生物与医学2021medrxiv.org
按年龄和性别分析连续接种 COVID-19 疫苗后心肌炎的风险
Risk of myocarditis following sequential COVID-19 vaccinations by age and sex
入门 · 约 45 分钟读完前置知识：基础流行病学概念、心肌炎基本医学常识
导读
这篇预印本研究按年龄和性别分层比较了连续接种 COVID-19 疫苗后心肌炎的风险与感染后心肌炎风险。核心发现是：心肌炎风险主要集中在 40 岁以下男性，尤其是接种第二剂 Moderna (mRNA-1273) 疫苗后风险高于感染本身（估计多出约 101 例 vs 感染后 7 例）；而在总体人群中，感染导致心肌炎住院或死亡的风险仍高于疫苗接种。
HN 关注点：是因为这是少见的按年龄和性别细分的疫苗心肌炎风险数据，直接触及'疫苗政策是否应一刀切'的争论焦点。
HN 评论精选
这几条评论里：支持 1 补充 2 亲历 1
补充指出论文核心结论：年轻男性第二剂 Moderna 的心肌炎风险高于感染
这篇论文的核心论点是：40 岁以下男性接种两剂疫苗后患心肌炎的风险可能大于因感染 COVID 而患心肌炎的风险。此前也有类似研究，但据我所见没有像这样按年龄和性别细分的。论文写道：尽管心肌炎事件更多发生在年长者身上，但疫苗接种后的风险主要集中在 40 岁以下年轻男性，该群体接种疫苗和感染后的风险相近。显著的例外是：年轻男性接种第二剂 mRNA-1273 后，接种导致心肌炎的风险高于感染，估计第二剂后新增约 101 例，而 SARS-CoV-2 检测阳性后仅约 7 例。有人把他们的数据做成了图表，看起来更清楚一些。
simonsarris查看英文原文
This paper essentially argues that the risk of myocarditis in under-40 males getting 2 shots is greater (perhaps much greater) than the risk of getting it from COVID. There have been similar studies before, but none (that I saw) broken down by age and sex like this. It reads: > Despite more myocarditis events occurring in older persons, the risk following COVID-19 vaccination was largely restricted to younger males aged less than 40 years, where the risks of myocarditis following vaccination and infection were similar. However, the notable exception was that in younger males receiving a second dose of mRNA-1273 vaccine, the risk of myocarditis was higher following vaccination than infection, with an additional 101 events estimated following a second dose of mRNA-1273 vaccine compared to 7 events following a positive SARS-CoV-2 test. This guy made a graph of their data, which makes it a little more clear: https://twitter.com/VPrasadMDMPH/status/1475145220618526729
亲历亲历者分享接种后的担忧，后确认高风险主要限于 Moderna
哇，我几天前刚打了 Pfizer 加强针，我是 40 岁以下男性，而且以前得过心包炎……我本来就担心对我这个年龄段风险大于收益，但没有按年龄分层的数据来证明。现在有点后悔，尤其是我只是在妻子的催促下去打的。我平白无故增加了自己得心脏问题的几率。编辑：有人指出风险显著升高只出现在 Moderna (mRNA-1273)，Pfizer (BNT162b2) 在第二、三剂后风险只是略高。看来我没事 :)
hnuser847查看英文原文
Wow, I just got the Pfizer booster a few days ago and I'm an under-40 male who has previously had pericarditis... I was worried about the risk being greater than the reward for my age group but didn't have the age-stratified data to prove it. Kind of regretting it now, especially since I only got it at the urging of my wife. I just needlessly increased the odds of a giving myself a heart issue for absolutely no reason. Edit: somebody else pointed out that the significantly elevated risk was only observed for Moderna (mRNA-1273). Pfizer (BNT162b2) only has a slightly elevated risk after the 2nd and 3rd doses. Looks like I'll be okay after all :)
支持强调疫苗政策需按年龄性别分层，不能一刀切
论文总结：在总体人群中，感染导致心肌炎住院或死亡的风险高于疫苗接种，且连续接种 mRNA 疫苗（包括第三剂 BNT162b 加强针）后风险仍然不高。但接种后心肌炎风险在年轻男性中持续偏高，尤其是第二剂 mRNA-1273 之后。这对政策制定者和公众是重要提醒：疫苗政策不能简化为简单的二选一。疫苗可以对总体人群有益，同时对某些亚群构成额外风险。按年龄和性别分层是让这类讨论准确、有成效的关键。而且这类异常需要很长时间和大样本才能有足够的统计功效被检测到，我们需要的是耐心和同理心，而不是沮丧的争吵。
criticaltinker查看英文原文
> In summary, the risk of hospital admission or death from myocarditis is greater following COVID-19 infection than following vaccination and remains modest following sequential doses of mRNA vaccine including a third booster dose of BNT162b in the overall population. > However, the risk of myocarditis following vaccination is consistently higher in younger males, particularly following a second dose of RNA mRNA-1273 vaccine. This is an important reminder for policy makers and the public that vaccination policy cannot be reduced to a simple dichotomy. Vaccines can be beneficial for the overall population AND present excess risk for certain sub-populations. Stratifying by age and sex is essential for discussions on this topic to be accurate and productive. Moreover, it takes a long time and a large sample size for these anomalies to be detected with significant statistical power. Let's do our best to avoid frustrated bickering, we need all the patience and empathy we can muster.
补充补充资料：动物研究提示回抽注射或可降低心肌炎风险
一项动物研究发现，注射时回抽（确认针头未进入血管）可能降低疫苗诱发心肌炎的风险。虽然尚未在人体上重复验证，但这似乎值得进一步研究。
nradov查看英文原文
An animal study found that aspiration during injection could reduce the risk of vaccine induced myocarditis. It hasn't been reproduced in humans but this seems like something worthy of further research. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab707/6353927
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- 2021Hacker News 讨论帖190 分 · 194 评
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