疫苗相关性葡萄膜炎的发病机制、诊断和治疗的研究进展

A review of pathogenesis and diagnosis and treatment of vaccine-associated uveitis

疫苗相关性葡萄膜炎(VAU)是接种疫苗后发生的一种罕见的不良反应。VAU临床多表现为前葡萄膜炎,症状轻微且对局部糖皮质激素治疗反应好,但其也可出现严重的后葡萄膜炎或全葡萄膜炎,如多发性一过性白点综合征、Vogt-Koyanagi-Harada综合征、急性后极部多灶性鳞状色素上皮病变等。VAU的发病机制尚不明确,目前主要包括疫苗Shoenfeld综合征、免疫复合物沉积引起的Ⅲ型超敏反应、减毒活疫苗的直接感染及分子拟态理论。VAU有一定的自限性,大多数患者在不治疗的情况下可自愈。未来在临床中建议对所有葡萄膜炎患者询问最近的疫苗接种史。对于灭活疫苗、重组/亚单位疫苗接种史患者,应考虑发生Shoenfeld综合征的可能性,仔细寻找其自身免疫性疾病相关病史、体征及症状。

Vaccine-associated uveitis(VAU)usually refers to a rare adverse reaction that occurs after vaccination.The clinical manifestations of VAU are most often anterior with mild symptoms and responded promptly to topical corticosteroids.However,more severe forms of posterior and panuveitis may also occur,such as multiple evanescent white dot syndrome,Vogt-Koyanagi-Harada syndrome,and acute posterior multifocal placoid pigment epitheliopathy.The pathogenesis of VAU is still unclear.Currently,it mainly includes vaccine Shoenfeld syndrome,type III hypersensitivity reaction caused by immune complex deposition,direct infection with live attenuated vaccine,and molecular mimicry theory.VAU is self-limiting,and most patients heal without treatment.In the future,it is recommended to ask all patients with uveitis about their recent vaccination history in the clinic.For patients with inactivated vaccine or recombinant/subunit vaccination history,the possibility of developing Shoenfeld syndrome should be considered,and the history,signs and symptoms related to autoimmune diseases should be carefully looked for.