Girard Marc
1 bd de la République 78000-Versailles, France.
Autoimmun Rev. 2005 Feb;4(2):96-100. doi: 10.1016/j.autrev.2004.10.002.
According to Hippocratic tradition, the safety level of a preventive medicine must be very high, as it is aimed at protecting people against diseases that they may not contract. This paper points out that information on the safety of hepatitis B vaccine (HBV) is biased as compared to classical requirements of evidence-based medicine (EBM), as exemplified by a documented selectivity in the presentation or even publication of available clinical or epidemiological data. Then, a review is made of data suggesting that HBV is remarkable by the frequency, the severity and the variety of its complications, some of them probably related to a mechanism of molecular mimicry leading to demyelinating diseases, and the others reproducing the spectrum of non-hepatic manifestations of natural hepatitis B. To be explained, this unusual spectrum of toxicity requires additional investigations based upon complete release of available data.
根据希波克拉底传统，预防医学的安全水平必须非常高，因为其目的是保护人们预防可能不会感染的疾病。本文指出，与循证医学（EBM）的经典要求相比，乙肝疫苗（HBV）的安全性信息存在偏差，这体现在现有临床或流行病学数据的呈现甚至发表上存在记录在案的选择性。然后，对一些数据进行了综述，这些数据表明乙肝疫苗在并发症的发生率、严重程度和种类方面都很显著，其中一些可能与导致脱髓鞘疾病的分子模拟机制有关，另一些则再现了自然乙肝的非肝脏表现谱。为了解释这种异常的毒性谱，需要在完全公开现有数据的基础上进行更多调查。
