Narcolepsy Onset Is Seasonal and Increased following the 2009 H1N1 Pandemic in China
Narcolepsy Onset Is Seasonal and Increased following the 2009 H1N1 Pandemic in China
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DOI：
10.1002/ana.22587
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发表时间：
2011-09-01
影响因子：
11.2
通讯作者：
Mignot, Emmanuel
中科院分区：
文献类型：
--
作者：
Han, Fang;Lin, Ling;Mignot, Emmanuel
目的：发作性睡病是由下丘脑内下丘脑下丘脑促性腺激素/增食欲素神经元丢失引起的，这可能是自身免疫过程的结果。最近，北欧地区接种甲流疫苗后出现发作性睡病的报道引起了人们的关注。方法：本研究是对北京地区确诊的发作性睡病患者进行回顾性分析，中国(19982010)。从629名患者(86%的儿童)收集了自我报告的发病月份和年份。使用图形呈现、自相关、卡方和傅立叶分析来评估发病的月度变化。结果：发作性睡病的发病具有季节性，受月份和日历年的影响显著。发病在11月份最少，4月份最多，从低谷到高峰期增加了6.7倍。研究每年的变化，我们发现在2009年H1N1冬季流感大流行后，发作性睡病的发病率增加了3倍。这一增长不太可能用增加疫苗接种来解释，因为142名患者中只有8名(5.6%)回忆起接受了H1N1疫苗接种。相关分析表明，流感/感冒或H1N1感染的季节性高峰与发作性睡病的发病高峰之间存在显著的延迟5-7个月。解释：在中国看来，发作性睡病的发生与包括H1N1流感在内的上呼吸道感染的季节性和年度性模式高度相关。2010年，与冬季H1N1感染相比，发作性睡病的季节性发病高峰期推迟了6个月，而且这种相关性与大多数样本中的H1N1疫苗接种无关。Ann Neurol 2011；70：410-417
Objective: Narcolepsy is caused by the loss of hypocretin/orexin neurons in the hypothalamus, which is likely the result of an autoimmune process. Recently, concern has been raised over reports of narcolepsy in northern Europe following H1N1 vaccination.Methods: The study is a retrospective analysis of narcolepsy onset in subjects diagnosed in Beijing, China ( 19982010). Self-reported month and year of onset were collected from 629 patients (86% children). Graphical presentation, autocorrelations, chi-square, and Fourier analysis were used to assess monthly variation in onset. Finally, 182 patients having developed narcolepsy after October 2009 were asked for vaccination history.Results: The occurrence of narcolepsy onset was seasonal, significantly influenced by month and calendar year. Onset was least frequent in November and most frequent in April, with a 6.7-fold increase from trough to peak. Studying year-to-year variation, we found a 3-fold increase in narcolepsy onset following the 2009 H1N1 winter influenza pandemic. The increase is unlikely to be explained by increased vaccination, as only 8 of 142 (5.6%) patients recalled receiving an H1N1 vaccination. Cross-correlation indicated a significant 5- to 7-month delay between the seasonal peak in influenza/cold or H1N1 infections and peak in narcolepsy onset occurrences.Interpretation: In China, narcolepsy onset is highly correlated with seasonal and annual patterns of upper airway infections, including H1N1 influenza. In 2010, the peak seasonal onset of narcolepsy was phase delayed by 6 months relative to winter H1N1 infections, and the correlation was independent of H1N1 vaccination in the majority of the sample. ANN NEUROL 2011;70:410-417