Histological and serological features of acute liver injury after SARS-CoV-2 vaccination.
Histological and serological features of acute liver injury after SARS-CoV-2 vaccination.
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DOI：
10.1016/j.jhepr.2022.100605
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发表时间：
2023-01
期刊：
影响因子：
8.3
通讯作者：
Beretta-Piccoli, Benedetta Terziroli
中科院分区：
文献类型：
--
作者：
Codoni, Greta;Kirchner, Theresa;Engel, Bastian;Villamil, Alejandra Maria;Efe, Cumali;Staettermayer, Albert Friedrich;Weltzsch, Jan Philipp;Sebode, Marcial;Bernsmeier, Christine;Lleo, Ana;Gevers, Tom JG.;Kupcinskas, Limas;Castiella, Agustin;Pinazo, Jose;De Martin, Eleonora;Bobis, Ingrid;Sandahl, Thomas Damgaard;Pedica, Federica;Invernizzi, Federica;Del Poggio, Paolo;Bruns, Tony;Kolev, Mirjam;Semmo, Nasser;Bessone, Fernando;Giguet, Baptiste;Poggi, Guido;Ueno, Masayuki;Jang, Helena;Elpek, Gulsum Ozlem;Soylu, Nese Karadag;Cerny, Andreas;Wedemeyer, Heiner;Vergani, Diego;Mieli-Vergani, Giorgina;Lucena, M. Isabel;Andrade, Raul J.;Zen, Yoh;Taubert, Richard;Beretta-Piccoli, Benedetta Terziroli
越来越多的报道称，严重急性呼吸道综合征冠状病毒2型（SARS-CoV-2）疫苗接种后出现具有自身免疫特征的肝损伤。我们调查了一个大型国际队列的个人与急性肝炎后出现的SARS-CoV-2疫苗接种，侧重于组织学和血清学特征。入选的个体无已知的既存肝脏疾病，且在任何抗SARS-CoV-2疫苗接种后3个月内转氨酶水平≥ 5倍正常上限，并进行肝活检。招募了59名患者; 35名女性;中位年龄54岁。他们暴露于mRNA、载体、灭活和蛋白质疫苗的各种组合。肝组织学显示45例（76%）以小叶性肝炎为主，10例（17%）以门静脉性肝炎为主，4例（7%）为其他类型; 7例纤维化Ishak分期≥3，与更严重的界面性肝炎相关。在31例患者中进行了自身免疫血清学集中检测，结果显示23例（74%）抗抗核抗体，19例（61%）抗平滑肌抗体，8例（26%）抗胃壁细胞抗体，4例（13%）抗肝肾微粒体抗体，4例（13%）抗线粒体抗体。91%的患者接受类固醇±硫唑嘌呤治疗。所有病例的血清转氨酶水平均有所改善，3个月后24/58（41%）和6个月后30/46（65%）恢复正常。1例患者需要肝移植。在15名再次接触SARS-CoV-2疫苗的患者中，有3人复发。SARS-CoV-2疫苗接种后出现的急性肝损伤通常与小叶性肝炎和阳性自身抗体相关。肝损伤和SARS-CoV-2疫苗之间是否存在因果关系仍有待确定。密切的后续行动是必要的，以评估这种情况的长期结果。已经发表了接种严重急性呼吸道综合征冠状病毒2型（SARS-CoV-2）疫苗后肝损伤的病例。我们调查了一个大型国际队列的个人与急性肝炎后SARS-CoV-2疫苗接种，重点是肝活检结果和自身抗体：肝活检经常显示小叶炎症，这是典型的近期损伤，和自身抗体经常是阳性的。肝损伤和SARS-CoV-2疫苗之间是否存在因果关系仍有待确定。密切的后续行动是必要的，以评估这种情况的长期结果。我们报告了59例SARS-CoV-2疫苗接种后急性肝损伤的病例。组织学显示大多数小叶性肝炎，无相关纤维化。ANA阳性率为65%，SMA阳性率为54%，IgG升高率为35%。6个月时，65%的病例转氨酶正常，1例患者需要肝移植。
Liver injury with autoimmune features after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is increasingly reported. We investigated a large international cohort of individuals with acute hepatitis arising after SARS-CoV-2 vaccination, focusing on histological and serological features. Individuals without known pre-existing liver diseases and transaminase levels ≥5x the upper limit of normal within 3 months after any anti-SARS-CoV-2 vaccine, and available liver biopsy were included. Fifty-nine patients were recruited; 35 females; median age 54 years. They were exposed to various combinations of mRNA, vectorial, inactivated and protein-based vaccines. Liver histology showed predominantly lobular hepatitis in 45 (76%), predominantly portal hepatitis in 10 (17%), and other patterns in four (7%) cases; seven had fibrosis Ishak stage ≥3, associated with more severe interface hepatitis. Autoimmune serology, centrally tested in 31 cases, showed anti-antinuclear antibody in 23 (74%), anti-smooth muscle antibody in 19 (61%), anti-gastric parietal cells in eight (26%), anti-liver kidney microsomal antibody in four (13%), and anti-mitochondrial antibody in four (13%) cases. Ninety-one percent were treated with steroids ± azathioprine. Serum transaminase levels improved in all cases and were normal in 24/58 (41%) after 3 months, and in 30/46 (65%) after 6 months. One patient required liver transplantation. Of 15 patients re-exposed to SARS-CoV-2 vaccines, three relapsed. Acute liver injury arising after SARS-CoV-2 vaccination is frequently associated with lobular hepatitis and positive autoantibodies. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. A close follow-up is warranted to assess the long-term outcomes of this condition. Cases of liver injury after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) have been published. We investigated a large international cohort of individuals with acute hepatitis after SARS-CoV-2 vaccination, focusing on liver biopsy findings and autoantibodies: liver biopsy frequently shows inflammation of the lobule, which is typical of recent injury, and autoantibodies are frequently positive. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. Close follow-up is warranted to assess the long-term outcome of this condition. We report on 59 individuals with acute liver injury after SARS-CoV-2 vaccination. Histology shows mostly lobular hepatitis without relevant fibrosis. 65% were ANA positive, 54% were SMA positive, 35% had elevated IgG. Transaminases were normal in 65% of cases at 6 months, one patient required liver transplantation.
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影响因子：
12.8
作者：
Avci E;Abasiyanik F
通讯作者：
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影响因子：
7.8
作者：
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DOI：
10.15585/mmwr.mm7027e2
发表时间：
2021-07-09
期刊：
MMWR. Morbidity and mortality weekly report
影响因子：
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作者：
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Oliver SE
影响因子：
3.1
作者：
Chow, Kenneth W.;Pham, Nguyen, V;Ibrahim, Britney M.;Hong, Kimberly;Saab, Sammy
通讯作者：
Saab, Sammy
影响因子：
12.8
作者：
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