Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, Donghu District, China.
J Med Virol. 2023 Jul;95(7):e28946. doi: 10.1002/jmv.28946.
Thrombotic microangiopathy (TMA) associated with coronavirus disease 2019 (COVID-19) vaccination has been reported, however, the clinical characteristics and pathogenesis remained mysterious. We reviewed 84 TMA cases post-COVID-19 vaccination, including 64 patients diagnosed with thrombotic thrombocytopenic purpura (TTP), 17 cases presented as atypical hemolytic uremic syndrome (aHUS), and three cases manifested as unclassified TMA. TMA episodes were mostly associated with messenger RNA vaccines. For TTP, 67.6% of females developed symptoms after the first dose of the vaccine, and 63.0% of males were secondary to the second dose (p = 0.015). Compared with TTP, aHUS generally appeared within 7 days (p = 0.002) and showed higher levels of serum creatinine (p < 0.001). 87.5% of TTP received plasma exchange (PEX)-based treatment, and 52.9% of aHUS adopted non-PEX-based therapies (p < 0.001). Mechanistically, complement dysfunction, neutrophil activation, and the generation of pathogenic autoantibodies resulting from molecular mimicry contribute to explaining the pathogenesis of TMA post-COVID-19 vaccination.
血栓性微血管病（TMA）与 2019 年冠状病毒病（COVID-19）疫苗接种有关，但临床特征和发病机制仍不清楚。我们回顾了 84 例 COVID-19 疫苗接种后发生的 TMA 病例，包括 64 例诊断为血栓性血小板减少性紫癜（TTP）的患者，17 例表现为非典型溶血性尿毒症综合征（aHUS），3 例表现为未分类的 TMA。TMA 发作大多与信使 RNA 疫苗有关。对于 TTP，67.6%的女性在接种第一剂疫苗后出现症状，63.0%的男性是第二剂疫苗的继发症（p=0.015）。与 TTP 相比，aHUS 通常在 7 天内出现（p=0.002），且血清肌酐水平更高（p<0.001）。87.5%的 TTP 接受基于血浆置换（PEX）的治疗，52.9%的 aHUS 采用非 PEX 为基础的治疗（p<0.001）。从机制上讲，补体功能障碍、中性粒细胞激活以及分子模拟产生的致病性自身抗体导致 COVID-19 疫苗接种后 TMA 的发生。
