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标题: COVID-19 疫苗接种降低了肝硬化患者的住院率 [打印本页]

作者: StephenW 时间: 2021-11-15 20:11 标题: COVID-19 疫苗接种降低了肝硬化患者的住院率

COVID-19 疫苗接种降低了肝硬化患者的住院率
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根据 The Liver Meeting Digital Experience 上发表的研究，COVID-19 疫苗接种与肝硬化和其他高风险合并症患者的住院风险降低相关。

“肝脏是受 COVID-19 影响的第二大最常见器官，肝硬化患者因 COVID-19 导致的死亡率高达 32%，而在总人口中为 8%。死亡率与肝硬化的严重程度直接相关。 COVID-19 导致 46% 的肝硬化患者失代偿，”智利天主教大学医学院的 Luis Antonio Díaz 医学博士在演讲中说。 “一个重要的方面是，大多数疫苗研究都排除了肝硬化患者。另一方面，肝硬化患者有免疫失调，他们可能会对疫苗接种的有效性产生一些担忧。”

为了调查接种 COVID-19 疫苗对肝硬化患者的影响，研究人员分析了智利卫生部国家 SARS-CoV-2 监测计划的数据。 Díaz 及其同事每周两次更新合并症的发病率和患病率报告，并使用准实验设计来评估接种第二剂 COVID-19 疫苗后住院率降低的效果。回归不连续性模型估计了由住院率决定的疫苗接种的影响。

在 1,648,680 例 COVID-19 病例（中位年龄，38 岁；50.2% 女性）中，发病率为每 100,000 名居民 8,472.9 例，其中 50.1% 接受了一剂或两剂 CoronaVac（Sinovac Life Sciences，北京，中国） ) 疫苗 (79.4%)、BNT162b2 mRNA (Pfizer/BioNTech) 疫苗 (18.7%) 或 Vaxzevria (Oxford-AstraZeneca) 疫苗 (1.9%)。总体而言，0.1% 的 COVID-19 病例有潜在肝硬化，42.9% 需要住院治疗。

与第二次接种疫苗后 2 周后未接种疫苗的患者相比，肝硬化患者接种疫苗与住院率下降相关（–12.69；95% CI，–21.71 至–2.68；P < .01）。这种趋势也出现在心力衰竭、糖尿病、高血压和哮喘患者中，尽管降低住院率的好处在肝硬化中更高。

“患有潜在肝硬化的患者的住院率高于整体人群。我们的全国性研究表明，针对 COVID-19 的疫苗接种与肝硬化患者的住院风险较低以及其他合并症的类似益处之间存在关联，”迪亚兹总结道。 “这些患者的风险更高，而且不安全。高度鼓励高危人群接种疫苗。”

作者: StephenW 时间: 2021-11-15 20:12

COVID-19 vaccination decreases hospitalization rates in patients with cirrhosis
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COVID-19 vaccination correlated with a decreased risk for hospitalization among patients with cirrhosis and other high-risk comorbidities, according to research presented at The Liver Meeting Digital Experience.

“The liver is the second most common organ affected by COVID-19 and mortality due to COVID-19 is higher in cirrhotic patients reaching 32% compared to 8% in the overall population. Mortality is directly associated to the severity of cirrhosis. COVID-19 causes decompensation in 46% of patients with cirrhosis,” Luis Antonio Díaz, MD, of the Pontificia Universidad Católica de Chile School of Medicine, said during the presentation. “An important aspect is that most of the vaccine studies exclude individuals with cirrhosis. On the other side, cirrhotic patients have immune dysregulation and they could have some concerns with the vaccination effectiveness.”

Aimed to investigate the impact of vaccination against COVID-19 in patients with cirrhosis, researchers analyzed data from the Chilean Ministry of Health national SARS-CoV-2 surveillance program. Díaz and colleagues further updated incidence rates and prevalence reports of comorbidities twice a week and used a quasi-experimental design to assess the effect of decreasing hospitalization rates following administration of the second COVID-19 vaccine dose. Regression discontinuity models estimated the impact of vaccinations determined by hospitalization rates.

Among 1,648,680 COVID-19 cases (median age, 38 years; 50.2% women), accounting for an incidence rate of 8,472.9 cases per 100,000 inhabitants, 50.1% received either one dose or two doses of the CoronaVac (Sinovac Life Sciences, Beijing, China) vaccine (79.4%), the BNT162b2 mRNA (Pfizer/BioNTech) vaccine (18.7%) or the Vaxzevria (Oxford-AstraZeneca) vaccine (1.9%). Overall, 0.1% of COVID-19 cases had underlying cirrhosis and 42.9% required hospitalization.

Vaccination among patients with cirrhosis correlated with a decline in hospitalization rates (–12.69; 95% CI, –21.71 to –2.68; P < .01) compared with those who were not vaccinated beyond 2 weeks following the second vaccine dose. This trend was also seen among patients with heart failure, diabetes, hypertension and asthma though the benefit of decreased hospitalization rates was higher in cirrhosis.

“Patients with underlying cirrhosis have a higher hospitalizations rate than the overall population. Our nationwide study showed an association between vaccination against COVID-19 and a lower hospitalization risk in patients with cirrhosis and a similar benefit in other comorbidities,” Díaz concluded. “Those patients are at a higher risk and not safe. Vaccination in high-risk groups is highly encouraged.”

作者: StephenW 时间: 2021-11-15 20:14

肝硬化患者的 COVID-19 疫苗保护“越来越低”
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根据 The Liver Meeting Digital Experience 上的一份报告，与未接种疫苗的对照组相比，mRNA COVID 疫苗接种提供的保护在肝硬化患者中建立效力较慢，并且总体上较低。

“接种两剂疫苗后，COVID-19 减少了 78%，住院或死亡减少了 100%。然而，前 28 天没有发现差异，这表明与临床试验中正常健康对照的数据相比，接种疫苗的保护越来越低，”迈阿密米勒大学附属副教授 Binu V. John, MD, MPH Bruce W. Carter VA 医学中心的医学院和肝病学主任在他的演讲中说。

John 及其同事进行了一项回顾性队列研究，研究通过退伍军人管理局卫生系统接受至少一剂辉瑞或 Moderna COVID-19 mRNA 疫苗的肝硬化患者。他们将至少接种一剂疫苗的退伍军人（n = 20,037）与未接种疫苗的退伍军人一对一配对。研究的时间段是从 2020 年 12 月 18 日到 2021 年 3 月 17 日。

疫苗平均分配（51% Moderna；49% Pfizer），99.7% 接受第一剂的患者也接受了第二剂。两种疫苗的结果非常相似，足以保证结果的组合。

“我们发现在接种疫苗后，疫苗和对照组中的 COVID-19 数量相似，直到 28 天，因此疫苗组中有 77 例感染，而对照组为 88 例，但这些差异在 28 天后开始出现分歧， ”约翰说。

研究人员展示了一剂 mRNA 疫苗，28 天后 COVID-19 感染减少 64.8%，100% 防止因 COVID-19 感染而住院或死亡。与代偿期肝硬化 (66.8%) 相比，失代偿期肝硬化患者 (50.3%) 减少 COVID-19 感染的相关性较低。

约翰报告说，第二剂使 COVID-19 感染减少了 78.6%，并且在 7 天后与 COVID-19 相关的住院或死亡减少了 100%。

在讨论中，约翰指出，这项研究处于大流行初期，他们仍在收集数据。

“我们现在有更多关于更长时间随访的扩展数据，我们看到与最初没有发现死亡的结果不同……我们现在看到的是死亡和住院，”约翰说。 “我们仍然发现死亡人数减少有很强的关联。”

此外，delta 变体似乎正在影响肝硬化人群的疫苗效力，他说。由于 VA 现在完全有资格获得第三剂，约翰说他们预计正在进行分析。

作者: StephenW 时间: 2021-11-15 20:14

COVID-19 vaccine protection ‘lower and slower’ in patients with cirrhosis
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Protection provided by the mRNA COVID vaccinations is slower to build to efficacy and lower overall in patients with cirrhosis as compared to unvaccinated controls, according to a presentation at The Liver Meeting Digital Experience.

“After two doses of vaccine, there was a 78% reduction in COVID-19 and a 100% reduction of hospitalization or death. However, no differences were noted in the first 28 days indicating that protection with vaccination is lower and slower compared to data in normal healthy controls from clinical trials,” Binu V. John, MD, MPH, affiliate associate professor at the University of Miami Miller School of Medicine and chief of hepatology at the Bruce W. Carter VA Medical Center, said during his presentation.

John and colleagues performed a retrospective cohort study looking at patients with cirrhosis who received at least one dose of either the Pfizer or Moderna COVID-19 mRNA vaccines through the Veterans Administration Health System. They matched veterans who received at least one dose (n = 20,037) one-to-one with unvaccinated veterans. The time period studied was from Dec. 18, 2020, to March 17, 2021.

The vaccines were evenly split (51% Moderna; 49% Pfizer) and 99.7% of patients who received the first dose also received their second dose. Results of the two vaccines were similar enough to warrant combination of results.

“We find that after vaccine administration, there was similar numbers of COVID-19 in vaccines and controls until 28 days, so there’s 77 infections in the vaccine group compared to 88 patients in the control, but these differences start to diverge after 28 days,” John said.

Researchers showed one dose of an mRNA vaccine with a 64.8% reduction in COVID-19 infections after 28 days and 100% protection against hospitalization or death due to COVID-19 infection. The association of reduced COVID-19 infections was lower among patients with decompensated cirrhosis (50.3%) compared to compensated cirrhosis (66.8%).

A second dose produced a 78.6% reduction in COVID-19 infections and 100% reduction in COVID-19 related hospitalization or death after 7 days, John reported.

In the discussion, John noted that this study was early in the pandemic and they are still gathering data.

“We now have more extended data on longer follow up and we are seeing that unlike the initial result where we found no deaths ... we are now seeing deaths and hospitalization,” John said. “We are still finding a very strong association with reduced death.”

Additionally, the delta variant seems to be impacting vaccine efficacy in the cirrhotic population, he said. As the VA is now fully eligible for a third dose, John said they anticipate ongoing analyses.

作者: 桦子 时间: 2021-11-16 07:55

这个名字COVID-19来源于corona（冠状）、virus（病毒）以及disease（疾病）三个词，而19则代表这个疾病出现的年份2019年。新冠肺炎疫情是在2019年12月31日上报至世界卫生组织的。

作者: 万寿无疆 时间: 2021-11-17 05:10

肝硬化感染新冠很危险啊

作者: Newbegin 时间: 2021-11-19 12:13

本帖最后由 Newbegin 于 2021-11-19 12:53 编辑

StephenW 发表于 2021-11-15 20:14
肝硬化患者的 COVID-19 疫苗保护“越来越低”
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mRNA 疫苗对代偿期肝硬化还是有可观的保护作用，老天爷开了一扇门：

“研究人员展示了一剂 mRNA 疫苗，28 天后 COVID-19 感染减少 64.8%，100% 防止因 COVID-19 感染而住院或死亡。与代偿期肝硬化 (66.8%) 相比，失代偿期肝硬化患者 (50.3%) 减少 COVID-19 感染的相关性较低。”

吐槽一下：
文章标题与内容不符合，记者耸人听闻，只是为了要大家快去打第二剂疫苗：
“
发表于 2021-11-15 20:14

肝硬化患者的 COVID-19 疫苗保护“越来越低”
添加到电子邮件警报

根据 The Liver Meeting Digital Experience 上的一份报告，与未接种疫苗的对照组相比，mRNA COVID 疫苗接种提供的保护在肝硬化患者中建立效力较慢，并且总体上较低。

“接种两剂疫苗后，COVID-19 减少了 78%，住院或死亡减少了 100%。然而，前 28 天没有发现差异，这表明与临床试验中正常健康对照的数据相比，接种疫苗的保护越来越低，”迈阿密米勒大学附属副教授 Binu V. John, MD, MPH Bruce W. Carter VA 医学中心的医学院和肝病学主任在他的演讲中说”

作者: StephenW 时间: 2021-11-19 14:42

回复 Newbegin 的帖子

谢谢. “越来越低”不是准确的翻译 , ‘lower and slower’ 较低的功效 , 效力较慢.

作者: Newbegin 时间: 2021-11-19 21:05

本帖最后由 Newbegin 于 2021-11-19 21:22 编辑

StephenW 发表于 2021-11-19 14:42
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谢谢. “越来越低”不是准确的翻译 , ‘lower and slower’ 较低的功效 , 效力较慢. ...

谢谢StephenW老师的专家点评和解疑。我也读了您在其他帖中对抗友新冠疫苗的回复，很中肯。

您可能也注意到了，澳州和米国两个机构对新冠对乙人风险评估有明显差别; 都好久未更新了，形势一直在变化中。谢谢您长期的双语分享。
https://www.hep.org.au/hep-b/covid-19-and-hep-b-faq/

Hep B and COVID-19
I have hep B, am I at higher risk of catching COVID-19?

NO. There is no evidence that people living with hep B are at higher risk of catching COVID-19.

Follow Government advice on keeping safe and stopping the spread of COVID-19 >>> CLICK HERE

I have hep B, am I at higher risk of severe illness from COVID-19?

NO. There is no evidence that having hep B puts you at a higher risk of severe illness from COVID-19. Hep B itself is not a listed health condition that may contribute to more severe illness with COVID-19.

I have hep B so are there extra precautions I need to take against COVID-19?

TAKE THE SAME PRECAUTIONS AS EVERYONE.We all need to take precautions to stop the spread of COVID-19, whether we have hep B or not, for our health and for our community as a whole.

Versus:
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/liver-disease.html

作者: StephenW 时间: 2021-11-20 04:24

回复 Newbegin 的帖子

再次谢谢你.

就个人而言，对于 COVID-19，还有很多未知。一开始，我们有来自医生的评论，然后是病毒学家、免疫学家，现在是流行病学家。但是 COVID-19 病毒很棘手，就像 HBV 病毒一样。大型制药公司从疫苗中赚了很多钱，从 1 剂到 3 剂，然后是每年！现在他们正在推出治疗方法。因为 COVID-19 是一种 RNA 病毒，所以它是可以治愈的。
Personally, with COVID-19, there are many unknown. At the beginning, we have comments from medical doctors, then virologists, immunologists, now epidemioloists. But the COVID-19 virus is tricky, just like the HBV virus. Big Pharma are making a lot of money from the vaccines, from 1 dose to 3 doses, then annually! Now they are bringing out treatments. Because COVID-19 is an RNA virus, it can be cured.

作者: Newbegin 时间: 2021-11-20 10:13

StephenW 发表于 2021-11-20 04:24
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再次谢谢你.

能否请教Stephen老师，为什么“ 因为 COVID-19 是一种 RNA 病毒，所以它是可以治愈的”？我正纳闷为什么CDC说大多数从有症状算扯起，居家隔离10天后就可以自由活动了(也就是宿主把covid-19清除, 而不是变成长期携劳），而DNA病毒如乙肝更易变成慢性？谢谢！

作者: StephenW 时间: 2021-11-20 13:32

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我对SARS-Cov2知之甚少.
我的理由是：
1. 就像 HCV 一样，COVID-19 也是一种 RNA 病毒 . HCV 已经有了治愈的药物。
2. 所有RNA病毒都在细胞核(nucleus)外复制，因此病毒产生的一些蛋白质很容易受到攻击 . 例如，切割病毒产生的蛋白质长链所需的酶(enzyme).
3. 病毒RNA在被感染细胞的细胞质中(cytoplasm)只能存活很短的时间 . 如果没有新的病毒颗粒形成感染新细胞或重新感染现有细胞，病毒就会消失.

当然，目前还没有针对 HCV 的疫苗, COVID-19 已经有几种疫苗和单克隆(monoclonal)抗体来预防感染 .此外，COVID-19 是空气传播的，传染性很强 . COVID-19 引起的疾病可能非常严重。

作者: Newbegin 时间: 2021-11-20 23:32

StephenW 发表于 2021-11-20 13:32
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我对SARS-Cov2知之甚少.

谢谢Stephen老师的精辟解释，原来HCV能治愈也与它是RNA病毒有关。Covid-19这种RNA病毒为什么这么容易产生变异？有横向比较它在人体中载量(肺部或咽喉部或血液）与乙肝在血液中的载量吗? (乙肝在大三中可达到10的八次方）.

不好意思问您这么多问题，谢谢！

作者: StephenW 时间: 2021-11-21 14:49

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你的问题很中肯 , 我也想要答案 . 因为我不知道答案，我在网上快速搜索了一些材料信息.

据研究人员, Covid-19不容易产生变异, 因为它有校对(proof reading)机制来纠正复制中的错误.但是对COVID的突变有更多的追踪.

Covid-19 在血液中最高的载量大约是 10的8.4 次方copies per ml, 暴露(exposure)后约 3 周达到峰值, 然后下降.

Covid-19的受体是ACE2. ACE2 在许多器官中表达，肺组织也有表达 . HBV受体NTCP主要在肝组织中表达 .

Covid-19可以感染许多器官，引起严重的免疫反应，导致严重的疾病 .HBV只会感染肝脏 .

作者: Newbegin 时间: 2021-11-21 23:29

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谢谢Stephen老师释疑！
看来它本身并不容易产生变异，不同株型的出现只是传播太广太快了（呼吸传染）.

作者: tlyuhq 时间: 2021-11-22 19:55

新冠肺炎疫苗与肝硬化的关系，不能相信西方几个人的“无病呻吟”。如果真的影响很大，国家会告诉乙肝患者尤其是肝硬化患者的。

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