Lunn Michael P
Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, Queen Square and Department of Neurology, UCL Institute of Neurology, London, UK.
Curr Opin Neurol. 2022 Oct 1;35(5):571-578. doi: 10.1097/WCO.0000000000001086. Epub 2022 Jul 18.
Guillain-Barre syndrome is sometimes a severe and disabling postinfectious neuromuscular paralysis that is causally associated with a number of well defined infections, and occasionally with immunization. The severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) pandemic and the worldwide immunization programme provoked fears of an epidemic of coronavirus disease 2019 (COVID-19) related disease. As we emerge from the pandemic this review summarises some of the huge volume of publications about Guillain-Barre syndrome (GBS), COVID-19 and immunisation against it.
In the early months of COVID-19, there were concerns of significant numbers of cases of GBS resulting from SARS-CoV-2 infection. Large epidemiological studies have provided reassurance that the association of GBS with COVID-19 is small or absent. Despite considerable efforts, plausible pathogenic mechanisms aligned with our understanding of GBS causation have not been identified. Reliable data from national surveillance of COVID-19 vaccinations have shown GBS to occur at about 5.8 cases per million first doses of adenovirus vectored COVID-19 vaccines, otherwise not distinguishable from incident naturally occurring cases. However, this risk is far outweighed by the protective benefits of vaccination in the at-risk older deciles of age.
With no obvious link of GBS to COVID-19 epitopes, in particular the spike (S-)protein, but a clearly demonstrable causation in some susceptible individuals from the global rollout of novel adenovirus vectored vaccine technologies, adenoviruses are of significant interest in the pathogenesis of GBS as well as vectors in their many expanding pharmaceutical applications.
吉兰-巴雷综合征有时是一种严重且致残的感染后神经肌肉麻痹，与多种明确的感染有因果关系，偶尔也与免疫接种有关。严重急性呼吸综合征冠状病毒2（Sars-CoV-2）大流行和全球免疫计划引发了对2019冠状病毒病（COVID-19）相关疾病流行的担忧。随着我们从大流行中走出，本综述总结了关于吉兰-巴雷综合征（GBS）、COVID-19及其免疫接种的大量出版物中的一些内容。
在COVID-19流行的最初几个月，人们担心Sars-CoV-2感染会导致大量GBS病例。大型流行病学研究已消除疑虑，表明GBS与COVID-19的关联很小或不存在。尽管付出了巨大努力，但尚未确定与我们对GBS病因的理解相符的合理致病机制。来自全国COVID-19疫苗接种监测的可靠数据显示，每百万剂首剂腺病毒载体COVID-19疫苗中约有5.8例发生GBS，否则与自然发生的病例无法区分。然而，在高危的老年人群体中，这种风险远远小于疫苗接种带来的保护益处。
虽然GBS与COVID-19表位，特别是刺突（S-）蛋白没有明显联系，但在全球推广新型腺病毒载体疫苗技术的过程中，在一些易感个体中明确证明了因果关系，因此腺病毒在GBS发病机制以及其在众多不断扩展的药物应用中的载体方面具有重大研究价值。
