Objective To investigate the relationship between inherent susceptibility and arthritis after influenza A H1N1 vaccination. Methods Two cases were described and the clinical and HLA-DR4 genotype characterisitics were analyzed. Rheumatoid factor was detected with immune turbidimetry, AFP/AKA and ANA were tested with indirect immunoinfluscent assay( IFA ), and anti-CCP was tested with enzyme linked immunosorbent assay( ELISA ). HLA-DR4 was tested by polymerase chain reaction( PCR ) amplification. Results These two patients who developed arthritis after HI Nl vaccination were both females. One arthritis was temporary and HLA-DR4 was negative. The other developed rheumatoid arthritis and was HLA-DR4 positive. Conclusion The inherent background may play an important role in developing rheumatoid arthritis after vaccination.%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.
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