Department of Clinical Microbiology, Infectious Diseases (A.-M.C.-A., E.H., C.A.) and Department of Public Health and Clinical Medicine, Sunderby Research Unit (M.E., L.H.), Umeå University, Umeå, Sweden; Department of Mathematics and Statistics, The Open University, Milton Keynes, UK (H.W.); and Department of Medicine, Center for Infectious Medicine, Karolinska Institutet, Huddinge, Sweden (J.K.).
Circulation. 2014 Mar 25;129(12):1295-302. doi: 10.1161/CIRCULATIONAHA.113.001870. Epub 2014 Jan 7.
We recently observed that cardiovascular causes of death are common in patients with hemorrhagic fever with renal syndrome (HFRS), which is caused by hantaviruses. However, it is not known whether HFRS is a risk factor for the acute cardiovascular events of acute myocardial infarction (AMI) and stroke.
Personal identification numbers from the Swedish HFRS patient database (1997-2012; n=6643) were cross-linked with the National Patient Register from 1987 to 2011. Using the self-controlled case series method, we calculated the incidence rate ratio of AMI/stroke in the 21 days after HFRS against 2 different control periods either excluding (analysis 1) or including (analysis 2) fatal AMI/stroke events. The incidence rate ratios for analyses 1 and 2 for all AMI events were 5.53 (95% confidence interval [CI], 2.6-11.8) and 6.02 (95% CI, 2.95-12.3) and for first AMI events were 3.53 (95% CI, 1.25-9.96) and 4.64 (95% CI, 1.83-11.77). The incidence rate ratios for analyses 1 and 2 for all stroke events were 12.93 (95% CI, 5.62-29.74) and 15.16 (95% CI, 7.21-31.87) and for first stroke events were 14.54 (95% CI, 5.87-36.04) and 17.09 (95% CI, 7.49-38.96). The majority of stroke events occurred in the first week after HFRS. Seasonal effects were not observed, and apart from 1 study, neither sex nor age interacted with the associations observed in this study.
There is a significantly increased risk for AMI and stroke in the immediate time period after HFRS. Therefore, HFRS patients should be carefully monitored during the acute phase of disease to ensure early recognition of symptoms of impending AMI or stroke.
我们最近观察到，汉坦病毒引起的肾综合征出血热（HFRS）患者中常见心血管死亡原因。然而，HFRS 是否是急性心肌梗死（AMI）和中风等急性心血管事件的危险因素尚不清楚。
利用瑞典 HFRS 患者数据库（1997-2012 年；n=6643）中的个人识别号码，与 1987 年至 2011 年的全国患者登记处进行交叉链接。采用自对照病例系列法，我们计算了 HFRS 后 21 天内 AMI/中风的发生率比值与 2 个不同的对照期（分析 1 排除、分析 2 包括致命 AMI/中风事件）相比。分析 1 和 2 的所有 AMI 事件的发生率比值分别为 5.53（95%置信区间[CI]，2.6-11.8）和 6.02（95% CI，2.95-12.3），首次 AMI 事件的发生率比值分别为 3.53（95% CI，1.25-9.96）和 4.64（95% CI，1.83-11.77）。分析 1 和 2 的所有中风事件的发生率比值分别为 12.93（95% CI，5.62-29.74）和 15.16（95% CI，7.21-31.87），首次中风事件的发生率比值分别为 14.54（95% CI，5.87-36.04）和 17.09（95% CI，7.49-38.96）。大多数中风事件发生在 HFRS 后的第一周。未观察到季节性影响，除了一项研究外，性别和年龄均未与本研究观察到的关联相互作用。
HFRS 后即刻发生 AMI 和中风的风险显著增加。因此，HFRS 患者在疾病急性期应密切监测，以确保早期识别即将发生的 AMI 或中风的症状。
