Neurology:接种新冠肺炎疫苗后脑静脉窦血栓形成及血栓事件的系统评价和荟萃分析

2021-10-19 Naomii MedSci原创

大约一半的血小板减少患者存在脑静脉窦血栓,而几乎三分之一的血小板减少患者无法存活。需要进一步的研究来确定腺病毒载体疫苗接种后血小板减少的独立预测因素。

     在国家和国际药物警戒监管机构最近发布的安全信号,以及越来越多的关于脑静脉窦血栓(CVST)和罕见部位血栓合并血小板减少(TTS)的报道表明,TTS与基于病毒载体的SARS-CoV疫苗注射相关。在没有血小板减少的情况下接种SARS-CoV-2疫苗后,还报告了更多的CVST和血栓或血栓栓塞事件,这随即引发关注,即TTS与其他SARS-CoV-2疫苗接种相关的暂时发生的血栓有什么不同。

     根据目前的定义,布莱顿诊断标准要求在没有事先接触肝素进行TTS诊断的情况下,同时存在血栓形成和新发的血小板减少症。虽然最近已经确定TTS与循环血小板激活抗血小板因子4(PF4)抗体(Abs)之间的因果联系,但PF4-Abs的存在还没有被纳入当前的TTS诊断标准。此外,关于TTS在SARS中所占比例的证据有限。

     近日,一项发表在Neurology上的研究试图提供不符合TTS诊断标准的CVST在TTS患者和接种SARS-CoV-2疫苗后发生血栓、血栓栓塞事件的患者中所占比例的最新数据。此外,使用荟萃分析方法评估了接种疫苗后出现CVST或血栓事件(包括CVST)的患者的易感危险因素、临床特征和死亡率。

     研究对临床试验、队列、病例系列和基于登记的研究进行了系统的回顾和荟萃分析,目的是评估(1)CVST、TTS相关的CVST和TTS的合并死亡率;(2)有任何血栓事件和TTS的患者中CVST患者的合并比例。次要结果包括接种疫苗后血栓事件患者的临床特征。这项荟萃分析是根据系统综述和荟萃分析指南的首选报告项目进行报告的,并且是根据流行病学中观察性研究的荟萃分析提案编写的。

  • 69项研究进入定性分析,其中370名患者患有CVST,4182名患者中有任何血栓事件与SARS-CoV-2载体疫苗接种相关。23项研究进一步纳入定量荟萃分析。
  • 在TTS病例中,CVST的合并比例为51%(95%CI:36-66%;I2=61%)。
  • 与接种后有血栓事件的非TTS患者相比,TTS患者发生CVST的可能性更高(OR:13.8;95%CI:2.0-97.3;I2=78%)。
  • TTS和TTS相关CVST的合并死亡率分别为28%(95%CI:2136%)和38%(95%CI:27-49%)。
  • 血栓并发症在接种SARS-CoV-2疫苗后2周内发生(平均间隔:10天;95%可信区间:8-12),主要影响45岁以下的女性(69%,95%可信区间:60-77%),无论有无血栓形成的危险因素。

      大约一半的TTS患者存在CVST,而几乎三分之一的TTS患者无法存活。需要进一步的研究来确定腺病毒载体疫苗接种后TTS的独立预测因素。

文献来源:https://n.neurology.org/content/early/2021/10/05/WNL.0000000000012896.long

 

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    2022-05-18 yinhl1978
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    2021-12-25 fusion
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    2021-10-20 huagfeg
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在新冠肺炎疫情前的脑静脉窦血栓患者中,基线血小板减少不常见,肝素诱导的血小板减少和血小板因子4/肝素抗体罕见

拓展阅读

接种217针新冠疫苗,身体会发生什么?柳叶刀:全球接种最多的“狂人”,免疫系统竟一切正常!

The Lancet Infectious Diseases:在整个过度接种的过程中,这位大爷(下文被称为HIM)没有报告任何与接种疫苗相关的副作用,62项常规临床化学指标均未出现异常。

厦门大学韩家淮院士团队:为什么新冠疫苗的保护时间如此之短?——有关 COVID-19 疫苗的现状及未来

在这篇研究热点中,厦门大学生命科学学院韩家淮团队分析相关数据,提出新冠疫苗保护率下降迅速与新冠病毒本身性质密切相关。

高福院士团队最新:动态清零结束后,长新冠的发生率近50%,疫苗或改变现状

Emerging Microbes & Infection随着接种疫苗的剂量增加,保护作用也会有所增强;其中,接种4-5针新冠疫苗,表现出最强的保护作用,高烧、寒战、腹泻以及一些中长期症状会显著减少。

冠疫苗接种后,乳房假体包膜挛缩预后

今天我们介绍一个病例,一名大约6个月前植入硅胶植入物的患者在注射第二剂辉瑞疫苗后,一侧乳房突然出现严重包膜挛缩。据作者所知,这是第一份这种类型的报告。

上海最近“阳”的人又多了?警惕诱发这种病!

最近这段时间,除了35℃+炙烤大地,上海曜影医院24小时应急门诊,每天都会遇到好几例“阳”:

上海交大李青峰/复旦张文宏合作《STTT》:I型神经纤维瘤病患者接种新冠疫苗后呈现高水平免疫反应

开展相关研究以评价NF1患者接种新冠疫苗的安全性和有效性,具有重要的临床和社会意义。