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新冠病毒疫苗接种后的系统性红斑狼疮患者:病情发作及预防措施

Systematic lupus erythematous patients following COVID-19 vaccination: Its flares up and precautions.

作者信息

Khatri Govinda, Shaikh Somina, Rai Aneesh, Cheema Huzaifa Ahmad, Essar Mohammad Yasir

机构信息

Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.

Department of Medicine, King Edward Medical University, Lahore, Pakistan.

出版信息

Ann Med Surg (Lond). 2022 Aug;80:104282. doi: 10.1016/j.amsu.2022.104282. Epub 2022 Jul 31.

DOI:10.1016/j.amsu.2022.104282
PMID:35936557
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9339251/
Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease that can cause both direct and indirect inflammatory damage to multiple organs. Clinical symptoms in the skin, joints, kidneys, and central nervous system, as well as serological indicators such as antinuclear antibodies (ANA), notable antibodies to dsDNA, are used to diagnose SLE. mRNA SARS-CoV-2 vaccines have been shown to trigger SLE flares and the development of new rheumatic diseases. SARS-CoV-2 mRNA vaccinations increase type I interferon (INF), which is not only known to have a role in the antiviral response but is also a crucial cytokine in the pathophysiology of SLE. Furthermore, both the mRNA and adenovirus vaccines boost the production of type 1 interferons, which are required for the spread of SARS-CoV-2. The danger of not administering the COVID-19 vaccination to SLE patients is significantly larger than the likelihood of its adverse effects, which are most likely caused by intrinsic immune failure, demographic disease activity, medications, linked organ damage, and comorbidities. The adverse effects of COVID-19 vaccination in SLE patients are common (about 50%), although they do not interfere with daily functioning in the majority of cases. Several precautions can be taken to avoid the complications associated with COVID-19 vaccinations.

摘要

系统性红斑狼疮(SLE)是一种自身免疫性疾病,可对多个器官造成直接和间接的炎症性损害。皮肤、关节、肾脏和中枢神经系统的临床症状,以及抗核抗体(ANA)、抗双链DNA显著抗体等血清学指标,都用于诊断SLE。已证明mRNA新冠病毒疫苗会引发SLE病情加重和新的风湿性疾病。接种新冠病毒mRNA疫苗会增加I型干扰素(INF),I型干扰素不仅在抗病毒反应中起作用,也是SLE病理生理学中的关键细胞因子。此外,mRNA疫苗和腺病毒疫苗都会促进I型干扰素的产生,而I型干扰素是新冠病毒传播所必需的。不给SLE患者接种新冠疫苗的风险明显大于其不良反应的可能性,这些不良反应很可能是由内在免疫功能衰竭、疾病活动度、药物、相关器官损害和合并症引起的。新冠疫苗接种对SLE患者的不良反应很常见(约50%),不过在大多数情况下并不影响日常功能。可以采取多种预防措施来避免与新冠疫苗接种相关的并发症。

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本文引用的文献

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Systemic lupus erythematous after Pfizer COVID-19 vaccine: a case report.辉瑞 COVID-19 疫苗接种后出现系统性红斑狼疮:一例报告。
Clin Rheumatol. 2022 May;41(5):1597-1601. doi: 10.1007/s10067-022-06126-x. Epub 2022 Mar 16.
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Safety and disease flare of autoimmune inflammatory rheumatic diseases: a large real-world survey on inactivated COVID-19 vaccines.自身免疫性炎性风湿性疾病的安全性与疾病复发:一项关于灭活新冠疫苗的大型真实世界调查
Ann Rheum Dis. 2022 Mar;81(3):443-445. doi: 10.1136/annrheumdis-2021-221736. Epub 2021 Nov 25.
3
The Use of COVID-19 Vaccines in Patients with SLE.COVID-19 疫苗在系统性红斑狼疮患者中的应用。
Curr Rheumatol Rep. 2021 Nov 12;23(11):79. doi: 10.1007/s11926-021-01046-2.
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New-onset Evans syndrome associated with systemic lupus erythematosus after BNT162b2 mRNA COVID-19 vaccination.接种 BNT162b2 mRNA COVID-19 疫苗后出现与系统性红斑狼疮相关的新发性 Evans 综合征。
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Local and systemic reactogenicity of COVID-19 vaccine BNT162b2 in patients with systemic lupus erythematosus and rheumatoid arthritis.COVID-19 疫苗 BNT162b2 在系统性红斑狼疮和类风湿关节炎患者中的局部和全身反应原性。
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