Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.
Department of Neurology, Cantonal Hospital, St Gallen, Switzerland.
Eur J Neurol. 2024 Dec;31(12):e16462. doi: 10.1111/ene.16462. Epub 2024 Oct 4.
Infections and vaccinations have been identified as potential immunological triggers of neuralgic amyotrophy (NA), but the exact type and frequency of the preceding agents is unknown.
This was a multicentre, prospective, observational, matched case-control study. NA was diagnosed by neuromuscular experts according to validated clinical criteria and electrodiagnostic studies. Clinical data and biological samples of NA patients were collected within 90 days from disease onset between June 2018 and December 2023. All NA patients were asked about prior infection and vaccination in the month before disease onset. Serological tests for hepatitis E virus, human immunodeficiency virus, severe acute respiratory syndrome coronavirus 2, Epstein-Barr virus, cytomegalovirus, parvovirus B19, varicella-zoster virus, Borrelia burgdorferi, Mycoplasma pneumoniae and Bartonella henselae were performed in a central laboratory. Each case was matched with a healthy control for age, sex, place of residence and time of blood collection.
Fifty-seven patients and corresponding controls were included. The mean age was 45 years for both groups. NA onset was preceded by a symptomatic infectious trigger confirmed by microbiological tests in 15/57 (26.3%) patients. Coronavirus disease 2019 vaccination was considered a potential trigger in 7/57 (12.3%) subjects. An acute viral infection was associated with a bilateral involvement of the brachial plexus (p = 0.003, Cramèr's V = 0.43).
Confirmed immune triggers (infection or vaccination) preceded disease onset in 22/57 (38.6%) NA cases. We suggest to test NA patients in the acute phase for intracellular antigens, especially in the case of concomitant bilateral involvement and hepatitis.
感染和疫苗接种已被确定为神经痛性肌萎缩（NA）的潜在免疫触发因素，但确切的先前因素类型和频率尚不清楚。
这是一项多中心、前瞻性、观察性、匹配病例对照研究。根据经过验证的临床标准和电诊断研究，由神经肌肉专家诊断 NA。在 2018 年 6 月至 2023 年 12 月期间，在疾病发作后 90 天内，从临床数据和生物样本中收集 NA 患者的资料。所有 NA 患者均被询问疾病发作前一个月的先前感染和疫苗接种情况。在中央实验室进行了针对戊型肝炎病毒、人类免疫缺陷病毒、严重急性呼吸综合征冠状病毒 2、EB 病毒、巨细胞病毒、细小病毒 B19、水痘带状疱疹病毒、伯氏疏螺旋体、肺炎支原体和汉塞巴尔通体的血清学检测。每个病例均与年龄、性别、居住地和采血时间相匹配的健康对照相匹配。
共纳入 57 例患者和相应的对照。两组的平均年龄均为 45 岁。在 15/57（26.3%）例患者中，通过微生物学检测证实，NA 发作前存在有症状的感染性触发因素。在 7/57（12.3%）患者中，新冠病毒疾病 2019 疫苗接种被认为是潜在的触发因素。急性病毒感染与臂丛双侧受累相关（p=0.003，Cramèr 的 V=0.43）。
在 57 例 NA 病例中，有 22/57（38.6%）例明确的免疫触发因素（感染或疫苗接种）在疾病发作前存在。我们建议在急性期对 NA 患者进行细胞内抗原检测，特别是在伴有双侧受累和肝炎的情况下。
