接种 COVID-19 疫苗后的自身免疫性肝炎。
Autoimmune hepatitis after COVID-19 vaccination.
机构信息
Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), Beijing, China.
出版信息
Front Immunol. 2022 Nov 25;13:1035073. doi: 10.3389/fimmu.2022.1035073. eCollection 2022.
Abstract
Vaccination is one of the most vigorous ways to intervene in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Cases of autoimmune hepatitis (AIH) after coronavirus disease (COVID-19) vaccination have been increasingly reported. Twenty-seven cases of AIH are summarized in this study, providing emerging evidence of autoimmune reactions in response to various COVID-19 vaccines, including in patients with special disease backgrounds such as primary sclerosing cholangitis (PSC), liver transplantation, and previous hepatitis C virus (HCV) treatment. Molecular mimicry, adjuvants, epitope spreading, bystander activation, X chromosome, and sceptical hepatotropism of SARS-CoV-2 may account for, to some extent, such autoimmune phenomena. Immunosuppressive corticosteroids perform well with or without azathioprine in such post-COVID-19-vaccination AIH. However, determination of the exact mechanism and establishment of causality require further confirmation.
摘要
接种疫苗是干预严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）大流行最有力的方法之一。越来越多的报道称，接种冠状病毒病（COVID-19）疫苗后会出现自身免疫性肝炎（AIH）病例。本研究总结了 27 例 AIH 病例，为各种 COVID-19 疫苗引起的自身免疫反应提供了新的证据，包括原发性硬化性胆管炎（PSC）、肝移植和先前丙型肝炎病毒（HCV）治疗等特殊疾病背景的患者。分子模拟、佐剂、表位扩展、旁观者激活、X 染色体和 SARS-CoV-2 的可疑嗜肝性可能在一定程度上解释了这种自身免疫现象。免疫抑制性皮质类固醇在 COVID-19 疫苗接种后 AIH 中联合或不联合硫唑嘌呤均有良好疗效。然而，确切的机制和因果关系的确立需要进一步的证实。
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