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[NEJM最新论文]:流感病毒感染可能增加急性心肌梗死风险
2018年02月14日 时讯速递, 进展交流 暂无评论

ORIGINAL ARTICLE

Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection

Jeffrey C. Kwong, Kevin L. Schwartz, Michael A. Campitelli, et al

N Engl J Med 2018; 378:345-353

DOI: 10.1056/NEJMoa1702090

Abstract

BACKGROUND 背景

Acute myocardial infarction can be triggered by acute respiratory infections. Previous studies have suggested an association between influenza and acute myocardial infarction, but those studies used nonspecific measures of influenza infection or study designs that were susceptible to bias. We evaluated the association between laboratory-confirmed influenza infection and acute myocardial infarction.

急性呼吸道感染可诱发急性心肌梗死。既往研究提示流感和急性心肌梗死相关,但是,这些研究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。

METHODS 方法

We used the self-controlled case-series design to evaluate the association between laboratory-confirmed influenza infection and hospitalization for acute myocardial infarction. We used various high-specificity laboratory methods to confirm influenza infection in respiratory specimens, and we ascertained hospitalization for acute myocardial infarction from administrative data. We defined the “risk interval” as the first 7 days after respiratory specimen collection and the “control interval” as 1 year before and 1 year after the risk interval.

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确诊呼吸道样本的流感感染,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”。

RESULTS 结果

We identified 364 hospitalizations for acute myocardial infarction that occurred within 1 year before and 1 year after a positive test result for influenza. Of these, 20 (20.0 admissions per week) occurred during the risk interval and 344 (3.3 admissions per week) occurred during the control interval. The incidence ratio of an admission for acute myocardial infarction during the risk interval as compared with the control interval was 6.05 (95% confidence interval [CI], 3.86 to 9.50). No increased incidence was observed after day 7. Incidence ratios for acute myocardial infarction within 7 days after detection of influenza B, influenza A, respiratory syncytial virus, and other viruses were 10.11 (95% CI, 4.37 to 23.38), 5.17 (95% CI, 3.02 to 8.84), 3.51 (95% CI, 1.11 to 11.12), and 2.77 (95% CI, 1.23 to 6.24), respectively.

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)。

CONCLUSIONS 结论

We found a significant association between respiratory infections, especially influenza, and acute myocardial infarction. (Funded by the Canadian Institutes of Health Research and others.)

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)。

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