Zinman Lorne, Thoma Jessica, Kwong Jeffrey C, Kopp Alex, Stukel Thérèse A, Juurlink David N
Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
Muscle Nerve. 2009 Dec;40(6):947-51. doi: 10.1002/mus.21440.
Influenza vaccination has been associated with adverse events including Guillain-Barré syndrome. Because the safety of influenza vaccination in patients with myasthenia gravis (MG) has not been established, some clinicians discourage vaccination for these patients. We explored whether the administration of influenza vaccine to patients with MG might increase the risk of myasthenic crisis. Using population-based healthcare data from Ontario, Canada, from 1992 to 2007, we utilized the self-matched, case-series method of detecting adverse events following vaccination. We studied patients with established myasthenia who were hospitalized for MG within 42 weeks of influenza vaccination. We defined the primary risk interval as the 6 weeks following vaccination. Between January 1, 1992 and March 31, 2006, we identified 3667 hospital admissions for MG. No seasonal trend in MG admissions was evident. In 513 instances, hospitalization occurred within 42 weeks following vaccination in patients previously diagnosed with MG. Among these patients, 266 (52%) were men, the median age was 74 years, and 86 (17%) had previously undergone thymectomy. The estimated relative incidence of admission for MG in the primary risk interval compared with the control interval was 0.84 (95% confidence interval 0.65-1.09). We found similar results in stratified analyses according to gender, age, and thymectomy status. Vaccination of patients with MG against influenza was not found to be associated with exacerbations of the disease. Our findings do not support the practice of withholding influenza vaccination in patients with MG.
流感疫苗接种与包括格林-巴利综合征在内的不良事件有关。由于重症肌无力（MG）患者接种流感疫苗的安全性尚未确立，一些临床医生不鼓励为这些患者接种疫苗。我们探讨了为MG患者接种流感疫苗是否会增加肌无力危象的风险。利用加拿大安大略省1992年至2007年基于人群的医疗保健数据，我们采用自我匹配的病例系列方法来检测接种疫苗后的不良事件。我们研究了在接种流感疫苗后42周内因MG住院的确诊重症肌无力患者。我们将主要风险期定义为接种疫苗后的6周。在1992年1月1日至2006年3月31日期间，我们确定了3667例因MG住院的病例。MG住院病例无明显季节性趋势。在513例病例中，先前诊断为MG的患者在接种疫苗后42周内住院。在这些患者中，266例（52%）为男性，中位年龄为74岁，86例（17%）先前接受过胸腺切除术。与对照期相比，主要风险期内MG住院的估计相对发病率为0.84（95%置信区间0.65 - 1.09）。我们在根据性别、年龄和胸腺切除状态进行的分层分析中发现了类似结果。未发现为MG患者接种流感疫苗与疾病加重有关。我们的研究结果不支持不给MG患者接种流感疫苗的做法。
