加拿大麦克马斯特大学Ishac Nazy团队研究了辅助免疫球蛋白治疗疫苗诱导的血栓性血小板减少症的疗效。2021年6月9日出版的《新英格兰医学杂志》发表了这项成果。

针对Covid-19腺病毒载体疫苗的一种罕见副作用，即疫苗诱导的免疫性血栓性血小板减少症（VITT），指南建议使用大剂量静脉注射免疫球蛋白（IVIG）加抗凝治疗。研究组描述了接种ChAdOx1-nCoV-19疫苗后在加拿大发现VITT的首批患者中的3例对IVIG治疗的反应。

3名患者的年龄为63-72岁，其中一名为女性。在整理该报告时，加拿大已将ChAdOx1-nCoV-19疫苗的使用限制在55岁及以上的人群，因为有报道称VITT主要发生在年轻人身上。该研究中有两名患者表现为肢体动脉血栓形成；第三例有脑静脉和动脉血栓形成。

肝素和血小板因子4（PF4）对血清诱导的血小板活化有不同的影响，提示血清VITT表现的异质性。IVIG注射后，3例患者血清中抗体诱导的血小板活化均降低。

附：英文原文

Title: Adjunct Immune Globulin for Vaccine-Induced Thrombotic Thrombocytopenia

Author: Alex Bourguignon, M.D.,, Donald M. Arnold, M.D.,, Theodore E. Warkentin, M.D.,, James W. Smith, B.Sc.,, Tania Pannu, M.D.,, Jeffrey M. Shrum, M.D.,, Zainab A.A. Al Maqrashi, M.D.,, Anjali Shroff, M.D.,, Marie-Claude Lessard, M.D.,, Normand Blais, M.D.,, John G. Kelton, M.D.,, and Ishac Nazy, Ph.D.

Issue&Volume: 2021-06-09

Abstract: The use of high-dose intravenous immune globulin (IVIG) plus anticoagulation is recommended for the treatment of vaccine-induced immune thrombotic thrombocytopenia (VITT), a rare side effect of adenoviral vector vaccines against coronavirus disease 2019 (Covid-19). We describe the response to IVIG therapy in three of the first patients in whom VITT was identified in Canada after the receipt of the ChAdOx1 nCoV-19 vaccine. The patients were between the ages of 63 and 72 years; one was female. At the time of this report, Canada had restricted the use of the ChAdOx1 nCoV-19 vaccine to persons who were 55 years of age or older on the basis of reports that VITT had occurred primarily in younger persons. Two of the patients in our study presented with limb-artery thrombosis; the third had cerebral venous and arterial thrombosis. Variable patterns of serum-induced platelet activation were observed in response to heparin and platelet factor 4 (PF4), indicating the heterogeneity of the manifestations of VITT in serum. After the initiation of IVIG, reduced antibody-induced platelet activation in serum was seen in all three patients.

DOI: 10.1056/NEJMoa2107051

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2107051