{"id":61171,"date":"2024-09-01T00:32:43","date_gmt":"2024-08-31T22:32:43","guid":{"rendered":"https:\/\/www.infokuryr.cz\/n\/?p=61171"},"modified":"2024-08-31T13:57:32","modified_gmt":"2024-08-31T11:57:32","slug":"japonska-serie-pripadu-naznacuje-vzacne-ale-skutecne-intersticialni-plicni-onemocneni-zpusobene-mrna-vakcinou-pfizer","status":"publish","type":"post","link":"https:\/\/www.infokuryr.cz\/n\/2024\/09\/01\/japonska-serie-pripadu-naznacuje-vzacne-ale-skutecne-intersticialni-plicni-onemocneni-zpusobene-mrna-vakcinou-pfizer\/","title":{"rendered":"Japonsk\u00e1 s\u00e9rie p\u0159\u00edpad\u016f nazna\u010duje vz\u00e1cn\u00e9, ale skute\u010dn\u00e9 interstici\u00e1ln\u00ed plicn\u00ed onemocn\u011bn\u00ed zp\u016fsoben\u00e9 mRNA vakc\u00ednou Pfizer"},"content":{"rendered":"
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U 70let\u00e9 \u017eeny se jeden den po p\u00e1t\u00e9m o\u010dkov\u00e1n\u00ed proti COVID-19 objevila du\u0161nost (pocit, \u017ee se nem\u016f\u017ee nadechnout). P\u0159i konzultaci bezprost\u0159edn\u011b p\u0159ed posledn\u00ed d\u00e1vkou o\u010dkov\u00e1n\u00ed byl proveden RTG sn\u00edmek hrudn\u00edku, kter\u00fd neprok\u00e1zal \u017e\u00e1dn\u00e9 abnormality. Po p\u00e1t\u00e9 vakcina\u010dn\u00ed d\u00e1vce mRNA v\u0161ak dal\u0161\u00ed vy\u0161et\u0159en\u00ed odhalilo bilater\u00e1ln\u00ed difuzn\u00ed tupost na rentgenov\u00e9m sn\u00edmku. Obvykle se jedn\u00e1 o oblast opacity (rentgen) nebo zv\u00fd\u0161en\u00e9ho \u00fatlumu (CT) v d\u016fsledku vyt\u011bsn\u011bn\u00ed tekutiny, kolapsu d\u00fdchac\u00edch cest, fibr\u00f3zy nebo neoplastick\u00e9ho procesu. Bronchoalveol\u00e1rn\u00ed lav\u00e1\u017e, diagnostick\u00fd postup, kter\u00fd vyu\u017e\u00edv\u00e1 bronchoskop k odstran\u011bn\u00ed vzorku tekutiny z plic, ukazuje p\u0159evahu lymfocyt\u016f (b\u00edl\u00fdch krvinek) a transbronchi\u00e1ln\u00ed plicn\u00ed biopsie (TBLB), minim\u00e1ln\u011b invazivn\u00ed postup, kter\u00fd odstra\u0148uje mal\u00e9 vzorky tk\u00e1n\u011b z plic. pl\u00edce \u2013 co\u017e zahrnuje odb\u011br mal\u00fdch vzork\u016f tk\u00e1n\u011b z plic, kter\u00e9 pomohou diagnostikovat plicn\u00ed probl\u00e9my \u2013 uk\u00e1zaly r\u016fst alveol\u00e1rn\u00edho epitelu a tak\u00e9 organizovanou polyp\u00f3zn\u00ed granula\u010dn\u00ed tk\u00e1\u0148 v alveol\u00e1rn\u00edch kan\u00e1lc\u00edch a bronchiolech. I p\u0159es pod\u00e1v\u00e1n\u00ed kortikosteroid\u016f zobrazovac\u00ed vy\u0161et\u0159en\u00ed prok\u00e1zalo perzistuj\u00edc\u00ed fibr\u00f3zu a vy\u017eadovala dlouhodobou oxygenoterapii. Pro \u017eenu tohoto v\u011bku to nen\u00ed dobr\u00fd v\u00fdsledek. A\u010dkoli ned\u00e1vn\u00e9 zpr\u00e1vy nazna\u010duj\u00ed, \u017ee kortikosteroidy jsou \u00fa\u010dinn\u00e9 u interstici\u00e1ln\u00edch plicn\u00edch onemocn\u011bn\u00ed vyvolan\u00fdch l\u00e9ky v kontextu o\u010dkov\u00e1n\u00ed mRNA COVID-19, tento p\u0159\u00edpad p\u0159edstavoval m\u00edrn\u011b odli\u0161n\u00fd klinick\u00fd obraz.<\/span><\/p>\n

Podle t\u00e9to s\u00e9rie p\u0159\u00edpad\u016f Soichiho Maruyamy z Nihon University v Japonsku a jeho koleg\u016f je interstici\u00e1ln\u00ed plicn\u00ed onemocn\u011bn\u00ed vyvolan\u00e9 vakc\u00ednou prim\u00e1rn\u011b pom\u011brn\u011b vz\u00e1cn\u00e9, ale s tak vz\u00e1cn\u00fdm stavem se setkali u \u017een bezprost\u0159edn\u011b po o\u010dkov\u00e1n\u00ed mRNA Pfizer Du\u0161nost se objevila. Jak ji\u017e bylo zm\u00edn\u011bno, interstici\u00e1ln\u00ed plicn\u00ed onemocn\u011bn\u00ed neboli \u201eDI-ILD\u201c se objevilo po vakcinaci mRNA COVID-19. Auto\u0159i t\u00e9to studie potvrzuj\u00ed p\u0159\u00edpad DI-ILD histopatologick\u00fdm vy\u0161et\u0159en\u00edm a poukazuj\u00ed na d\u016fle\u017eitost toho, aby l\u00e9ka\u0159sk\u00e1 komunita z\u016fstala ostra\u017eit\u00e1\u201c.<\/span><\/p>\n

Mo\u017en\u00e9 mechanismy \u00fa\u010dinku<\/strong><\/span><\/p>\n

Jak popsali auto\u0159i v Cureus, japon\u0161t\u00ed l\u00e9ka\u0159i-v\u011bdci objevili DI-ILD o\u010dkovanou mRNA COVID-19 u pacienta, u kter\u00e9ho neexistovala \u017e\u00e1dn\u00e1 jin\u00e1 p\u0159\u00ed\u010dina n\u00e1hl\u00e9ho n\u00e1stupu ILD ne\u017e ned\u00e1vn\u00e9 o\u010dkov\u00e1n\u00ed mRNA COVID-19.<\/span><\/p>\n

Vakc\u00edna mRNA spole\u010dnosti Pfizer, nazvan\u00e1 BNT162b2, zapouzd\u0159en\u00e1 v lipidov\u00fdch nano\u010d\u00e1stic\u00edch, je podle Soichiho a koleg\u016f jednozna\u010dn\u011b p\u0159\u00ed\u010dinou tohoto vz\u00e1cn\u00e9ho onemocn\u011bn\u00ed. Ve sv\u00e9 recenzovan\u00e9 a publikovan\u00e9 pr\u00e1ci vysv\u011btluj\u00ed mo\u017en\u00fd mechanismus za zran\u011bn\u00edm:<\/span><\/p>\n

„Kdy\u017e mRNA dos\u00e1hne c\u00edlov\u00e9 bu\u0148ky, je absorbov\u00e1na a je exprimov\u00e1n k\u00f3dovan\u00fd protein SARS-CoV-2. Spike protein je pak prezentov\u00e1n na bun\u011b\u010dn\u00e9m povrchu, kde je rozpozn\u00e1n dendritick\u00fdmi bu\u0148kami, kter\u00e9 zase spou\u0161t\u011bj\u00ed bun\u011b\u010dn\u00e9 a humor\u00e1ln\u00ed imunitn\u00ed reakce. Existuje v\u0161ak podez\u0159en\u00ed, \u017ee fragmenty antigen\u016f a\/nebo souvisej\u00edc\u00edch peptid\u016f se uvol\u0148uj\u00ed do krevn\u00edho \u0159e\u010di\u0161t\u011b a \u017ee lipidov\u00e9 nano\u010d\u00e1stice by mohly m\u00edt proz\u00e1n\u011btliv\u00e9 \u00fa\u010dinky.<\/span><\/p>\n

Mohly by takov\u00e9 imunitn\u00ed reakce souviset s DI-ILD?<\/strong><\/span><\/p>\n

Auto\u0159i t\u00e9to studie odkazuj\u00ed na pr\u016fzkum japonsk\u00e9ho ministerstva zdravotnictv\u00ed, pr\u00e1ce a soci\u00e1ln\u00edch v\u011bc\u00ed ze dne 12. b\u0159ezna 2023, kter\u00fd vych\u00e1z\u00ed z odhadovan\u00fdch 294 416 519 d\u00e1vek podan\u00fdch spole\u010dnost\u00ed Pfizer japonsk\u00e9 populaci. Bylo identifikov\u00e1no 81 p\u0159\u00edpad\u016f (0,000028 %) interstici\u00e1ln\u00ed pneumonie, a\u010dkoli skute\u010dn\u00e9 p\u0159\u00edznaky jsou vz\u00e1cn\u00e9 a auto\u0159i nev\u011bd\u00ed, kolik z t\u011bchto p\u0159\u00edpad\u016f bylo DI-ILD.<\/span><\/p>\n

A co p\u0159\u00edpadov\u00e1 literatura?<\/strong><\/span><\/p>\n

T\u00fdm hledal v literatu\u0159e DI-ILD o\u010dkovan\u00fd mRNA COVID-19. To zahrnovalo hled\u00e1n\u00ed \u201echarakteristik t\u011bchto pacient\u016f, jako je n\u00e1stup respira\u010dn\u00edch p\u0159\u00edznak\u016f brzy po o\u010dkov\u00e1n\u00ed, n\u00e1stup onemocn\u011bn\u00ed b\u011bhem prvn\u00edho nebo druh\u00e9ho obdob\u00ed o\u010dkov\u00e1n\u00ed, vysok\u00e9 hladiny KL-6 a SP-D (v rozmez\u00ed 214-4084 U\/ ml nebo 73,1-675,5 ng\/ml), vzor organizuj\u00edc\u00ed se pneumonie na CT hrudn\u00edku, vysok\u00e9 procento lymfocyt\u016f v tekutin\u011b BAL a vysok\u00e1 odpov\u011b\u010f na steroidy\u201c.<\/span><\/p>\n

Aktu\u00e1ln\u00ed v\u00fdzvy<\/strong><\/span><\/p>\n

Interstici\u00e1ln\u00ed pneumonie pacienta, kter\u00e1 se objevila po p\u00e1t\u00e9 vakcinaci, \u0161patn\u011b reagovala na steroidy. Auto\u0159i nazna\u010duj\u00ed, \u017ee by to mohlo b\u00fdt zp\u016fsobeno t\u00edm, \u017ee \u201epacient nav\u0161t\u00edvil na\u0161i ambulanci a\u017e m\u011bs\u00edc po propuknut\u00ed nemoci. „Krom\u011b toho plicn\u00ed fibr\u00f3za pravd\u011bpodobn\u011b do t\u00e9to doby d\u00e1le postoupila, co\u017e m\u00e1 za n\u00e1sledek nevratn\u00e9 zm\u011bny plicn\u00edch struktur.“<\/span><\/p>\n

Ze zn\u00e1m\u00fdch kazuistik byla TBLB provedena ve dvou p\u0159\u00edpadech [12,14]. Polypoidn\u00ed organizace a fibr\u00f3za v alveol\u00e1rn\u00edm prostoru byly pozorov\u00e1ny ve v\u0161ech p\u0159\u00edpadech, p\u0159i\u010dem\u017e fibr\u00f3za byla v \u010dasn\u00fdch st\u00e1di\u00edch relativn\u011b jednotn\u00e1. Patologick\u00fd obraz se od kryptogenn\u00ed organizuj\u00edc\u00ed se pneumonie li\u0161il silnou infiltrac\u00ed z\u00e1n\u011btliv\u00fdch bun\u011bk ve spojen\u00ed s atypick\u00fdmi alveol\u00e1rn\u00edmi epiteli\u00e1ln\u00edmi bu\u0148kami. P\u0159edpokl\u00e1d\u00e1 se, \u017ee DI-ILD zp\u016fsoben\u00e1 vakc\u00ednou mRNA BNT162b2 je projevem organizuj\u00edc\u00ed se pneumonie s t\u011b\u017ek\u00fdm z\u00e1n\u011btem.<\/span><\/p>\n

Shrnut\u00ed<\/strong><\/span><\/p>\n

DI-ILD vyvolan\u00e9 mRNA se zd\u00e1 b\u00fdt extr\u00e9mn\u011b vz\u00e1cn\u00e9 a auto\u0159i neposkytuj\u00ed dostate\u010dn\u00e9 informace pro stanoven\u00ed kauz\u00e1ln\u00edho vztahu. Vyd\u00e1vaj\u00ed sv\u00e9 obvykl\u00e9 prohl\u00e1\u0161en\u00ed, \u017ee \u010dist\u00e9 p\u0159\u00ednosy p\u0159eva\u017euj\u00ed nad riziky, ale poznamen\u00e1vaj\u00ed, \u017ee DI-ILD se m\u016f\u017ee objevit po o\u010dkov\u00e1n\u00ed mRNA COVID-19. Doporu\u010duj\u00ed tak\u00e9 dal\u0161\u00ed studie o mRNA COVID-19 a navrhuj\u00ed, aby se DI-ILD vyvolan\u00e9 vakc\u00ednou stalo povinn\u00fdm t\u00e9matem.<\/span><\/p>\n<\/div>\n<\/div>\n

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Zdroj<\/a><\/span><\/h3>\n

 <\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

U 70let\u00e9 \u017eeny se jeden den po p\u00e1t\u00e9m o\u010dkov\u00e1n\u00ed proti COVID-19 objevila du\u0161nost (pocit, \u017ee…<\/p>\n","protected":false},"author":2,"featured_media":61172,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[7],"tags":[105,677,694,315,46],"_links":{"self":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts\/61171"}],"collection":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/comments?post=61171"}],"version-history":[{"count":0,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts\/61171\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/media\/61172"}],"wp:attachment":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/media?parent=61171"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/categories?post=61171"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/tags?post=61171"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}