Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Department of Microbiology, Tumor and Cell biology, Karolinska Institutet, Stockholm, Sweden.
J Intern Med. 2019 Jun;285(6):635-652. doi: 10.1111/joim.12875. Epub 2019 Jan 29.
It is now well recognized that cardiovascular events (CVE) occur quite commonly, both in the acute phase and in the long-term, in patients with community-acquired pneumonia (CAP). CVE have been noted in up to 30% of patients hospitalized with all-cause CAP. One systematic review and meta-analysis of hospitalized patients with all-cause CAP noted that the incidence rates for overall cardiac events were 17.7%, for incident heart failure were 14.1%, for acute coronary syndromes were 5.3% and for incident cardiac arrhythmias were 4.7%. In the case of pneumococcal CAP, almost 20% of patients studied had one or more of these cardiac events. Recent research has provided insights into the pathogenesis of the acute cardiac events occurring in pneumococcal infections. With respect to the former, key involvements of the major pneumococcal protein virulence factor, pneumolysin, are now well documented, whilst systemic platelet-driven neutrophil activation may also contribute. However, events involved in the pathogenesis of the long-term cardiovascular sequelae remain largely unexplored. Emerging evidence suggests that persistent antigenaemia may predispose to the development of a systemic pro-inflammatory/prothrombotic phenotype underpinning the risk of future cardiovascular events. The current manuscript briefly reviews the occurrence of cardiovascular events in patients with all-cause CAP, as well as in pneumococcal and influenza infections. It highlights the close interaction between influenza and pneumococcal pneumonia. It also includes a brief discussion of mechanisms of the acute cardiac events in CAP. However, the primary focus is on the prevalence, pathogenesis and prevention of the longer-term cardiac sequelae of severe pneumococcal disease, particularly in the context of persistent antigenaemia and associated inflammation.
现在人们已经充分认识到，社区获得性肺炎（CAP）患者在急性期和长期都会经常发生心血管事件（CVE）。在因各种原因住院的 CAP 患者中，高达 30%的患者出现 CVE。一项对因各种原因住院的 CAP 患者进行的系统评价和荟萃分析指出，总体心脏事件的发生率为 17.7%，新发心力衰竭为 14.1%，急性冠状动脉综合征为 5.3%，新发心律失常为 4.7%。在肺炎球菌性 CAP 的情况下，研究中近 20%的患者出现了上述一种或多种心脏事件。最近的研究提供了对肺炎球菌感染中急性心脏事件发生的发病机制的深入了解。就前者而言，肺炎球菌主要蛋白毒力因子肺炎球菌溶血素的关键作用已得到充分证实，而系统性血小板驱动的中性粒细胞激活也可能起作用。然而，与长期心血管后遗症发病机制相关的事件仍在很大程度上尚未得到探索。新出现的证据表明，持续的抗原血症可能使机体处于一种全身性促炎/促血栓形成表型，从而增加未来发生心血管事件的风险。本文简要回顾了 CAP 患者以及肺炎球菌和流感感染患者中心血管事件的发生情况。它强调了流感和肺炎球菌性肺炎之间的密切相互作用。它还包括对 CAP 中急性心脏事件的发病机制的简要讨论。然而，主要重点是严重肺炎球菌病的长期心脏后遗症的患病率、发病机制和预防，特别是在持续抗原血症和相关炎症的背景下。
