小柯机器人

HIV感染者心脏猝死和心肌纤维化发生率研究
2021-06-20 16:25

美国加州大学旧金山分校Zian H. Tseng团队研究了HIV感染者心脏猝死和心肌纤维化的尸检结果。相关论文于2021年6月16日发表于《新英格兰医学杂志》上。

经尸检确定的人类免疫缺陷病毒(HIV)感染者心源性猝死和心律失常导致猝死的发生率尚未明确。

2011年2月1日至2016年9月16日,研究组前瞻性地确定了18-90岁患者中所有因院外心脏骤停导致的新发死亡,并对其进行了全面尸检和毒理学组织学检查。比较两组间心源性猝死和心律失常性猝死的发生率。

在610例HIV阳性意外死亡病例中,109例因院外心脏骤停死亡,其中48例符合世界卫生组织的心源性猝死标准,不到一半(22人)是由心律失常引起的。2011年2月1日至2014年3月1日,在无HIV感染的人群中,共有505例推定的心源性猝死。

已知HIV感染者中推定的心源性猝死发病率为每10万人-年53.3例,而无HIV感染者中发病率为每10万人-年23.7例;心律失常所致猝死的发生率分别为每10万人-年25.0例和13.3例。在所有推定的心源性猝死中,已知HIV感染者中因隐性药物过量致死的比例为34%,显著高于无HIV感染者(13%)。HIV阳性患者间质性心肌纤维化组织学水平高于无HIV感染的患者。

研究结果表明,在这项尸检研究中,HIV阳性患者的推定心源性猝死和心肌纤维化发生率显著高于那些无HIV感染的患者。在HIV阳性患者中,有三分之一的明显心源性猝死是由于药物服用过量所致。

附:英文原文

Title: Sudden Cardiac Death and Myocardial Fibrosis, Determined by Autopsy, in Persons with HIV

Author: Zian H. Tseng, M.D.,, Ellen Moffatt, M.D.,, Anthony Kim, M.D.,, Eric Vittinghoff, Ph.D.,, Phil Ursell, M.D.,, Andrew Connolly, M.D., Ph.D.,, Jeffrey E. Olgin, M.D.,, Joseph K. Wong, M.D.,, and Priscilla Y. Hsue, M.D.

Issue&Volume: 2021-06-16

Abstract:

Background

The incidence of sudden cardiac death and sudden death caused by arrhythmia, as determined by autopsy, in persons with human immunodeficiency virus (HIV) infection has not been clearly established.

Methods

Between February 1, 2011, and September 16, 2016, we prospectively identified all new deaths due to out-of-hospital cardiac arrest among persons 18 to 90 years of age, with or without known HIV infection, for comprehensive autopsy and toxicologic and histologic testing. We compared the rates of sudden cardiac death and sudden death caused by arrhythmia between groups.

Results

Of 109 deaths from out-of-hospital cardiac arrest among 610 unexpected deaths in HIV-positive persons, 48 met World Health Organization criteria for presumed sudden cardiac death; of those, fewer than half (22) had an arrhythmic cause. A total of 505 presumed sudden cardiac deaths occurred between February 1, 2011, and March 1, 2014, in persons without known HIV infection. Observed incidence rates of presumed sudden cardiac death were 53.3 deaths per 100,000 person-years among persons with known HIV infection and 23.7 deaths per 100,000 person-years among persons without known HIV infection (incidence rate ratio, 2.25; 95% confidence interval [CI], 1.37 to 3.70). Observed incidence rates of sudden death caused by arrhythmia were 25.0 and 13.3 deaths per 100,000 person-years, respectively (incidence rate ratio, 1.87; 95% CI, 0.93 to 3.78). Among all presumed sudden cardiac deaths, death due to occult drug overdose was more common in persons with known HIV infection than in persons without known HIV infection (34% vs. 13%). Persons who were HIV-positive had higher histologic levels of interstitial myocardial fibrosis than persons without known HIV infection.

Conclusions

In this postmortem study, the rates of presumed sudden cardiac death and myocardial fibrosis were higher among HIV-positive persons than among those without known HIV infection. One third of apparent sudden cardiac deaths in HIV-positive persons were due to occult drug overdose.

DOI: NJ202106173842410

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1914279

 

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home


本期文章:《新英格兰医学杂志》:Vol.384 No.24

分享到:

0