对“神经传导研究支持SARSCoV-2相关格林-巴利亚型的分类”的回应

Q4 Immunology and Microbiology
Gustavo Figueiredo da Silva, Caroline Figueiredo da Silva, Raddib Eduardo Noleto da Nobrega Oliveira, Fabiana Romancini, Rafael Marques Mendes, Amanda Locks, Maria Francisca Moro Longo, Carla Heloisa Cabral Moro, Alexandre Luiz Longo, Vera Lucia Braatz
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引用次数: 0

摘要

我们饶有兴趣地阅读了Finsterer等人对我们之前发表的病例报告《2019冠状病毒病疫苗后格林-巴罗综合征:时间关联》的评论我们理解所作的评论是有趣的讨论点。Finsterer等人质疑的主要观点是,格林-巴勒综合征(GBS)的诊断是一种时间关联,不一定是因果关系,可以通过几个组成部分来阐明。首先,由于文章撰写的时间,文献中报告的病例没有目前那么多,正如信中正确描述的那样“在最近对SARS-CoV-2疫苗的神经副作用的审查中,描述了300例SC2VaG”第二,由于病例诊断资源有限,在巴西南部的一家公立医院。缺乏诊断测试,如Finsterer等人提到的那些(神经肌电图、细胞因子、趋化因子和脑脊液中胶质标记物的调查),是在确定相关性的因果关系之前必须强调的因素。除了前面两点之外,还有对这篇文章所处大流行时期的敏感性。在反疫苗团体不断壮大的背景下,一项重要的疫苗接种运动开始了,这促使人们在将因果关系联系起来,而不可能通过更详细的测试排除其他原因时要谨慎。最后,强调了与其他科学成果相比,病例报告的证据水平。因此,为了确定SARS-CoV-2疫苗与GBS之间的可靠相关性,有必要进行更高水平的证据研究,例如随机临床试验和系统评价。3此外,值得注意的是,出现症状和诊断之间的延迟是由于患者将最初的变化解释为精神疾病,花了2个月的时间在该地区寻求参考医疗服务。因此,正如Finsterer等人所强调的那样,我们作者一致认为诊断和治疗的延迟可能是导致预后较差的因素之一。作者还强调,患者的神经系统检查结果是文章中描述的,因此,没有提到的,例如几对脑神经的受累,没有出现。因此,鉴于上述所有原因,尽管Finsterer等人提出了有趣而中肯的评论,但作者采用了更谨慎的方法,因此将该案例定义为一种时间关联,而不一定是因果关系。没有宣布。所有作者都同意稿件的内容。所有作者都参与了数据采集和分析,并参与了稿件的起草。所有知情同意均获得受试者和/或监护人的同意。研究方案的批准:无。注册处及注册编号研究/试验:无。动物研究:无。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Response to “Nerve conduction studies support the classification of SARSCoV-2 associated Guillain-Barre subtypes”

We read with interest the comments made by Finsterer et al.1 on our previously published case report “Guillain–Barré syndrome after coronavirus disease 2019 vaccine: A temporal association”.2 We understand that the comments made are interesting points of discussion.

The main point questioned by Finsterer et al., the diagnosis of Guillain-Barré syndrome (GBS) as a temporal association, not necessarily causal, can be elucidated due to several components. First, due to the time the article was written, in which there were not as many cases reported in the literature as currently, as correctly described in the letter “In a recent review of the neurological side effects of SARS-CoV-2 vaccines, 300 cases of SC2VaG were described”.1 Second, due to limited diagnostic resources in the case, a public hospital in southern Brazil. The absence of diagnostic tests, such as those mentioned by Finsterer et al. (electroneuromyography, investigation of cytokines, chemokines and glial markers in the CSF), are factors that must be highlighted before defining the causality of the association. Added to the two previous points is the sensitivity to the moment of the pandemic in which the article was produced. The beginning of an important vaccination campaign, in the midst of the growth of anti-vaccine groups, inspires caution when associating causality without the possibility of ruling out, through more elaborate tests, other causes. Finally, the level of evidence that a case report has in comparison to other scientific productions is highlighted. Then, for a reliable correlation between the SARS-CoV-2 vaccine and GBS, studies with a higher level of evidence are necessary, such as randomized clinical trials and systematic reviews.3

Furthermore, it is noteworthy that the delay between the onset of symptoms and diagnosis was due to the patient having interpreted the initial changes as of psychiatric origin, taking 2 months to seek the medical service of reference in the region. Thus, there is a consensus among us authors that the delay in diagnosis and treatment, as well highlighted by Finsterer et al., may have been one of the factors that led to worse outcome. The authors also emphasize that the findings of the patient's neurological physical examination are those described in the article, so, those not mentioned, such as the involvement of several pairs of cranial nerves, were not present.

Therefore, for all the reasons mentioned above and despite the interesting and pertinent comments made by Finsterer et al., the authors adopted a more cautious approach and, thus, defined the case as a temporal association, not necessarily a causal one.

None declared.

All authors are in agreement with the content of the manuscript. All authors participated in the data acquisition and analysis, and contributed to the drafting of the manuscript.

All informed consent was obtained from the subject(s) and/or guardian(s). Approval of the research protocol: N/A. Registry and the Registration No. of the study/trial: N/A. Animal Studies: N/A.

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来源期刊
Clinical and Experimental Neuroimmunology
Clinical and Experimental Neuroimmunology Immunology and Microbiology-Immunology and Microbiology (miscellaneous)
CiteScore
1.60
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