SARS CoV-2 免疫接种后疫苗诱发肝损伤复发的结果和相关因素:一项全国性研究。

IF 3.7 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY
Ana Barreira-Díaz , Mar Riveiro-Barciela , Eva María Fernández-Bonilla , Vanesa Bernal , Agustín Castiella , Marta Casado-Martín , Carolina Delgado , María-Carlota Londoño , Álvaro Díaz-González , Indhira Pérez-Medrano , Andrés Conthe , Margarita Sala , Beatriz Mateos , Judith Gómez-Camarero , Dolores Antón-Conejero , Carmen Del Pozo-Calzada , Francisca Cuenca , Ares Villagrasa-Vilella , Magdalena Salcedo
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引用次数: 0

摘要

引言和目的据报道,SARS-CoV-2 疫苗引起肝损伤的模式各不相同。本研究的目的是描述全国范围内由 SARS CoV-2 疫苗引起肝损伤的患者队列,重点关注治疗情况以及进一步接种加强剂后的演变情况。结果共收集到 47 例病例:17 例接种了首剂疫苗,30 例接种了加强剂疫苗。年龄 57 岁,女性 30 人(占 63.8%),7 人(占 14.9%)曾患自身免疫性肝炎 (AIH)。大多数病例病情并不严重,但有 9 例(19.1%)患者出现了急性肝损伤或肝衰竭(ALF)。加强注射后出现肝损伤的病例往往更严重(P=0.084)。肝损伤模式为肝细胞性(80.9%)、混合性(12.8%)和胆汁淤积性(3.6.4%)。对 33 名患者进行了肝活检,其中 29 人发现了 AIH。41名患者(87.2%)接受了免疫抑制剂治疗,主要是皮质类固醇(35/41)。其中一名患者需要进行肝移植,另一名患者死于 ALF。6/41的患者停止了免疫抑制,但没有出现反弹。25 名受试者至少接受了一次强化治疗,7 人(28.0%)因肝损伤复发,但都不严重。接受加强治疗时使用免疫抑制剂的患者复发率较低(28.6% 对 88.9%,P=0.007)。再次接种疫苗后肝损伤复发的频率很高(28.0%),但程度较轻。加强免疫时的免疫抑制与较低的肝损伤风险有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Outcomes and factors associated with relapse of vaccine-induced liver injury after SARS CoV-2 immunization: A nationwide study

Introduction and Objectives

Different patterns of liver injury have been reported in association with the SARS-CoV-2 vaccines. The aim of this study was to describe a nationwide cohort of patients with SARS CoV-2 vaccine-induced liver injury, focusing on treatment and the evolution after further booster administration.

Patients and Methods

multicentre, retrospective-prospective study, including subjects who developed abnormal liver tests within 90 days after administration of SARS-CoV-2 vaccination.

Results

47 cases were collected: 17 after prime dose and 30 after booster. Age was 57 years, 30 (63.8 %) were female, and 7 (14.9 %) had a history of prior autoimmune hepatitis (AIH). Most cases were non-severe, though 9 (19.1 %) developed acute liver injury or failure (ALF). Liver injury tended to be more severe in those presenting after a booster (p=0.084). Pattern of liver injury was hepatocellular (80.9 %), mixed (12.8 %) and 3 (6.4 %) cholestatic. Liver biopsy was performed on 33 patients; 29 showed findings of AIH. Forty-one (87.2 %) patients received immunosuppressants, mostly corticosteroids (35/41). One required liver transplantation and another died due to ALF. Immunosuppression was discontinued in 6/41 patients without later rebound. Twenty-five subjects received at least one booster and 7 (28.0 %) relapsed from the liver injury, but all were non-severe. Recurrence was less frequent among patients on immunosuppressants at booster administration (28.6 % vs. 88.9 %, p=0.007).

Conclusions

SARS CoV-2 vaccine-induced liver injury is heterogeneous but mostly immune-mediated. Relapse of liver injury after re-exposure to vaccine is frequent (28.0 %) but mild. Immunosuppression at booster administration is associated with a lower risk of liver injury.

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来源期刊
Annals of hepatology
Annals of hepatology 医学-胃肠肝病学
CiteScore
7.90
自引率
2.60%
发文量
183
审稿时长
4-8 weeks
期刊介绍: Annals of Hepatology publishes original research on the biology and diseases of the liver in both humans and experimental models. Contributions may be submitted as regular articles. The journal also publishes concise reviews of both basic and clinical topics.
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