Оценка гуморального ответа на вакцинацию Гам-Ковид-Вак (Sputnik V) против COVID-19 у пациентов на амбулаторном гемодиализе и перитонеальном диализе


DOI: https://dx.doi.org/10.18565/nephrology.2022.3.8-14

Шутов Е.В., Большаков С.А., Котлярова Г.В., Емельянова Э.Б., Сороколетов С.М., Долидзе Д.Д.

1) ГБУЗ ГКБ им. С.П. Боткина, Москва, Россия; 2) Российская медицинская академия непрерывного профессионального образования, Москва, Россия
Введение. Новая коронавирусная инфекция (COVID-19) является высококонтагиозной инфекционной болезнью, обусловливающей от 20 до 30% летального исхода пациентов с терминальной хронической болезнью почек, получавших гемодиализ (ГД) или перитонеальный диализ (ПД). Главное место в профилактике заболевания отведено вакцинации как одному из наиболее эффективных методов снижения смертности.
Цель исследования: оценка уровня гуморального ответа на вакцинацию Гам-Ковид-Вак (Спутник V) против COVID-19 от пациентов, получающих амбулаторный гемодиализ и перитонеальный диализ, по сравнению со здоровыми лицами.
Материал и методы. В исследование вошли 103 пациента на диализе, из них 48 не были инфицированы до проведения стандартной вакцинации и 55 ппосле перенесенной новой коронавирусной инфекции; контролем служили 25 и 30 здоровых добровольцев соответственно. Оценивался гуморальный ответ всех исследуемых на вакцинацию по общему уровню SARS-CoV-2 IgG
и уровню IgG антител к рецептор-связывающему домену субъединицы S1 белка SARS-CoV-2. Сравнение уровня сероконверсии проводилось во всех группах (у больных на ГД, ПД и в контроле).
Результаты. Уровень SARS-CoV-2 IgG в группе исследуемых, не болевших COVID-19, составил у больных на ГД 10,2±2,2, на ПД – 9,3±2,9 ЕД/мл, и они статистически достоверно не различались. В группе контроля он оказался достоверно выше – 17,37±5,5 ЕД/мл (р<0,05). Уровень IgG антител к спайковому (S) белку коронавируса составил у больных на ГД 79,9±12,7
BAU/мл, на ПД – 80,7±17,5. В группе контроля он оказался достоверно выше – 272,5±17,6 BAU/мл (р<0,05). Исследование уровней антител к вирусу SARS-CoV-2 в группах испытуемых, перенесших COVID-19, показало отсутствие достоверных различий между группами.
Выводы. У больных, ранее не болевших COVID-19 и получавших ПД и ГД, наблюдается сниженный гуморальный ответ на вакцинацию Гам-Ковид-Вак (Спутник V) по сравнению с контрольной группой. Это обусловливает необходимость динамического контроля уровня антител и более раннего введения бустерной дозы вакцины. У больных на диализе и в контрольной группе, перенесших COVID-19, образуется сравнимый уровень сероконверсии.
Ключевые слова: COVID-19, ХБП, вакцина, иммунитет, перитонеальный диализ, гемодиализ
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Об авторах / Для корреспонденции

Шутов Евгений Викторович – д.м.н., профессор, руководитель Межокружного нефрологического центра ГБУЗ ГКБ им. С.П. Боткина, заведующий кафедрой нефрологии и диализа РМАНПО, Москва; e-mail: shutov_e_v@mail.ru. ORCID: https://orcid.org/0000-0002-1047-0378
Большаков Степан Алексеевич – врач-терапевт, младший научный сотрудник отдела наука ГБУЗ ГКБ им. С.П. Боткина, Москва; e-mail: bolshakoff123@yandex.ru ORCID: https://orcid.org/0000-0002-4556-6740
Котлярова Галина Владимировна – заведующая отделением амбулаторного гемодиализа межокружного нефрологического центра ГБУЗ ГКБ им. С.П. Боткина, Москва; e-mail: galopa@yandex.ru. ORCID: https://orcid.org/0000-0001-9970-4486
Емельянова Эльвира Борисовна – к.м.н., заведующая клинико-диагностической лабораторией ГБУЗ ГКБ им. С.П. Боткина, Москва, Россия. e-mail: e.allvira@gmail.com Сороколетов Сергей Михайлович – д.м.н., заместитель главного врача по терапевтической помощи ГБУЗ ГКБ им. С.П. Боткина, Москва; e-mail: sorokoletov-sm@mail.ru Долидзе Давид Джонович – д.м.н., профессор, заведующий научно-клиническим отделом ГБУЗ ГКБ им. С.П. Боткина, Москва; e-mail: ddolidzed@mail.ru
ORCID: https://orcid.org/0000-0002-0517-8540


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