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基础科研：如何接种新冠疫苗才能降低病毒载量，获得更好的预防效果？Nat Med重磅研究答疑

2021-12-15 生物探索 网络

Delta突变
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尽管病毒载量是检测感染的常见指标，但PCR阳性并不一定意味着存在活病毒，所以病毒载量与传染之间的相关性仍有待进一步研究。

本文转载自“Hanson临床科研”微信公众号。

 

由于Delta突变株具有更高的传染性，给人类造成了巨大的危害；而以色列的报告显示，Omicron突变株的传染性可能是Delta突变株的1.3倍，也由此造成了更大的恐慌。

 

Delta突变株如何达到了原始毒株2倍的传染性？中国广东省疾控中心的研究显示，这主要是由于：Delta突变株感染后的病毒载量比原始毒株高1,260倍。

Delta突变株感染后病毒载量是原始新冠病毒的1000多倍！
疫苗接种目前是预防感染COVID-19的关键手段，但之前对于“疫苗接种是否能够降低突破性感染者的病毒载量”一直没有定论，甚至出现完全相反的结果。
 
美国加州大学上传于medRxiv的一项研究，是否接种疫苗不影响感染者病毒载量。
 
但这些研究有着类似的不足：只是简单区分接种疫苗与否，而未考虑接种了何种疫苗、接种状况和接种时间如何。
 
而更多的证据显示：不同疫苗、是否完全接种、接种后时间延长，都影响着疫苗的有效性。
2021年11月2日，以色列研究者在Nat Med发表了该领域极具影响力的研究，结果显示：完全接种BNT162b2及加强接种后的一段时间内，疫苗接种显著降低了Delta突变株感染者的病毒载量。
本研究在测序时区分了三种新冠病毒（SARS-CoV-2）基因E, N和RdRp，并对其循环阈值（Ct，Ct值越低说明病毒载量越高）做了多因素线性回归分析，纳入的参数包括：感染时的疫苗接种后时间段、是否加强接种；并以性别、年龄等做了校正。
 
结果显示，完全接种BNT162b2 mRNA疫苗后，接种者的Ct值显著增高；在接种两个月后开始减弱，并在接种6个月时几乎降低到未接种者的水平。
 
但加强接种后，接种者的Ct值再次增高。
（受试者的基因测序结果。图源：原文表1）
作者通过图1更清楚地展示了Ct值随着接种时间及接种状态而变化的趋势。并且这种变化在不同病毒基因测序、不同年龄段、患者是否重症等情况下均观察到了一致的结果。
 
（Ct值在完全接种疫苗后不同时间/状态的变化。图源：原文图1）
由此，研究者认为，完全接种BNT162b2 mRNA疫苗，不仅可以预防感染COVID-19，在完全接种初期，疫苗可有效降低Delta突变株的病毒载量，降幅约为10倍。
疫苗接种降低突破性感染者病毒载量的效果随着接种时间延长而逐渐下降，并在接种约6个月时几乎降低到未接种疫苗者水平。但是，加强接种BNT162b2可以再次降低突破性感染者病毒载量。
这项研究首次解决了疫苗差异、接种状态及时间等因素对病毒载量的影响，对“确定疫苗接种能够降低病毒载量”的结论起到一锤定音的作用。
需要注意的是，由于不同疫苗诱导产生的中和抗体不同，所以该研究结果仅适用于新冠mRNA疫苗BNT162b2。
 
另外，尽管病毒载量是检测感染的常见指标，但PCR阳性并不一定意味着存在活病毒，所以病毒载量与传染之间的相关性仍有待进一步研究。

End

参考资料：

[1]https://www.jpost.com/health-and-wellness/coronavirus/covid-1st-data-about-vaccine-efficacy-against-omicron-expected-tuesday-687392

[2]https://doi.org/10.1101/2021.07.07.21260122.

[3]https://doi.org/10.1101/2021.09.28.21264262

[4]doi: 10.1016/S0140-6736(21)02717-3. 

[5]doi: 10.1038/s41591-021-01575-4. 

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    2022-02-13 szhvet

    #基础科研#

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    2021-12-15 grace5703

    #病毒载量#

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    2021-12-15 ms3994565386320060

    #Med#

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