| 摘要: |
| ［摘要］ 目的 探讨肾移植受者感染新型冠状病毒（SARS-CoV-2）奥密克戎（Omicron）变异株的临床特征，分析新型冠状病毒感染(COVID-19)和病毒转阴时间的影响因素。方法 回顾性分析2022年12月至2023年2月在山西省第二人民医院肾移植中心随访的肾移植受者SARS-CoV-2 Omicron变异株的感染情况，以网络问卷方式进行问卷填写，对感染者年龄、性别、吸烟、共病情况（合并慢性病）、肾移植术后时间、病毒转阴时间、新型冠状病毒疫苗（简称“新冠疫苗”）接种、免疫抑制方案、服用熊去氧胆酸及SARS-CoV-2抗体产生等情况进行调查，并分析新冠疫苗接种情况和病毒转阴时间的影响因素。结果 628例肾移植受者参加调查问卷，其中感染组476例，非感染组152例。感染组男女比例为1.9∶1，以轻型为主；合并1种及以上慢性病者占75.21%，以高血压、糖尿病为主。非/部分接种组和完全/增强接种组分别为300例和328例。在感染时距离末次疫苗接种的时间>6个月者占82.59%（166/201）；200例肾移植受者感染后行SARS-CoV-2抗体检测，感染至抗体检测中位时间为47 d，IgG阳性或弱阳性者占48.50%（97/200）。病毒转阴时间与免疫抑制方案相关，含霉酚酸(MPA)类药物的免疫抑制方案病毒转阴时间较含咪唑立宾（MZR）方案长。感染组和非感染组在年龄、性别、肾移植术后时间、共病及新冠疫苗接种方面比较差异无统计学意义（P>0.05）。新冠疫苗接种情况与性别及肾移植术后时间有关。结论 肾移植受者在各年龄段及术后不同时期对于SARS-CoV-2 Omicron变异株普遍易感，以轻型为主。感染后普遍产生SARS-CoV-2 IgG抗体。服用含MZR的免疫抑制方案较含MPA类药物方案感染后病毒转阴时间短。接种新冠疫苗有一定的保护作用，男性及肾移植术后时间较长的肾移植受者疫苗接种率高。 |
| 关键词: 新型冠状病毒 奥密克戎变异株 肾移植 |
| DOI：10.3969/j.issn.1674-3806.2023.10.03 |
| 分类号:R 617 |
| 基金项目:山西省卫生健康委科研课题（编号：2023XG036）；山西省卫生健康委基金项目（编号：2021136） |
|
| Analysis on the clinical characteristics of SARS-CoV-2 Omicron variant infection in kidney transplant recipients |
|
GUO Xiao-hong, LI Ning, WANG Ming-jun, et al.
|
|
Center for Kidney Transplantation, the Second People′s Hospital of Shanxi Province, Taiyuan 030012, China
|
| Abstract: |
| ［Abstract］ Objective To explore the clinical characteristics of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) Omicron variant infection in kidney transplant recipients and to analyse the factors influencing coronavirus disease 2019(COVID-19) and the time when the viruses turn negative. Methods The infection profiles of SARS-CoV-2 Omicron variants in kidney transplant recipients who were followed up in the Center for Kidney Transplantation of the Second People′s Hospital of Shanxi Province from December 2022 to February 2023 were retrospectively analyzed. The questionnaire was filled out by internet-based survey, and the epidemiological investigation was conducted on the infected patients′ age, gender, smoking, comorbidity(complicated with chronic diseases), time after kidney transplantation, the time when the viruses turned negative, SARS-CoV-2 vaccine(referred to as “COVID-19 vaccine”) inoculation, immunosuppression regimen, oral administration of ursodeoxycholic acid and SARS-CoV-2 antibody production. The factors influencing COVID-19 vaccine inoculation and the time when the viruses turned negative were analyzed. Results Six hundred and twenty-eight kidney transplant recipients participated in the survey questionnaire, including 476 in the infected group and 152 in the non-infected group. In the infected group, the male to female ratio was 1.9∶1, and the clinical symptoms of SARS-CoV-2 Omicron variant infection were generally mild; 75.21% of the COVID-19 infected kidney transplant recipients were complicated with one or more chronic diseases, mainly including hypertension and diabetes. There were 300 and 328 cases in the non-vaccination/partical vaccination group and the complete vaccination/enhanced vaccination group, respectively. 82.59%(166/201) of the patients got infected at the time more than 6 months since their last vaccination; SARS-CoV-2 antibodies were tested after infection in 200 kidney transplant recipients, and the median time from infection to antibody detection was 47 days, and 48.50%(97/200) of the patients were IgG positive or weakly positive; the time when the viruses turned negative was correlated with immunosuppression regimen, and the time(when the viruses turned negative) of the immunosuppression regimen containing mycophenolate(MPA) was longer than that of the regimen containing mizoribine(MZR). There were no significant differences in age, gender, time after kidney transplantation, comorbidity and SARS-CoV-2 vaccine inoculation between the infected group and the non-infected group(P>0.05). The SARS-CoV-2 vaccine inoculation was related to gender and time after kidney transplantation. Conclusion Kidney transplant recipients are generally susceptible to SARS-CoV-2 Omicron variants at all ages and during different postoperative periods, and the clinical symptoms are generally mild. SARS-CoV-2 IgG antibody is commonly produced after infection. Kidney transplant recipients with immunosuppression regimen containing MZR have a shorter time when the viruses turn negative after infection than those with MPA. Vaccination has a certain protective effect, and the vaccination rate is high in males and kidney transplant recipients with a longer time after kidney transplantation. |
| Key words: Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) Omicron variant Kidney transplantation |
