Acute Inflammatory Diseases of the Central Nervous System After SARS-CoV-2 Vaccination.
Acute Inflammatory Diseases of the Central Nervous System After SARS-CoV-2 Vaccination.
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DOI：
10.1212/nxi.0000000000200063
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发表时间：
2023-01
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影响因子：
--
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中科院分区：
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急性炎症性中枢神经系统疾病包括视神经脊髓炎谱系疾病(NMOSDs)和髓鞘少突胶质细胞糖蛋白抗体相关疾病(MOGAD)。接种疫苗后报告了MOGAD和急性播散性脑脊髓炎(ADEM)。因此，大规模的SARS-CoV-2疫苗接种计划可能会导致这些情况的发生率增加。我们描述了在接种SARS-CoV-2疫苗后8周内出现类似NMOSD或MOGAD的新的急性中枢神经系统脱髓鞘患者的特征。这项研究包括了从SARS-CoV-2疫苗接种计划引入到2022年5月期间在英国接受高度专业化的NMOSD服务的一系列预期病例。25名患者在接种阿斯利康(ChAdOx1S)或辉瑞(BNT162b2)疫苗后8周内出现新的视神经炎(ON)和/或横贯性脊髓炎(TM)±其他中枢神经系统炎症。复习他们的临床记录和临床调查，包括MRI扫描。采用活细胞法检测髓鞘少突胶质细胞糖蛋白(MOG)和水通道蛋白4(AQP4)抗体。根据最后一次临床评估，患者的结果被评级为好、中或差。在确诊的25例患者中(中位年龄38岁，女性14例)，12例(48%)有MOG抗体(MOGIg+)，2例(8%)有水通道蛋白4抗体(AQP4Ig G+)，11例(44%)都没有。14名抗体阳性患者中有12名(86%)接种了ChAdOx1S疫苗。MOGIg G+患者以TM最常见(10/12，83%)，常合并ADEM样脑/脑干病变(6/12，50%)。横贯性脊髓炎在10名患者中有7名是纵向广泛的。2021年春季新增MOGAD病例的高峰可归因于疫苗后病例。AQP4Ig G+患者均表现为脑部病变和TM。与BNT162b2组的1/5(20%)相比，血清阴性的6例ChAdOx1S患者中有4例(67%)发生了纵向广泛的TM(LETM)，面神经炎症仅在ChAdOx1S患者中有报道(2/5，40%)。1例血清阴性ChAdOx1S受体确诊为格林-巴利综合征，另1例疑似格林-巴利综合征。ChAdOx1S与12/14例抗体阳性有关，以MOGAD居多。MOGAD患者表现不典型，仅2例孤立性ON(BNT162b2疫苗接种后1例)，但有频繁的ADEM样脑损害和LETM。在血清阴性组中，ChAdOx1S和BNT162b2受体之间存在表型差异。这些观察结果可能支持ChAdOx1S疫苗在炎症性中枢神经系统疾病，特别是MOGAD中的致病作用。对这一队列的进一步研究可以为疫苗相关免疫病理学提供见解。
Acute inflammatory CNS diseases include neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD). Both MOGAD and acute disseminated encephalomyelitis (ADEM) have been reported after vaccination. Consequently, the mass SARS-CoV-2 vaccination program could result in increased rates of these conditions. We described the features of patients presenting with new acute CNS demyelination resembling NMOSDs or MOGAD within 8 weeks of SARS-CoV-2 vaccination. The study included a prospective case series of patients referred to highly specialized NMOSD services in the UK from the introduction of SARS-CoV-2 vaccination program up to May 2022. Twenty-five patients presented with new optic neuritis (ON) and/or transverse myelitis (TM) ± other CNS inflammation within 8 weeks of vaccination with either AstraZeneca (ChAdOx1S) or Pfizer (BNT162b2) vaccines. Their clinical records and paraclinical investigations including MRI scans were reviewed. Serologic testing for antibodies to myelin oligodendrocyte glycoprotein (MOG) and aquaporin 4 (AQP4) was performed using live cell–based assays. Patients' outcomes were graded good, moderate, or poor based on the last clinical assessment. Of 25 patients identified (median age 38 years, 14 female), 12 (48%) had MOG antibodies (MOGIgG+), 2 (8%) had aquaporin 4 antibodies (AQP4IgG+), and 11 (44%) had neither. Twelve of 14 (86%) antibody-positive patients received the ChAdOx1S vaccine. MOGIgG+ patients presented most commonly with TM (10/12, 83%), frequently in combination with ADEM-like brain/brainstem lesions (6/12, 50%). Transverse myelitis was longitudinally extensive in 7 of the 10 patients. A peak in new MOGAD cases in Spring 2021 was attributable to postvaccine cases. Both AQP4IgG+ patients presented with brain lesions and TM. Four of 6 (67%) seronegative ChAdOx1S recipients experienced longitudinally extensive TM (LETM) compared with 1 of 5 (20%) of the BNT162b2 group, and facial nerve inflammation was reported only in ChAdOx1S recipients (2/5, 40%). Guillain-Barre syndrome was confirmed in 1 seronegative ChAdOx1S recipient and suspected in another. ChAdOx1S was associated with 12/14 antibody-positive cases, the majority MOGAD. MOGAD patients presented atypically, only 2 with isolated ON (1 after BNT162b2 vaccine) but with frequent ADEM-like brain lesions and LETM. Within the seronegative group, phenotypic differences were observed between ChAdOx1S and BNT162b2 recipients. These observations might support a causative role of the ChAdOx1S vaccine in inflammatory CNS disease and particularly MOGAD. Further study of this cohort could provide insights into vaccine-associated immunopathology.
影响因子：
5.8
作者：
McLean-Tooke A;Lucas M;French M
通讯作者：
French M