提示: 手机请竖屏浏览!

实验室确诊的流感感染后发生的急性心肌梗死
Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection


Jeffrey C. Kwong ... 心脑血管疾病 呼吸系统疾病 • 2018.01.25
NEJM 动画解读

流感感染后的心肌梗死
相关阅读
• 流感——心肌梗死的又一危险因素 • 2017~2018流感季的流感疫苗建议

NEJM研究确认流感病毒感染与心肌梗死强相关

 

汪道文

华中科技大学同济医学院附属同济医院

 

过去已经有研究显示,急性呼吸道感染可以触发急性心血管事件,包括脑卒中、冠心病,尤其是急性心肌梗死发病;同样地,医生很早就注意到流行性感冒(流感)与急性心肌梗死有关。但是当时流感的检测不特异或者研究设计有偏差,所以结论可靠性存在疑虑。

查看更多

摘要


背景

急性呼吸道感染可触发急性心肌梗死。既往研究提示流感和急性心肌梗死相关,但是它们采用了非特异的方法检测流感感染,或研究设计容易出现偏倚。本研究中,我们评估了实验室确诊的流感感染和急性心肌梗死的关系。

 

方法

我们采用了自身对照的病例系列研究来评估实验室确诊的流感感染与急性心肌梗死住院之间的关系。我们采用多种高特异性的实验室检测方法来确定呼吸道样本的流感感染情况,并且从住院资料中证实住院原因为急性心肌梗死。我们将呼吸道样本采集后的7日定义为“风险间期”,风险间期的前一年和后一年定义为“对照间期”。

 

结果

我们确认了流感检测结果阳性之前和之后一年内因急性心肌梗死所致的364次住院治疗。其中,20次(每周20.0次住院)发生于风险间期,344次(每周3.3次住院)发生于对照间期。风险间期和对照间期急性心肌梗死住院的发生率比值为6.05(95%置信区间[CI],3.86~9.50)。流感感染确诊7日之后,急性心肌梗死住院的发生率没有提高。乙型流感病毒、甲型流感病毒、呼吸道合胞病毒和其他病毒感染确诊后7日内,急性心肌梗死的发生率比值分别为10.11(95% CI,4.37~23.38)、5.17(95% CI,3.02~8.84)、3.51(95% CI,1.11~11.12)和2.77(95% CI,1.23~6.24)。

 

结论

我们发现呼吸道感染,尤其是流感与急性心肌梗死显著相关(由加拿大卫生研究院[Canadian Institutes of Health Research]等资助)。





作者信息

Jeffrey C. Kwong, M.D., Kevin L. Schwartz, M.D., Michael A. Campitelli, M.P.H., Hannah Chung, M.P.H., Natasha S. Crowcroft, M.D., Timothy Karnauchow, Ph.D., Kevin Katz, M.D., Dennis T. Ko, M.D., Allison J. McGeer, M.D., Dayre McNally, M.D., Ph.D., David C. Richardson, M.D., Laura C. Rosella, Ph.D., M.H.Sc., Andrew Simor, M.D., Marek Smieja, M.D., Ph.D., George Zahariadis, M.D., and Jonathan B. Gubbay, M.B., B.S., M.Med.Sc.
From the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children’s Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John’s (G.Z.) — all in Canada. Address reprint requests to Dr. Kwong at the Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada, or at jeff.kwong@utoronto.ca.

 

参考文献

1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006;367:1747-1757.

2. Collins S. Excess mortality from causes other than influenza and pneumonia during influenza epidemics. Public Health Rep 1932;47:2159-2189.

3. Housworth J, Langmuir AD. Excess mortality from epidemic influenza, 1957-1966. Am J Epidemiol 1974;100:40-48.

4. Stern MP, Gaskill SP. Secular trends in ischemic heart disease and stroke mortality from 1970 to 1976 in Spanish-surnamed and other white individuals in Bexar County, Texas. Circulation 1978;58:537-543.

5. Alling DW, Blackwelder WC, Stuart-Harris CH. A study of excess mortality during influenza epidemics in the United States, 1968-1976. Am J Epidemiol 1981;113:30-43.

6. Manton KG, Stallard E. Temporal trends in U. S. multiple cause of death mortality data: 1968 to 1977. Demography 1982;19:527-547.

7. Tillett HE, Smith JW, Gooch CD. Excess deaths attributable to influenza in England and Wales: age at death and certified cause. Int J Epidemiol 1983;12:344-352.

8. Reichert TA, Simonsen L, Sharma A, Pardo SA, Fedson DS, Miller MA. Influenza and the winter increase in mortality in the United States, 1959-1999. Am J Epidemiol 2004;160:492-502.

9. Madjid M, Miller CC, Zarubaev VV, et al. Influenza epidemics and acute respiratory disease activity are associated with a surge in autopsy-confirmed coronary heart disease death: results from 8 years of autopsies in 34,892 subjects. Eur Heart J 2007;28:1205-1210.

10. Warren-Gash C, Bhaskaran K, Hayward A, et al. Circulating influenza virus, climatic factors, and acute myocardial infarction: a time series study in England and Wales and Hong Kong. J Infect Dis 2011;203:1710-1718.

11. Foster ED, Cavanaugh JE, Haynes WG, et al. Acute myocardial infarctions, strokes and influenza: seasonal and pandemic effects. Epidemiol Infect 2013;141:735-744.

12. Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. Risk of myocardial infarction and stroke after acute infection or vaccination. N Engl J Med 2004;351:2611-2618.

13. Corrales-Medina VF, Madjid M, Musher DM. Role of acute infection in triggering acute coronary syndromes. Lancet Infect Dis 2010;10:83-92.

14. Warren-Gash C, Hayward AC, Hemingway H, et al. Influenza infection and risk of acute myocardial infarction in England and Wales: a CALIBER self-controlled case series study. J Infect Dis 2012;206:1652-1659.

15. Macintyre CR, Heywood AE, Kovoor P, et al. Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study. Heart 2013;99:1843-1848.

16. Guan X, Yang W, Sun X, et al. Association of influenza virus infection and inflammatory cytokines with acute myocardial infarction. Inflamm Res 2012;61:591-598.

17. Pönkä A, Jalanko H, Pönkä T, Stenvik M. Viral and mycoplasmal antibodies in patients with myocardial infarction. Ann Clin Res 1981;13:429-432.

18. Warren-Gash C, Geretti AM, Hamilton G, Rakhit RD, Smeeth L, Hayward AC. Influenza-like illness in acute myocardial infarction patients during the winter wave of the influenza A H1N1 pandemic in London: a case-control study. BMJ Open 2013;3(5):e002604-e002604.

19. Buchan SA, Kwong JC. Trends in influenza vaccine coverage and vaccine hesitancy in Canada, 2006/07 to 2013/14: results from cross-sectional survey data. CMAJ Open 2016;4(3):E455-E462.

20. Williams WW, Lu PJ, O’Halloran A, et al. Surveillance of vaccination coverage among adult populations — United States, 2014. MMWR Surveill Summ 2016;65(1):1-36.

21. Grohskopf LASL, Sokolow LZ, Broder KR, et al. Prevention and control of seasonal influenza with vaccines. MMWR Recomm Rep 2016;65(5):1-54.

22. Austin PC, Daly PA, Tu JV. A multicenter study of the coding accuracy of hospital discharge administrative data for patients admitted to cardiac care units in Ontario. Am Heart J 2002;144:290-296.

23. Carrat F, Vergu E, Ferguson NM, et al. Time lines of infection and disease in human influenza: a review of volunteer challenge studies. Am J Epidemiol 2008;167:775-785.

24. Whitaker HJ, Farrington CP, Spiessens B, Musonda P. Tutorial in biostatistics: the self-controlled case series method. Stat Med 2006;25:1768-1797.

25. Redelmeier DA. The exposure-crossover design is a new method for studying sustained changes in recurrent events. J Clin Epidemiol 2013;66:955-963.

26. Osterholm MT, Kelley NS, Sommer A, Belongia EA. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infect Dis 2012;12:36-44.

27. Darvishian M, Bijlsma MJ, Hak E, van den Heuvel ER. Effectiveness of seasonal influenza vaccine in community-dwelling elderly people: a meta-analysis of test-negative design case-control studies. Lancet Infect Dis 2014;14:1228-1239.

28. Clar C, Oseni Z, Flowers N, Keshtkar-Jahromi M, Rees K. Influenza vaccines for preventing cardiovascular disease. Cochrane Database Syst Rev 2015;5:CD005050-CD005050.

29. Corrales-Medina VF, Musher DM, Wells GA, Chirinos JA, Chen L, Fine MJ. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012;125:773-781.

30. Lessler J, Reich NG, Brookmeyer R, Perl TM, Nelson KE, Cummings DA. Incubation periods of acute respiratory viral infections: a systematic review. Lancet Infect Dis 2009;9:291-300.

31. Ip DKM, Lau LLH, Chan KH, et al. The dynamic relationship between clinical symptomatology and viral shedding in naturally acquired seasonal and pandemic influenza virus infections. Clin Infect Dis 2016;62:431-437.

32. Aull L, Blumentals WA, Iacuzio DA, Cheng S. FluSTAR, a novel influenza surveillance system: outcomes from the 2005-2006 flu season. South Med J 2007;100:873-880.

服务条款 | 隐私政策 | 联系我们