发表评论-高鹏-万维博客-万维读者网（电脑版）

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.

尽管在 2019 年冠状病毒病 (COVID-19) 疫苗试验中未观察到心肌炎和心包炎是不良事件，但已有大量关于普通人群接种疫苗后疑似病例的报告。

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).

我们对 2020 年 12 月 1 日至 2021 年 8 月 24 日期间在英格兰接种 COVID-19 疫苗的 16 岁或以上人群进行了一项自我对照病例系列研究，以调查接种腺病毒 (ChAdOx1, n = 20,615,911) 或基于mRNA (BNT162b2, n = 16,993,389; mRNA-1273, n = 1,006,191) 冠状病毒疫苗，或SARS-CoV-2阳性 (1-28 天内)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.

我们发现，在接种后 1-28 天以及 SARS-CoV-2 阳性检测后，与第一剂 ChAdOx1 和 BNT162b2 疫苗以及第一剂和第二剂 mRNA-1273 疫苗相关的心肌炎风险增加。

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.

我们估计每 100 万接种 ChAdOx1、BNT162b2 和 mRNA 的人中发生额外的 2 起（95% 置信区间（CI）0, 3）、1 起（95% 置信区间 0, 2）和 6 起（95% 置信区间 2, 8）心肌炎事件（第一剂 28 天内）。第二剂 mRNA-1273 后的 28 天中，每 100 万人中发生额外 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 阳性检测后的 28 天内，每 100 万患者中发生额外 40 次心肌炎事件。我们还观察到在 SARS-CoV-2 检测呈阳性后发生心包炎和心律失常的风险增加。除了第二剂 mRNA-1273 后心律失常的风险增加之外，在任何 COVID-19 疫苗中均未观察到类似的关联。按年龄进行的亚组分析显示，与两种 mRNA 疫苗相关的心肌炎风险增加仅存在于 40 岁以下的人群中。