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JAMA Cardiology：早期生活创伤和不良心血管结局风险的关联

2020-11-14 MedSci原创 MedSci原创

早期生活创伤不良心血管结局风险
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有心肌梗死病史和早期生活创伤的年轻人和中年人发生不良心血管事件的风险比那些有较少或没有类似经历的人更高。

在有急性心肌梗死病史的个体中，那些在童年有不良经历的人是否比那些没有不良经历的人有更高的不良结果风险？实际上，发生在18岁之前的早期生活创伤与心血管疾病风险增加有关。这种影响可能通过神经内分泌变化而发生，从而增加抑郁和相关不良行为，并存在持久的炎症作用。而有急性心肌梗塞(MI)病史的青年和中年人，特别是妇女和其他边缘人群，往往有更高的心理社会逆境负担。因此，早期生活创伤的暴露可能会通过炎症增加这些患者不良结局的风险。

近日，JAMA Cardiology上发表了一项名为Association of Early-Life Trauma and Risk of Adverse Cardiovascular Outcomes in Young and Middle-aged Individuals With a History of Myocardial Infarction以年轻和中年有心肌梗死病史的患者为样本，主要为女性和其他边缘人群，研究早期创伤是否与不良心血管预后风险相关，以及全身炎症在其中是否起作用。

这项队列研究包括18至60岁的患者，基线数据收集时间为2011年6月至2016年3月，后续数据采集时间为2019年7月。分析始于2019年9月。使用早期创伤量表自我报告短表(ETI-SR-SF)对早期生活创伤进行评估，既作为一个连续变量，也作为一个二元变量，阈值为7分或更高。在基线时获得炎症标志物、白细胞介素6和c反应蛋白水平情况。

在313名参与者中，研究者排除了13名未完成ETI-SR-SF的个体，只剩下300名参与者在分析样本中。其中297例患者有随访资料。平均年龄51(7)岁，198(66%)为非裔美国人，150(50%)为女性。总共有154人(51%)报告早年有创伤，定义为ETI-SR-SF评分为7分或更高。与那些ETI-SR-SF得分小于7的参与者相比，得分为7或更高的参与者更有可能是黑人或非洲裔美国人，并具有更不利的社会经济、社会心理和心脏代谢特征。此外，那些ETI-SR-SF评分为7或更高的患者，白细胞介素6和CRP基线水平更高，不受人口统计学和临床危险因素以及抑郁和创伤后应激障碍症状的影响。

在3年的随访中，确定了59个复合终点的结局事件。与ETI-SR-SF得分小于7的参与者相比，得分为7或更高的参与者出现研究终点的概率是前者的2倍(40 [26%]vs 19 [13%];P = 04)。所有事件类型在ETI-SR-SF得分为7或更高的参与者中都比得分小于7的参与者更频繁。使用Cox比例风险模型，ETI-SR-SF评分每增加4分，复合结局的风险就会增加30% (95% CI, 10%-50%)。在人口统计学和临床因素调整后，这种相关性仅轻微减弱。对创伤后应激障碍和抑郁症的进一步调整并没有实质性改变结果。将ETI-SR-SF评分作为二元变量，结果一致。

年轻和中年有心肌梗死病史的个体早期生命创伤和不良心血管结局风险的关联

在这项针对近期心肌梗死的青年和中年成年人的研究中，根据ETI-SR-SF测量，早期生活逆境是一种常见的暴露，并与风险的显著增加相关。作为一个分类变量，早期生活的高水平逆境与心血管不良结局的风险大约翻倍相关。影响是有层次的。在调整人口学和心血管危险因素后，ETI-SR-SF评分每增加4分，研究终点的风险就增加20%，暴露最高四分位数的个体的风险比暴露最低四分位数的个体增加4倍以上。然而，在对基线炎症进行调整后，这种相关性不再具有统计学意义。这些结果表明，不良的童年经历在一定程度上通过炎症途径导致心肌梗死后心血管风险增加，这可能是由于糖皮质激素信号减弱与下游炎症级联的上调有关。

总之，有心肌梗死病史和早期生活创伤的年轻人和中年人发生不良心血管事件的风险比那些有较少或没有类似经历的人更高。我们的研究表明，早期生活逆境的暴露是这一群体的一个重要预后指标。

参考文献：Association of Early-Life Trauma and Risk of Adverse Cardiovascular Outcomes in Young and Middle-aged Individuals With a History of Myocardial Infarction. JAMA Cardiol. Published online November 13, 2020. doi:10.1001/jamacardio.2020.5749

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    2020-12-14 caoliehu

    #Cardiology#

    0

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    2020-12-04 12499e01m47暂无昵称

    #Cardiol#

    0

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    2020-11-16 gous

    #心血管结局#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=2069288, encodeId=7dc920692882c, content=<a href='/topic/show?id=125e40988d' target=_blank style='color:#2F92EE;'>#Cardiology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4098, encryptionId=125e40988d, topicName=Cardiology)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=316c73, createdName=caoliehu, createdTime=Mon Dec 14 07:48:43 CST 2020, time=2020-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782106, encodeId=80ec1e821066e, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Fri Dec 04 22:48:43 CST 2020, time=2020-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269376, encodeId=e6f912693e61f, content=<a href='/topic/show?id=49d1518915a' target=_blank style='color:#2F92EE;'>#心血管结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51891, encryptionId=49d1518915a, topicName=心血管结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Mon Nov 16 11:48:43 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335320, encodeId=5c65133532051, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Mon Nov 16 11:48:43 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899553, encodeId=7d3389955328, content=<a href='/topic/show?id=1c4010403242' target=_blank style='color:#2F92EE;'>#早期生活创伤#</a>的暴露可能会通过炎症增加这些患者不良结局的风险。为了健康，我们在日常生活中尽量避免增加体内的炎症反应。, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104032, encryptionId=1c4010403242, topicName=早期生活创伤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Mon Nov 16 10:16:32 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899236, encodeId=b291899236d0, content=实用，知识对我帮助大, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10713004529, createdName=lingf828, createdTime=Sun Nov 15 07:55:41 CST 2020, time=2020-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036341, encodeId=c5571036341e3, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Nov 14 23:48:43 CST 2020, time=2020-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899202, encodeId=7a25899202ef, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a2d5429609, createdName=ms1000002114994444, createdTime=Sat Nov 14 21:32:47 CST 2020, time=2020-11-14, status=1, ipAttribution=)]
    2020-11-16 ms920641618706883

    #创伤#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=2069288, encodeId=7dc920692882c, content=<a href='/topic/show?id=125e40988d' target=_blank style='color:#2F92EE;'>#Cardiology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4098, encryptionId=125e40988d, topicName=Cardiology)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=316c73, createdName=caoliehu, createdTime=Mon Dec 14 07:48:43 CST 2020, time=2020-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782106, encodeId=80ec1e821066e, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Fri Dec 04 22:48:43 CST 2020, time=2020-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269376, encodeId=e6f912693e61f, content=<a href='/topic/show?id=49d1518915a' target=_blank style='color:#2F92EE;'>#心血管结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51891, encryptionId=49d1518915a, topicName=心血管结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Mon Nov 16 11:48:43 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335320, encodeId=5c65133532051, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Mon Nov 16 11:48:43 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899553, encodeId=7d3389955328, content=<a href='/topic/show?id=1c4010403242' target=_blank style='color:#2F92EE;'>#早期生活创伤#</a>的暴露可能会通过炎症增加这些患者不良结局的风险。为了健康，我们在日常生活中尽量避免增加体内的炎症反应。, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104032, encryptionId=1c4010403242, topicName=早期生活创伤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Mon Nov 16 10:16:32 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899236, encodeId=b291899236d0, content=实用，知识对我帮助大, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10713004529, createdName=lingf828, createdTime=Sun Nov 15 07:55:41 CST 2020, time=2020-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036341, encodeId=c5571036341e3, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Nov 14 23:48:43 CST 2020, time=2020-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899202, encodeId=7a25899202ef, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a2d5429609, createdName=ms1000002114994444, createdTime=Sat Nov 14 21:32:47 CST 2020, time=2020-11-14, status=1, ipAttribution=)]
    2020-11-16 Jessica

    #早期生活创伤#的暴露可能会通过炎症增加这些患者不良结局的风险。为了健康，我们在日常生活中尽量避免增加体内的炎症反应。

    0

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    2020-11-15 lingf828

    实用，知识对我帮助大

    0

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    2020-11-14 旺医

    顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=2069288, encodeId=7dc920692882c, content=<a href='/topic/show?id=125e40988d' target=_blank style='color:#2F92EE;'>#Cardiology#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4098, encryptionId=125e40988d, topicName=Cardiology)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=316c73, createdName=caoliehu, createdTime=Mon Dec 14 07:48:43 CST 2020, time=2020-12-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1782106, encodeId=80ec1e821066e, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Fri Dec 04 22:48:43 CST 2020, time=2020-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1269376, encodeId=e6f912693e61f, content=<a href='/topic/show?id=49d1518915a' target=_blank style='color:#2F92EE;'>#心血管结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51891, encryptionId=49d1518915a, topicName=心血管结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7a9987, createdName=gous, createdTime=Mon Nov 16 11:48:43 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1335320, encodeId=5c65133532051, content=<a href='/topic/show?id=e7cc32022c7' target=_blank style='color:#2F92EE;'>#创伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32022, encryptionId=e7cc32022c7, topicName=创伤)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aa5a2500103, createdName=ms920641618706883, createdTime=Mon Nov 16 11:48:43 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899553, encodeId=7d3389955328, content=<a href='/topic/show?id=1c4010403242' target=_blank style='color:#2F92EE;'>#早期生活创伤#</a>的暴露可能会通过炎症增加这些患者不良结局的风险。为了健康，我们在日常生活中尽量避免增加体内的炎症反应。, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104032, encryptionId=1c4010403242, topicName=早期生活创伤)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20211019/df01a4bfb64246379ddfef3370d04115/e1274c8eb5e440918f56f83bcfea9031.jpg, createdBy=3a345397082, createdName=Jessica, createdTime=Mon Nov 16 10:16:32 CST 2020, time=2020-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899236, encodeId=b291899236d0, content=实用，知识对我帮助大, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=10713004529, createdName=lingf828, createdTime=Sun Nov 15 07:55:41 CST 2020, time=2020-11-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036341, encodeId=c5571036341e3, content=顶刊就是顶刊，谢谢梅斯带来这么高水平的研究报道，我们科里同事经常看梅斯，分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Nov 14 23:48:43 CST 2020, time=2020-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=899202, encodeId=7a25899202ef, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a2d5429609, createdName=ms1000002114994444, createdTime=Sat Nov 14 21:32:47 CST 2020, time=2020-11-14, status=1, ipAttribution=)]
    2020-11-14 ms1000002114994444

    学习了

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