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mRNA COVID-19 疫苗相关心肌炎的临床特征和预后因素。

Clinical characteristics and prognostic factors of myocarditis associated with the mRNA COVID-19 vaccine.

机构信息

Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.

出版信息

J Med Virol. 2022 Apr;94(4):1566-1580. doi: 10.1002/jmv.27501. Epub 2021 Dec 14.

Abstract

To analyze the clinical presentation and outcomes of myocarditis after administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccine. Nine case series and 15 case reports (74 patients) of myocarditis after administration of the BNT162b2 or mRNA-1273 vaccine were reviewed from PubMed, Scopus, Embase, and Web of Science. We analyzed clinical manifestations, diagnostic findings, and outcomes. In addition, we performed a pooled analysis and investigated risk factors leading to admission to the intensive care unit and recovery with conservative care. Most patients were male (94.6%), and the median age (range) was 17.6 (14-70) years. Patients who received the BNT162b2 (n = 58, 78.4%) vaccine presented fewer systemic symptoms and left ventricular dysfunction than mRNA-1273 recipients. Although patients under 20 years experienced more fever and myalgia, they had better ejection fraction and less prominent myocardial inflammation in magnetic resonance imaging than older patients. The clinical course of all patients was favorable without mortality, and one-third of patients resolved with conservative care alone. Risk factor analyses revealed that patients with gastrointestinal symptoms required intensive care (odds ratio: 20.3, 95% confidence interval 1.90-217, p = 0.013). The risk of fatality in myocarditis subjected to mRNA vaccination seems to be low. However, patients with gastrointestinal symptoms received more intensive care, and a significant proportion of patients recovered with conservative management.

摘要

分析 SARS-CoV-2 信使 RNA(mRNA)疫苗接种后心肌炎的临床表现和结局。从 PubMed、Scopus、Embase 和 Web of Science 中回顾了 9 项病例系列研究和 15 项病例报告(74 例患者),分析了心肌炎的临床表现、诊断结果和结局。此外,我们进行了汇总分析,并调查了导致入住重症监护病房和保守治疗恢复的危险因素。大多数患者为男性(94.6%),中位年龄(范围)为 17.6(14-70)岁。接受 BNT162b2(n=58,78.4%)疫苗的患者比接受 mRNA-1273 疫苗的患者表现出较少的全身症状和左心室功能障碍。尽管 20 岁以下的患者有更多的发热和肌痛,但他们的左心室射血分数更好,磁共振成像显示心肌炎症不明显。所有患者的临床病程均良好,无死亡病例,三分之一的患者仅通过保守治疗即可痊愈。危险因素分析显示,有胃肠道症状的患者需要重症监护(优势比:20.3,95%置信区间 1.90-217,p=0.013)。接受 mRNA 疫苗接种的心肌炎患者死亡风险似乎较低。然而,有胃肠道症状的患者接受了更多的重症监护,相当一部分患者通过保守治疗恢复。

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