題目：

Risks of myocarditis, pericarditis, and cardiac arrhythmias associated with COVID-19 vaccination or SARS-CoV-2 infection

雜誌：

Nature Medicine

作者：

Martina Patone et al., 2021

Although myocarditis and pericarditis were not observed as adverse events in coronavirus disease 2019 (COVID-19) vaccine trials, there have been numerous reports of suspected cases following vaccination in the general population. 

儘管在 2019 年冠狀病毒病 (COVID-19) 疫苗試驗中未觀察到心肌炎和心包炎是不良事件，但已有大量關於普通人群接種疫苗後疑似病例的報告。

We undertook a self-controlled case series study of people aged 16 or older vaccinated for COVID-19 in England between 1 December 2020 and 24 August 2021 to investigate hospital admission or death from myocarditis, pericarditis and cardiac arrhythmias in the 1–28 days following adenovirus (ChAdOx1, n = 20,615,911) or messenger RNA-based (BNT162b2, n = 16,993,389; mRNA-1273, n = 1,006,191) vaccines or a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive test (n = 3,028,867). 

我們對 2020 年 12 月 1 日至 2021 年 8 月 24 日期間在英格蘭接種 COVID-19 疫苗的 16 歲或以上人群進行了一項自我對照病例系列研究，以調查接種腺病毒 (ChAdOx1, n = 20,615,911) 或基於mRNA (BNT162b2, n = 16,993,389; mRNA-1273, n = 1,006,191) 冠狀病毒疫苗，或SARS-CoV-2陽性 (1-28 天內)因心肌炎、心包炎和心律失常而住院或死亡。

We found increased risks of myocarditis associated with the first dose of ChAdOx1 and BNT162b2 vaccines and the first and second doses of the mRNA-1273 vaccine over the 1–28 days postvaccination period, and after a SARS-CoV-2 positive test. 

我們發現，在接種後 1-28 天以及 SARS-CoV-2 陽性檢測後，與第一劑 ChAdOx1 和 BNT162b2 疫苗以及第一劑和第二劑 mRNA-1273 疫苗相關的心肌炎風險增加。

We estimated an extra two, one and six myocarditis events per 1 million people vaccinated with ChAdOx1, BNT162b2 and mRNA-1273, respectively, in the 28 days following a first dose and an extra ten myocarditis events per 1 million vaccinated in the 28 days after a second dose of mRNA-1273.

我們估計每 100 萬接種 ChAdOx1、BNT162b2 和 mRNA 的人中發生額外的 2 起（95% 置信區間（CI）0, 3）、1 起（95% 置信區間 0, 2）和 6 起（95% 置信區間 2, 8）心肌炎事件 （第一劑 28 天內）。第二劑 mRNA-1273 後的 28 天中，每 100 萬人中發生額外 10 起心肌炎事件。

This compares with an extra 40 myocarditis events per 1 million patients in the 28 days following a SARS-CoV-2 positive test. We also observed increased risks of pericarditis and cardiac arrhythmias following a positive SARS-CoV-2 test. Similar associations were not observed with any of the COVID-19 vaccines, apart from an increased risk of arrhythmia following a second dose of mRNA-1273. Subgroup analyses by age showed the increased risk of myocarditis associated with the two mRNA vaccines was present only in those younger than 40.

相比之下，在 SARS-CoV-2 陽性檢測後的 28 天內，每 100 萬患者中發生額外 40 次心肌炎事件。我們還觀察到在 SARS-CoV-2 檢測呈陽性後發生心包炎和心律失常的風險增加。除了第二劑 mRNA-1273 後心律失常的風險增加之外，在任何 COVID-19 疫苗中均未觀察到類似的關聯。按年齡進行的亞組分析顯示，與兩種 mRNA 疫苗相關的心肌炎風險增加僅存在於 40 歲以下的人群中。