Autonomic dysfunction and HPV immunization: an overview
Autonomic dysfunction and HPV immunization: an overview
复制标题
DOI：
10.1007/s12026-018-9036-1
复制
发表时间：
2018-12-01
影响因子：
4.4
通讯作者：
Martinez-Lavin, Manuel
中科院分区：
文献类型：
--
作者：
Blitshteyn, Svetlana;Brinth, Louise;Martinez-Lavin, Manuel
本文回顾了几个国家报告的病例系列，这些病例描述了疑似对HPV疫苗产生严重副作用的患者。所描述的症状非常相似，包括致残疲劳、头痛、广泛疼痛、晕厥、胃肠动力障碍、肢体无力、意识改变的记忆障碍发作和异常运动。这一系列的症状和体征被贴上不同的诊断标签，如复杂区域疼痛综合征(CRPS)、体位立位性心动过速综合征(POTS)、小纤维神经病(SFN)、肌痛性脑脊髓炎/慢性疲劳综合征(ME/CFS)或纤维肌痛。已知自身免疫和自身抗体存在于CRPS、POTS、SFN、ME/CFS和纤维肌痛患者的亚群中。这篇文章提出，疫苗触发、免疫介导的自主神经功能障碍可能导致HPV疫苗接种后新发综合征的发生，这可能发生在遗传易感人群中。认识到接种疫苗和症状出现之间的时间关系不一定等同于因果关系，越来越多的病例系列证据要求进行精心设计的病例对照研究，以确定这些症状群和HPV疫苗之间的流行率和可能的因果关系。由于个性化医学正在获得发展势头，广告组学和药物遗传学的使用最终可能有助于识别易受HPV疫苗不良事件影响的个体。
This article reviews the case series reported from several countries describing patients with suspected severe side effects to the HPV vaccines. The described symptom clusters are remarkably similar and include disabling fatigue, headache, widespread pain, fainting, gastrointestinal dysmotility, limb weakness, memory impairment episodes of altered awareness, and abnormal movements. This constellation of symptoms and signs has been labeled with different diagnoses such as complex regional pain syndrome (CRPS), postural orthostatic tachycardia syndrome (POTS), small fiber neuropathy (SFN), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), or fibromyalgia. It is known that autoimmunity and autoantibodies are present in a subset of patients with CRPS, POTS, SFN, ME/CFS, and fibromyalgia. This article proposes that vaccine-triggered, immune-mediated autonomic dysfunction could lead to the development of de novo post-HPV vaccination syndrome possibly in genetically susceptible individuals. Being cognizant that a temporal relationship between vaccination and symptom onset does not necessarily equate to causality, mounting evidence of case series calls for well-designed case-control studies to determine the prevalence and possible causation between these symptom clusters and HPV vaccines. Since personalized medicine is gaining momentum, the use of adversomics and pharmacogenetics may eventually help identify individuals who are predisposed to HPV vaccine adverse events.