm sim ntawm kev txhaj tshuaj SARS-CoV 2.25 Extrapolation los ntawm kev paub tias kev tiv thaiv kab mob cuam tshuam nrog kev laus yog pom ntxov ntxov hauv cov neeg mob tau lim ntshav thiab cov neeg laus muaj qhov txo qis ntawm cov tshuaj tiv thaiv kab mob protein ntau thiab nruab nrab cov tshuaj tiv thaiv kab mob ntawm 28 hnub tom qab kev txhaj tshuaj BNT162b2 dua li cov neeg mob yau qhia txog qhov xav tau ceev ceev rau qee cov ntaub ntawv yav tom ntej hauv cov neeg tsis muaj zog no.5,26 Reasurringly, cov ntaub ntawv tam sim no tau tshwm sim tias cov tshuaj tiv thaiv kab mob nruab nrab tsim los teb rau SARS-CoV-2 txhaj tshuaj tiv thaiv ntau dua. ruaj duativ thaiv kab moblos ntawm kev kis kab mob ntuj.27 Qhov no ua ke nrog cov ntaub ntawv peb nthuav tawm ntawm cov lus teb serological thiab kev tiv thaiv los ntawm kev rov ua dua tshiab zoo ib yam li cov neeg ua haujlwm saib xyuas kev noj qab haus huv muab kev cia siab rau cov lus teb piv rau cov tshuaj tiv thaiv hauv cov neeg mob ESKD.14,27 Tsis tas li ntawd, lub hauv paus serological txheej xwm ntawm cov neeg mob los ntawm yav dhau los Kev kis tus kab mob tuaj yeem cuam tshuam rau cov neeg mob ESKD vim tias muaj kev kis tus kab mob ntau heev hauv cov neeg mob tau txais ICHD, thiab nws yuav txaus siab los tshuaj xyuas seb cov tshuaj tiv thaiv cov lus teb tsis muaj zog hauv cov neeg mob tsis zoo.28
Txoj kev tshawb no muaj ob peb qhov kev txwv, ib feem vim yog lub sij hawm-rhiab qhov tshwm sim ntawm cov txiaj ntsig uas tau ua rau peb coj mus rau kev coj ua piv txwv. Txoj kev tshawb no yuav muaj zog ntxiv los ntawm kev sib ntxiv ntawm cov ntaub ntawv kuaj mob ntxiv ntawm cov kab mob kis thoob lub sijhawm. Muaj tseeb tiag, tau muaj cov ntaub ntawv tshaj tawm txog kev kis kab mob mus ntev, uas tej zaum yuav muaj ntau dua hauv cov neeg mob tiv thaiv kab mob.29,30 Txawm li cas los xij, peb tau siv 60- hnub txiav tawm rau "tshiab" PCR zoo, raws li tau siv los ntawm lwm tus yav dhau los.14 Nws tseem yog qhov tseem ceeb los qhia tias txhua tus neeg mob tau ua raws li niaj hnub asymptomatic PCR swabbing tom qab lub sijhawm no. Ib qho kev txwv ntxiv yog tias peb tsis muaj cov ntaub ntawv muaj nyob rau ntawm kab mob caj ces ntawm cov neeg mob kis, thiab nws muaj peev xwm hais tias "reinfections" yog vim qhov hloov pauv tshiab ntawm SARS-CoV-2, uas tuaj yeem tiv thaiv kev tiv thaiv kab mob rau cov kab mob yav dhau los. .31 Txawm li cas los xij, yog tias qhov no tshwm sim, peb yuav xav tias yuav pom qhov sib npaug ntawm cov tshiab
'tus kab mob sib txawv' thoob plaws txhua tus neeg mob. Peb cov ntaub ntawv serological tej zaum yuav muaj zog los ntawm kev tshuaj xyuas tag nrho cov neeg mob ntawm 6 lub hlis rau RBD cov tshuaj tiv thaiv, uas tau pom tias muaj kev sib raug zoo nrog cov tshuaj tiv thaiv kab mob titer.11 Thaum kawg, peb tau ua T-cell ELISpot kev soj ntsuam hauv tsuas yog xaiv cov rooj plaub raws li lub sijhawm thiab cov peev txheej txwv. tiv thaiv kev sim ntxiv nyob rau theem no. Txawm li cas los xij, lub zog loj ntawm peb txoj kev tshawb fawb yog tias, rau peb txoj kev paub, qhov no yog thawj daim ntawv tshaj tawm txog kev tiv thaiv kab mob ntev ntev hauv cov neeg mob tau txais kev lim ntshav, uas ntxiv nrog rau cov ntaub ntawv soj ntsuam cov txiaj ntsig hauv cov kab mob asymptomatic thiab cov tsos mob.
Hauv kev xaus, peb tau pom tias cov neeg mob tau txais kev lim ntshav mount lub cev tiv thaiv kab mob 6 lub hlis tom qab SARS-CoV-2(COVID-19) kab mob. Tsawg dua 3 feem pua ntawm cov neeg mob uas muaj tus kab mob no tsis muaj cov lus teb serological lossis T-cell ntawm 6 lub hlis. Peb kuj tau qhia tias qhov kev pheej hmoo ntawm kev kis tus kab mob PCR-zoo tom qab tau txo qis hauv cov neeg mob uas tau kuaj pom cov tshuaj tiv thaiv kab mob. Ua ke, cov ntaub ntawv no qhia tias kev tiv thaiv kab mob tom qab kis kab mob tuaj yeem tiv thaiv kev rov ua dua tshiab. Muab qhov muaj ntau tshaj ntawm thawj SARS-CoV-2(COVID-19) Kev kis kab mob thaum thawj nthwv dej hauv ICHD units, yog cov ntaub ntawv tseem ceeb rau cov zej zog nephrology thaum cov kev pab cuam txhaj tshuaj tawm.
SUPPLEMENTARY KHOOM
Cov ntaub ntawv ntxiv (PDF)
Daim duab S1. Schematic daim duab ntawm cov qauv los kuaj cov qauv los ntawm hom kev xeem ntawm Lub Sijhawm 0 (T0) thiab Lub Sijhawm 6 (T6) lub hlis.
Tab S1. Cov yam ntxwv ntawm 5 tus neeg mob seropositive uas tom qab pom tias yog SARS-CoV-2 zoo.
---Kidney International (2021) 99, 1470–1477; https://doi.org/10.1016/j.kint.2021.03.009
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