接种 SARS-CoV-2 疫苗后发生亚急性甲状腺炎和格雷夫斯病的患者的 HLA 分型：病例报告。
HLA typing of patients who developed subacute thyroiditis and Graves' disease after SARS-CoV-2 vaccination: a case report.
机构信息
Department of Endocrinology and Diabetes, Saitama Medical University, Morohongo 38, Moroyama, Iruma-gun, Saitama, 350-0495, Japan.
出版信息
BMC Endocr Disord. 2023 Mar 7;23(1):54. doi: 10.1186/s12902-023-01287-5.
BACKGROUND
Cases of subacute thyroiditis (SAT) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination have been reported. A human leukocyte antigen (HLA) allele, HLA-B*35, appears to be involved in the pathogenesis of SAT.
CASE PRESENTATION
We conducted HLA typing of one patient with SAT and another with both SAT and Graves' disease (GD), which developed after SARS-CoV-2 vaccination. Patient 1, a 58-year-old Japanese man, was inoculated with a SARS-CoV-2 vaccine (BNT162b2; Pfizer, New York, NY, USA). He developed fever (38 °C), cervical pain, palpitations, and fatigue on day 10 after vaccination. Blood chemistry tests revealed thyrotoxicosis and elevated serum C-reactive protein (CRP) and slightly increased serum antithyroid-stimulating antibody (TSAb) levels. Thyroid ultrasonography revealed the characteristic findings of SAT. Patient 2, a 36-year-old Japanese woman, was inoculated twice with a SARS-CoV-2 vaccine (mRNA-1273; Moderna, Cambridge, MA, USA). She developed fever (37.8 °C) and thyroid gland pain on day 3 after the second vaccination. Blood chemistry tests revealed thyrotoxicosis and elevated serum CRP, TSAb, and antithyroid-stimulating hormone receptor antibody levels. Fever and thyroid gland pain persisted. Thyroid ultrasonography revealed the characteristic findings of SAT (i.e., slight swelling and a focal hypoechoic area with decreased blood flow). Prednisolone treatment was effective for SAT. However, thyrotoxicosis causing palpitations relapsed thereafter, for which thyroid scintigraphy with technetium pertechnetate was conducted, and the patient was diagnosed with GD. Thiamazole treatment was then initiated, which led to improvement in symptoms.
CONCLUSION
HLA typing revealed that both patients had the HLA-B35:01, -C04:01, and -DPB105:01 alleles. Only patient 2 had the HLA-DRB111:01 and HLA-DQB103:01 alleles. The HLA-B35:01 and HLA-C04:01 alleles appeared to be involved in the pathogenesis of SAT after SARS-CoV-2 vaccination, and the HLA-DRB111:01 and HLA-DQB1*03:01 alleles were speculated to be involved in the postvaccination pathogenesis of GD.
背景
有报道称，接种严重急性呼吸综合征冠状病毒 2 （SARS-CoV-2）疫苗后会出现亚急性甲状腺炎（SAT）病例。人类白细胞抗原（HLA）等位基因 HLA-B*35 似乎与 SAT 的发病机制有关。
病例介绍
我们对一名 SAT 患者和另一名 SAT 合并 Graves 病（GD）患者进行了 HLA 分型，这两名患者均在接种 SARS-CoV-2 疫苗后发病。患者 1 为 58 岁日本男性，接种了 SARS-CoV-2 疫苗（BNT162b2；辉瑞，纽约，NY，美国）。他在接种后第 10 天出现发热（38°C）、颈部疼痛、心悸和疲劳。血液化学检查显示甲状腺毒症和血清 C 反应蛋白（CRP）升高，以及稍高的血清抗甲状腺刺激抗体（TSAb）水平。甲状腺超声检查显示 SAT 的特征性发现。患者 2 为 36 岁日本女性，两次接种 SARS-CoV-2 疫苗（mRNA-1273；Moderna，剑桥，MA，美国）。她在第二次接种后第 3 天出现发热（37.8°C）和甲状腺疼痛。血液化学检查显示甲状腺毒症和血清 CRP、TSAb 和促甲状腺刺激激素受体抗体水平升高。发热和甲状腺疼痛持续存在。甲状腺超声检查显示 SAT 的特征性发现（即轻微肿胀和局灶性低回声区域伴血流减少）。泼尼松龙治疗对 SAT 有效。然而，此后引起心悸的甲状腺毒症复发，为此进行了甲状腺锝扫描，患者被诊断为 GD。随后开始使用甲巯咪唑治疗，症状得到改善。
结论
HLA 分型显示两名患者均具有 HLA-B35:01、-C04:01 和 -DPB105:01 等位基因。只有患者 2 具有 HLA-DRB111:01 和 HLA-DQB103:01 等位基因。HLA-B35:01 和 HLA-C04:01 等位基因似乎与 SARS-CoV-2 疫苗接种后的 SAT 发病机制有关，而 HLA-DRB111:01 和 HLA-DQB1*03:01 等位基因则被推测与接种后的 GD 发病机制有关。
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