生物与医学2021nature.com
Covid-19 相关心肌炎与 mRNA 疫苗的比较
Myocarditis associated with Covid-19 compared to mRNA vaccines
进阶 · 约 25 分钟读完前置知识：流行病学基础、风险比/超额风险概念、疫苗不良事件监测
导读
这篇论文比较 SARS-CoV-2 感染与 mRNA 疫苗接种后心肌炎的风险。评论引用的摘要/数据显示，感染后的心肌炎风险总体显著更高；但在 40 岁以下人群中两者风险更接近，第二剂 Moderna 的额外风险在部分估计中甚至略高于感染后。
HN 关注点：疫苗与感染的心肌炎风险对比，讨论焦点包括年轻人群风险、研究对照设计以及个人接种后不良反应报告。
后来怎么样
该研究为 mRNA 疫苗心肌炎风险与 SARS-CoV-2 感染风险的量化比较提供了证据，被用于年轻人群（尤其第二剂 Moderna）接种的风险-获益评估和公共卫生沟通。
HN 评论精选
这几条评论里：支持 1 质疑 1 补充 1 亲历 1
支持批评评论者忽视摘要中感染风险远高于疫苗，并反对用个例和心悸推断因果。
这听起来可能有点苛刻，但所有抨击疫苗的读者都是故意选择性失明吗？摘要（学术版 TL;DR）里明明写着新冠导致心肌炎的可能性是疫苗的 7 到 40 倍。很多人写心悸，但心悸也可能由压力和焦虑引起。我 30 岁、身体不错，过去因严重压力每周都有心律不齐发作；现在我接种了疫苗（对 99.999% 的人来说这显然和出现这种症状无关，但很多评论者却得出那种结论），心悸消失了。请不要用轶事证据下结论。同理，我爷爷从 13 岁抽烟还活到 85 岁。
ppaattrriicckk查看英文原文
This probably sounds harsh, but are all vaccine-bashing readers deliberately selectively-illiterate? In the abstract (academic for "TL;DR") it literally states that Covid is between 7 and 40 times more likely to cause Myocarditis. And a lot of you write about palpitations, which can also be caused by stress and anxiety. I'm 30, in good physical shape, and used to have weekly episodes with irregular heartbeats due to severe stress. Now I'm vaccinated (which is for 99.999% of us obviously completely irrelevant to experiencing this, but a lot of commenters draw that conclusion) and the palpitations are gone. Let's not base conclusion on anecdotal evidence, please. For the same reason that my grandpa lived until 85 while smoking since he was 13.
质疑质疑研究缺乏未接种对照，并问为何强调心肌炎而非更常见的心律失常。
我是不是漏了什么？没有未接种疫苗的对照组。谁能说新冠没有加重疫苗带来的病症？为什么不做未接种对照组？研究说心律失常远更常见，为什么还如此强调心肌炎/心包炎？
Argonaut998查看英文原文
>People were considered eligible for inclusion in each study cohort if they had received at least one vaccine dose, were at least 16 years old and were admitted to hospital with, or died from, the outcome of interest between 1 December 2020 and 24 August 2021 Am I missing something? There is no control group for unvaccinated people. Who is to say that COVID didn't exacerbate the conditions delivered via the vaccine? Why wouldn't they put an unvaccinated control group? Why is there so much emphasis on myocarditis/pericarditis when the study claims that Cardiac arrhythmias were far more plentiful?
亲历个人报告接种后持续心悸/异位心跳，并已上报不良反应。
感谢发布。我六月接种第一剂 Pfizer，约三周后开始频繁心律不齐。有时每天，有时每周一两次。六个月后作为疫苗结果我仍经历异位心跳（虽然频率低很多）。我以前喝很多咖啡，但因心脏风险戒掉所有咖啡因。我向 Yellow Card 计划报告了，很高兴看到更多研究和关注。
echelon_musk查看英文原文
Thank you for posting this. I received my 1st Pfizer vaccine in June and around 3 weeks after the vaccine I started experiencing frequent irregular heartbeats. Sometimes it was every day, then sometimes once or twice a week. I still experience ectopic heartbeat now (although much less frequently) as a result of the vaccine 6 months later. I used to drink lots of coffee, but quit all caffeine in my life due to the risk to my heart! I reported this to the yellow card scheme, but I'm very glad to see more research being done and awareness.
补充引用研究数据指出 40 岁以下接种 Moderna 后超额心肌炎风险高于感染后。
所以根据这项研究，如果你不到 40 岁且接种了第二剂 Moderna 疫苗，你发生心肌炎的概率比感染新冠后更高。
jcbrand查看英文原文
> The risks are more evenly balanced in younger persons aged up to 40 years, where we estimated the excess in myocarditis events following SARS-CoV-2 infection to be 10 per million with the excess following a second dose of mRNA-1273 vaccine being 15 per million So according to this study, if you're under 40 and have taken the Moderna vaccine, you are more likely to develop Myocarditis than after a Covid infection.
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