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临床心血管急症与 COVID-19 疫苗接种的细胞基础:从梦想变为现实?

Clinical cardiovascular emergencies and the cellular basis of COVID-19 vaccination: from dream to reality?

机构信息

Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.

Department of Emergency, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China.

出版信息

Int J Infect Dis. 2022 Nov;124:1-10. doi: 10.1016/j.ijid.2022.08.026. Epub 2022 Sep 6.

Abstract

OBJECTIVES

SARS-CoV-2 is responsible for the global COVID-19 pandemic, with little prevention or treatment options. More than 600 million mortalities have been documented from SARS-CoV-2 infection, with the majority of fatalities occurring among elderly patients (aged >65 years). A number of vaccines have been developed in an effort to restrain the rapid spread of SARS-CoV-2. Considering the widespread administration of these vaccines, substantial side or undesired effects in multiple organ systems have emerged, necessitating essential critical care. Herein, we tabulate the adverse cardiovascular responses resulting from COVID-19 vaccines.

DESIGN OR METHODS

We searched PubMed for articles published through April, 2022, with the terms "SARS-CoV-2", "COVID-19", "cardiovascular", "SARS-CoV-2 vaccines", "COVID-19 vaccines", "myocarditis", "pericarditis", "thrombosis", "thrombocytopenia", "vaccine-induced thrombotic thrombocytopenia", "acute coronary syndrome", "myocardial infarction", "hypertension", "arrythmia", "postural orthostatic tachycardia syndrome", "Takotsubo cardiomyopathy", "cardiac arrest" and "death". We mainly selected publications from the past 3 years, but did not exclude widely referenced and highly regarded older publications. Besides, we searched the reference lists of articles identified by above search method and chose those we considered relevant.

RESULTS

COVID-19 vaccines evoke rare but fatal thrombotic events, whereas messenger RNA\055based vaccines appear to be associated with risks of pericarditis/myocarditis, with the latter being more predominant in young adults following the second dose. Reports of other cardiovascular responses, including hypertension, arrhythmia, acute coronary syndrome, and cardiac arrest, have also been indicated.

CONCLUSION

The undesired cardiovascular complications remain infrequent, giveng the large number of vaccinations inoculated to general population. And lower mortality takes precedence over the undesired cardiovascular complications.

摘要

目的

SARS-CoV-2 是导致全球 COVID-19 大流行的病原体,目前针对其预防或治疗手段有限。超过 6 亿人死于 SARS-CoV-2 感染,其中大部分死亡发生在老年患者(年龄>65 岁)中。为了抑制 SARS-CoV-2 的快速传播,已经开发了多种疫苗。考虑到这些疫苗的广泛应用,在多个器官系统中出现了大量的不良反应或不良作用,这需要进行必要的重症监护。在此,我们列出了 COVID-19 疫苗引起的不良心血管反应。

设计或方法

我们在 PubMed 上检索了截至 2022 年 4 月发表的文章,使用的术语有“SARS-CoV-2”、“COVID-19”、“心血管”、“SARS-CoV-2 疫苗”、“COVID-19 疫苗”、“心肌炎”、“心包炎”、“血栓形成”、“血小板减少症”、“疫苗诱导的血栓性血小板减少症”、“急性冠状动脉综合征”、“心肌梗死”、“高血压”、“心律失常”、“体位性心动过速综合征”、“Takotsubo 心肌病”、“心脏骤停”和“死亡”。我们主要选择了过去 3 年发表的出版物,但并未排除广泛引用和备受推崇的旧出版物。此外,我们还检索了上述搜索方法确定的文章的参考文献列表,并选择了我们认为相关的文章。

结果

COVID-19 疫苗会引发罕见但致命的血栓事件,而信使 RNA 疫苗似乎与心包炎/心肌炎的风险相关,在第二剂接种后,年轻人更易发生后者。其他心血管反应的报告,包括高血压、心律失常、急性冠状动脉综合征和心脏骤停,也已被指出。

结论

鉴于已向普通人群接种了大量疫苗,不良心血管并发症仍然罕见。而且,降低死亡率优先于不良心血管并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b090/9444584/c76e56da8c34/gr1_lrg.jpg

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