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目的报告2例H1N1流感疫苗接种后出现关节炎患者的临床特点及遗传背景,推测遗传易感性对疫苗诱发类风湿关节炎的作用。方法报道2例H1N1流感疫苗接种后其关节炎的临床及组织相溶性抗原DR4(HLA-DR4)基因表达特点,并进行文献复习。采集患者外周静脉血进行常规检验和相关免疫学分析。应用免疫比浊法(immune turbidimetry)检测类风湿因子(RF),间接免疫荧光法(indirect immunoinfluscent assay,IFA)检测抗核周因子抗体(APF)/抗角蛋白抗体(AKA)和抗核抗体(ANA),酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测抗环瓜氨酸肽抗体(抗CCP)。HLA-DR4的检测采用聚合酶链式反应(polymerase chain reaction,PCR),取外周抗凝血5ml,提取DNA,经过PCR扩增后进行琼脂糖凝胶电泳,检测是否有HLA-DR4条带。结果 2例中年女性患者在注射H1N1流感疫苗后1周内出现关节炎,其中1例症状为一过性,HLA-DR4阴性。另1例确诊为类风湿关节炎,需用改善病情药物治疗,HLA-DR4阳性。结论 2例患者的关节炎发生于H1N1流感疫苗接种后1周内,存在时间相关性。结合文献认为,H1N1疫苗总体安全性良好,部分患者在接种后可能会发生关节炎,遗传背景不同可能是部分患者发展为类风湿关节炎的原因。
Objective To report the clinical features and genetic background of 2 patients with arthritis after inoculation of two H1N1 influenza vaccines and to speculate the effect of genetic susceptibility to vaccine-induced rheumatoid arthritis. Methods The clinical and histocompatibility antigen DR4 (HLA-DR4) gene expression profiles of two arthritis patients after vaccination with H1N1 were reported and reviewed. Peripheral blood samples were collected for routine testing and related immunological analyzes. Immunofluorescence turbidimetry was used to detect rheumatoid factor (RF) and indirect immunoinfluorescent assay (IFA) to detect APF / AKA and antinuclear antibody ANA), anti-cyclic citrullinated peptide antibody (anti-CCP) by enzyme linked immunosorbent assay (ELISA). HLA-DR4 was detected by polymerase chain reaction (PCR), and 5ml of peripheral anticoagulant blood was taken for DNA extraction. After PCR amplification, agarose gel electrophoresis was performed to detect the presence or absence of HLA-DR4 bands. Results Two middle-aged women developed arthritis within 1 week after injection of the H1N1 influenza vaccine. One of the symptoms was transient and HLA-DR4 was negative. Another case of diagnosed as rheumatoid arthritis, need to improve the condition of drug treatment, HLA-DR4-positive. Conclusions Arthritis in 2 patients occurred within 1 week after the H1N1 flu vaccination, and there was a time-dependent relationship. According to the literature, the overall safety of the H1N1 vaccine is good, and some patients may have arthritis after inoculation. Different genetic backgrounds may be responsible for the development of rheumatoid arthritis in some patients.