Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, PR China.
Clin Exp Immunol. 2023 Oct 13;213(3):301-309. doi: 10.1093/cei/uxad043.
The occurrence of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) has been reported since the coronavirus disease 2019 (COVID-19) vaccination, but whether there is a causal relationship or coincidence remains to be verified. We combined the term COVID-19 vaccination with each word of AAV to search for case reports and case series published in PubMed, EMBASE, and Web of Science databases before 13 March 2023. A total of 56 patients who developed AAV after COVID-19 vaccination were identified from 44 research centers. Of the 56 subjects, 43 (76.7%) were vaccinated with the mRNA vaccine, followed by the adenovirus vaccine (14.3%) and inactivated vaccine (9.0%) (P = 0.015). Compared with relapsed AAV, new-onset AAV patients had at least two other diseases previously (P < 0.001). Twenty-five (44.6%) patients presented symptoms after the first injection, and the medium onset time was 12 (1-77) days, while Twenty-eight (50.0%) patients developed symptoms after the second dose, and their medium period was 14 (1-60) days. Forty-four (78.5%) patients achieved remission after immunosuppressive agents, plasma exchange, and hemodialysis. One (1.8%) patient died from progressive respiratory failure and nine (16.1%) did not recover, leaving five patients permanently dependent on hemodialysis. Pathogenic ANCA may be activated by enhanced immune response and epitope spreading after COVID-19 vaccination and induced the occurrence of AAV, especially in genetically susceptible populations.
自新型冠状病毒病 2019（COVID-19）疫苗接种以来，已报告抗中性粒细胞胞质抗体（ANCA）相关血管炎（AAV）的发生，但两者之间是否存在因果关系或巧合仍有待验证。我们将 COVID-19 疫苗与 AAV 的每个单词组合，在 2023 年 3 月 13 日之前在 PubMed、EMBASE 和 Web of Science 数据库中搜索发表的病例报告和病例系列。从 44 个研究中心共确定了 56 例 COVID-19 疫苗接种后发生 AAV 的患者。在 56 名受试者中，43 名（76.7%）接种了 mRNA 疫苗，其次是腺病毒疫苗（14.3%）和灭活疫苗（9.0%）（P = 0.015）。与复发性 AAV 相比，新发 AAV 患者此前至少患有其他两种疾病（P < 0.001）。25 名（44.6%）患者在第一次注射后出现症状，中位发病时间为 12（1-77）天，而 28 名（50.0%）患者在第二次注射后出现症状，中位发病时间为 14（1-60）天。44 名（78.5%）患者在接受免疫抑制剂、血浆置换和血液透析后缓解。1 名（1.8%）患者死于进行性呼吸衰竭，9 名（16.1%）未恢复，5 名患者永久性依赖血液透析。COVID-19 疫苗接种后，致病性 ANCA 可能通过增强的免疫反应和表位扩展而被激活，并导致 AAV 的发生，尤其是在遗传易感人群中。
