新型冠状病毒肺炎疫苗相关心肌炎临床特征与机制探究  

Clinical characteristics and mechanism of COVID-19 vaccine-related myocarditis

作　　者：韩拓 李盈[1] 刘莉君[2] 徐阳[3] 张婷[1] 王怡雯 王丽霞[1] 白亮[4] 王聪霞[1] HAN Tuo;LI Ying;LIU Lijun;XU Yang;ZHANG Ting;WANG Yiwen;WANG Lixia;BAI Liang;WANG Congxia(Department of Cardiology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004;Department of Oncology,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004;Department of Clinical Laboratory,The Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004;School of Basic Medical Sciences,Xi’an Jiaotong University,Xi’an 710061,China)

机构地区：[1]西安交通大学第二附属医院心血管内科,陕西西安710004 [2]西安交通大学第二附属医院肿瘤科,陕西西安710004 [3]西安交通大学第二附属医院检验科,陕西西安710004 [4]西安交通大学基础医学院,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2022年第4期528-533,共6页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.81273878)。

摘　　要：目的探究新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫苗(新冠肺炎疫苗)相关心肌炎的临床特征及其潜在机制。方法基于PubMed数据库检索截至2021年8月31日所有新冠肺炎疫苗相关心肌炎病例报道,逐条筛选后最终纳入29篇报道、共计71例心肌炎患者。归纳患者的人口学资料、疫苗接种情况、临床症状、生化及影像学检查、治疗措施与结局预后;根据患者既往病史,分为既往感染COVID-19者(prior COVID,n=12)和无COVID-19感染史者(non-prior COVID,n=59)。结果新冠肺炎疫苗相关心肌炎好发于男性(91.5%),多见于接种第二针mRNA疫苗后(81.7%),平均起病时间为3(1,25)d,主要临床表现为胸痛(94.4%)、发热(45.1%)、肌肉疼痛(26.8%)、气短(16.9%)等症状。几乎所有患者均出现肌钙蛋白的异常,并伴有C反应蛋白升高。非甾体类抗炎药和秋水仙碱被广泛用于临床治疗,约1/5患者给予对症支持后症状即得以缓解,多数患者住院时长为1~2周。既往感染COVID-19患者接种疫苗后心肌炎发生风险显著增加,且多见于接种第一针疫苗后(58.3%),其临床症状与转归与non-prior COVID者存在一定差异。结论心肌炎是COVID-19疫苗接种相关严重不良事件,整体发生率相对较低,临床症状普遍较轻且预后较好,可能与感染COVID-19后免疫系统预致敏和个体遗传易感性有关。Objective To investigate the clinical characteristics and potential mechanism of coronavirus disease 2019(COVID-19)vaccine-related myocarditis.Methods We made a systematic literature retrieval based on PubMed to search for all reports on COVID-19 vaccine-related myocarditis published by August 31,2021.A total of 29 reports involving 71patients with myocarditis were enrolled after screening.The patients’demographic data,vaccination,clinical manifestations,biochemical and imaging results,treatments,and outcomes were extracted and summarized.The patients were divided into prior COVID(n=12)and non-prior COVID(n=59)according to their previous medical history.Results COVID vaccine-related myocarditis was more common in men(91.5%)and after the second dose of mRNA vaccine(81.7%).The average time to onset was 3(1,25)days,and the main symptoms included chest pain(94.4%),fever(45.1%),myalgia(26.8%),and shortness of breath(16.9%).Abnormal troponin level was present in almost all the patients,with a common elevation of C-reactive protein.Non-steroidal anti-inflammatory drugs and colchicine were widely used in clinical treatment,and the symptoms of one-fifth of the patients were relieved after symptomatic therapy,with 1 to 2 weeks’length of hospital stay.However,the risk of vaccine-related myocarditis was significantly increased in patients with previous COVID-19 infection,which was more common after the first dose of vaccine(58.3%)other than the second dose.And the clinical symptoms and outcomes were somewhat different from those without COVID-19infection previously.Conclusion Myocarditis is one of the serious adverse events related to COVID-19 vaccine,with an overall relatively low incidence,mild clinical severity,and favorable prognosis.Vaccine-related myocarditis may be a combined result of primed immune system and individual susceptibility after infection with COVID-19.

关 键 词：新型冠状病毒肺炎 疫苗接种 心肌炎 自身免疫 

分 类 号：R542.2[医药卫生—心血管疾病]