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编译：刘金淑 河南省濮阳市油田总医院
审核：陈志锦 东莞市厚街人民医院
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急性心肌梗死可由急性呼吸道感染引起，以前的研究表明流感与急性心肌梗死存在关联，但这些研究使用非特异性流感感染措施，或研究设计易受偏倚影响。近期，研究人员评估了实验室确认的流感感染与急性心肌梗死之间的相关性。
研究人员采用自我控制的病例系列进行设计，来评估实验室确诊的流感感染与因急性心肌梗死住院治疗之间的关系。他们使用各种高特异性实验室方法来确认呼吸道标本中的流感感染，并且从管理数据中确定急性心肌梗死的住院治疗。将“风险区间”定义为呼吸道标本收集后的前7天，将“控制区间”定义为风险区间的前后1年。
研究人员确定了在流感阳性检测结果前后1年内发生的急性心肌梗死住院患者364人，其中，20个（每周20.0次入院）发生在风险区间，344个（每周3.3次入院）发生在控制区间。与控制区间相比，风险区间的急性心肌梗塞住院发病比为6.05（95％置信区间[CI]，3.86〜9.50），且在第7天开始发病率没有观察到增加。在检测到乙型流感病毒，甲型流感病毒，呼吸道合胞病毒和其他病毒后7天内急性心肌梗塞的发病比分别为10.11（95％CI，4.37〜23.38）、5.17（95％ CI，3.02〜8.84）、3.51（95％CI，1.11〜11.12）和2.77（95％CI，1.23〜6.24）。
研究人员认为呼吸道感染，尤其是流感与急性心肌梗死之间存在显著相关性。
来源：NEJM
原文：
Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection
AbstractBACKGROUNDAcute myocardial infarction can be triggered by acute respiratory infections. Previous studies have suggested an association between influenza and acute myocardial infarction, but those studies used nonspecific measures of influenza infection or study designs that were susceptible to bias. We evaluated the association between laboratory-confirmed influenza infection and acute myocardial infarction.
METHODSWe used the self-controlled case-series design to evaluate the association between laboratory-confirmed influenza infection and hospitalization for acute myocardial infarction. We used various high-specificity laboratory methods to confirm influenza infection in respiratory specimens, and we ascertained hospitalization for acute myocardial infarction from administrative data. We defined the “risk interval” as the first 7 days after respiratory specimen collection and the “control interval” as 1 year before and 1 year after the risk interval.
RESULTSWe identified 364 hospitalizations for acute myocardial infarction that occurred within 1 year before and 1 year after a positive test result for influenza. Of these, 20 (20.0 admissions per week) occurred during the risk interval and 344 (3.3 admissions per week) occurred during the control interval. The incidence ratio of an admission for acute myocardial infarction during the risk interval as compared with the control interval was 6.05 (95% confidence interval [CI], 3.86 to 9.50). No increased incidence was observed after day 7. Incidence ratios for acute myocardial infarction within 7 days after detection of influenza B, influenza A, respiratory syncytial virus, and other viruses were 10.11 (95% CI, 4.37 to 23.38), 5.17 (95% CI, 3.02 to 8.84), 3.51 (95% CI, 1.11 to 11.12), and 2.77 (95% CI, 1.23 to 6.24), respectively.
CONCLUSIONSWe found a significant association between respiratory infections, especially influenza, and acute myocardial infarction. (Funded by the Canadian Institutes of Health Research and others.)
Supported by an operating grant (CIHR MOP 130568) from the Canadian Institutes of Health Research, by Public Health Ontario, and by the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information (CIHI) and by Cancer Care Ontario (CCO). However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of the CIHI or CCO. No endorsement by the Institute for Clinical Evaluative Sciences, Public Health Ontario, Ontario Ministry of Health and Long-Term Care, the CIHI, or CCO is intended or should be inferred.
We thank IMS Brogan for the use of its drug information database and Donald Redelmeier for helpful discussions about an earlier version of the manuscript.
Author AffiliationsFrom the Institute for Clinical Evaluative Sciences (J.C.K., K.L.S., M.A.C., H.C., D.T.K., L.C.R.), Public Health Ontario (J.C.K., K.L.S., N.S.C., L.C.R., J.B.G.), Dalla Lana School of Public Health (J.C.K., K.L.S., N.S.C., A.J.M., L.C.R.), and the Departments of Family and Community Medicine (J.C.K.) and Laboratory Medicine and Pathobiology (N.S.C., K.K., A.J.M., A.S., J.B.G.), University of Toronto, University Health Network (J.C.K.), North York General Hospital (K.K.), Sunnybrook Health Sciences Centre (D.T.K., A.S.), Sinai Health System (A.J.M.), and the Hospital for Sick Children (J.B.G.), Toronto, Children’s Hospital of Eastern Ontario (T.K., D.M.) and the Department of Pathology and Laboratory Medicine, University of Ottawa (T.K.), Ottawa, William Osler Health System, Brampton, ON (D.C.R.), McMaster University, Hamilton, ON (M.S.), London Health Sciences Centre, London, ON (G.Z.), and the Newfoundland and Labrador Public Health Laboratory, St. John’s (G.Z.) — all in Canada.
Address reprint requests to Dr. Kwong at the Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Ave., Toronto, ON M4N 3M5, Canada, or
atjeff.kwong@utoronto.ca.
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发表于 2018-3-2 08:17
