Myocarditis With COVID-19 mRNA Vaccines
Myocarditis With COVID-19 mRNA Vaccines
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DOI：
10.1161/circulationaha.121.056135
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发表时间：
2021-08-10
期刊：
影响因子：
37.8
通讯作者：
Hotez, Peter J.
中科院分区：
文献类型：
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作者：
Bozkurt, Biykem;Kamat, Ishan;Hotez, Peter J.
心肌炎已被认为是冠状病毒病2019 (COVID-19) mRNA疫苗接种的罕见并发症，特别是在年轻成人和青少年男性中。根据美国疾病控制和预防中心的数据，在12至39岁的人群中，每百万次接种第二剂mRNA疫苗，心肌炎/心包炎的发病率约为12.6例。在报告的病例中，心肌炎患者通常在第二剂mRNA疫苗接种后2至3天出现胸痛，并且心肌肌钙蛋白水平升高。心电图异常，大部分患者ST段升高，心脏MRI提示心肌炎。没有急性COVID-19或其他病毒感染的证据。1例心肌病基因检测呈阴性，但针对某些自身抗原的自身抗体水平和自然杀伤细胞的频率增加。虽然心肌炎发生的机制尚不清楚，但已经提出了严重急性呼吸综合征冠状病毒-2 （SARS-CoV-2）刺突蛋白与自身抗原之间的分子模仿，某些个体先前存在的免疫通路失调的触发，对mRNA的免疫反应和免疫通路的激活，以及细胞因子表达失调。男性在心肌炎病例中占优势的原因尚不清楚，但可能的解释与免疫反应和心肌炎中的性激素差异有关，也与女性心脏病的诊断不足有关。无论治疗与否，几乎所有患者的症状和体征都得到了缓解，诊断指标和影像学也得到了改善。尽管心肌炎病例很少，但COVID-19疫苗接种的获益-风险评估显示，所有年龄和性别群体均处于有利平衡状态；因此，建议所有12岁以上的人接种COVID-19疫苗。
Myocarditis has been recognized as a rare complication of coronavirus disease 2019 (COVID-19) mRNA vaccinations, especially in young adult and adolescent males. According to the US Centers for Disease Control and Prevention, myocarditis/pericarditis rates are approximate to 12.6 cases per million doses of second-dose mRNA vaccine among individuals 12 to 39 years of age. In reported cases, patients with myocarditis invariably presented with chest pain, usually 2 to 3 days after a second dose of mRNA vaccination, and had elevated cardiac troponin levels. ECG was abnormal with ST elevations in most, and cardiac MRI was suggestive of myocarditis in all tested patients. There was no evidence of acute COVID-19 or other viral infections. In 1 case, a cardiomyopathy gene panel was negative, but autoantibody levels against certain self-antigens and frequency of natural killer cells were increased. Although the mechanisms for development of myocarditis are not clear, molecular mimicry between the spike protein of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and self-antigens, trigger of preexisting dysregulated immune pathways in certain individuals, immune response to mRNA, and activation of immunologic pathways, and dysregulated cytokine expression have been proposed. The reasons for male predominance in myocarditis cases are unknown, but possible explanations relate to sex hormone differences in immune response and myocarditis, and also underdiagnosis of cardiac disease in women. Almost all patients had resolution of symptoms and signs and improvement in diagnostic markers and imaging with or without treatment. Despite rare cases of myocarditis, the benefit-risk assessment for COVID-19 vaccination shows a favorable balance for all age and sex groups; therefore, COVID-19 vaccination is recommended for everyone >= 12 years of age.