The Impacts of Influenza Infection and Vaccination on Exacerbation of Myasthenia Gravis.
The Impacts of Influenza Infection and Vaccination on Exacerbation of Myasthenia Gravis.
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DOI：
10.3988/jcn.2017.13.4.325
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发表时间：
2017-10
期刊：
影响因子：
--
通讯作者：
Kim BJ
中科院分区：
文献类型：
--
作者：
Seok HY;Shin HY;Kim JK;Kim BJ;Oh J;Suh BC;Kim SY;Kang SY;Ahn SW;Bae JS;Kim BJ
上呼吸道感染（URI），包括流感，可能会加剧重症肌无力（MG）的症状，这是一种导致肌肉无力的自身免疫性疾病。人们还担心流感疫苗可能引发或加重自身免疫性疾病。本研究的目的是确定流感感染和疫苗接种对MG患者症状严重程度的影响。2015年3月至8月期间，从10所大学附属医院招募了确诊为MG的患者。受试者在入组研究后的首次常规随访访视时完成问卷调查。获得患者病史以确定在前一个冬天是否经历过URI，在前一个冬天之前是否接种过流感疫苗，以及他们的MG症状是否在URI或疫苗接种期间或之后加重。流感样疾病（ILI）的定义和与普通感冒的区别是发热≥38℃，伴有咳嗽和/或咽喉痛。在258例入组患者[年龄54.1±15.2岁（平均值±SD），112例男性和185例全身性MG]中，133例（51.6%）接受了流感疫苗接种，121例（46.9%）在分析期间发生了普通感冒（96例患者）或ILI（25例患者）。10例（40%）患者在ILI后MG症状加重，而只有2例（1.5%）患者在流感疫苗接种后症状加重。ILI患者的症状加重率（10/25，40%）显著高于普通感冒患者（15/96，15.6%，p=0.006）。这项研究的结果表明，ILI加重自身免疫性疾病的潜在风险高于流感疫苗接种，这进一步表明可以为MG患者提供流感疫苗接种。
Upper respiratory infection (URI), including influenza, may exacerbate the symptoms of myasthenia gravis (MG), which is an autoimmune disease that causes muscle weakness. There is also concern that the influenza vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of influenza infection and vaccination on symptom severity in MG patients. Patients diagnosed with MG were enrolled from 10 university-affiliated hospitals between March and August 2015. Subjects completed a questionnaire at the first routine follow-up visit after enrolling in the study. The patient history was obtained to determine whether a URI had been experienced during the previous winter, if an influenza vaccination had been administered before the previous winter, and whether their MG symptoms were exacerbated during or following either a URI or vaccination. Influenza-like illness (ILI) was defined and differentiated from the common cold as a fever of ≥38℃ accompanied by a cough and/or a sore throat. Of the 258 enrolled patients [aged 54.1±15.2 years (mean±SD), 112 men, and 185 with generalized MG], 133 (51.6%) had received an influenza vaccination and 121 (46.9%) had experienced a common cold (96 patients) or ILI (25 patients) during the analysis period. MG symptoms were aggravated in 10 (40%) patients after ILI, whereas only 2 (1.5%) experienced aggravation following influenza vaccination. The rate of symptom aggravation was significantly higher in patients experiencing an ILI (10/25, 40%) than in those with the common cold (15/96, 15.6%, p=0.006). The results of this study suggest that the potential risk of aggravating autoimmune disease is higher for ILI than for influenza vaccination, which further suggests that influenza vaccination can be offered to patients with MG.
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