{"id":47268,"date":"2024-02-18T00:32:13","date_gmt":"2024-02-17T23:32:13","guid":{"rendered":"https:\/\/www.infokuryr.cz\/n\/?p=47268"},"modified":"2024-02-17T16:39:23","modified_gmt":"2024-02-17T15:39:23","slug":"nova-analyza-hodnoty-poskozeni-srdecniho-svalu-po-ockovani-proti-covid-jsou-alarmujici","status":"publish","type":"post","link":"https:\/\/www.infokuryr.cz\/n\/2024\/02\/18\/nova-analyza-hodnoty-poskozeni-srdecniho-svalu-po-ockovani-proti-covid-jsou-alarmujici\/","title":{"rendered":"Nov\u00e1 anal\u00fdza: hodnoty po\u0161kozen\u00ed srde\u010dn\u00edho svalu po o\u010dkov\u00e1n\u00ed proti COVID jsou alarmuj\u00edc\u00ed"},"content":{"rendered":"
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N\u011bmecko-\u0161v\u00fdcarsk\u00e1 anal\u00fdza: Hodnoty marker\u016f po\u0161kozen\u00ed srde\u010dn\u00edho svalu po COVID-19 vax: \u201eZnepokojiv\u00e9<\/strong><\/span><\/p>\n

Dr. Rainer Johannes Klement, l\u00e9ka\u0159sk\u00fd fyzik v nemocnici Leopoldina, Odd\u011blen\u00ed radia\u010dn\u00ed onkologie ve Schweinfurtu, N\u011bmecko, a Prof. Dr. Harald Walach, v\u00fdznamn\u00e1 osobnost v oblasti psychologie, filozofie a komplement\u00e1rn\u00ed medic\u00edny a tak\u00e9 zakladatel a v\u00fdkonn\u00fd \u0159editel Change Health Science Institute, kter\u00fd nad\u00e1le v\u00fdznamn\u011b p\u0159isp\u00edv\u00e1 do sv\u011bta zdrav\u00ed a v\u011bdy, spole\u010dn\u011b sestavili COVID-19. byly analyzov\u00e1ny \u00fadaje o infekci z evropsk\u00fdch zem\u00ed N\u011bmecka a \u0160v\u00fdcarska a tak\u00e9 o\u010dek\u00e1van\u00e1 frekvence zv\u00fd\u0161en\u00fdch hladin troponinu po infekci COVID-19 u hospitalizovan\u00fdch a nehospitalizovan\u00fdch lid\u00ed. Duo uv\u00e1d\u00ed, \u017ee v\u00fdskyt po\u0161kozen\u00ed srde\u010dn\u00edho svalu po o\u010dkov\u00e1n\u00ed proti COVID-19 p\u0159edstavuje \u201ev\u00fdznamn\u00fd pod\u00edl obecn\u00e9 populace\u201c a o\u010dek\u00e1v\u00e1 se, \u017ee bude \u201emnohem vy\u0161\u0161\u00ed ne\u017e po p\u0159irozen\u00fdch infekc\u00edch\u201c.<\/span><\/p>\n

Zji\u0161t\u011bn\u00ed publikovan\u00e1 v Egyptian Heart Journal vedla autory po p\u0159ezkoum\u00e1n\u00ed dat k z\u00e1v\u011bru, \u017ee sou\u010dasn\u00e9 paradigma l\u00e9ka\u0159sk\u00e9ho za\u0159\u00edzen\u00ed, \u017ee rozsah po\u0161kozen\u00ed myokardu je vy\u0161\u0161\u00ed po infekci COVID-19 ne\u017e po o\u010dkov\u00e1n\u00ed, jak navrhli Burgin et al. . n\u00e1roky mus\u00ed b\u00fdt zam\u00edtnuty.<\/span><\/p>\n

Doporu\u010den\u00ed<\/strong><\/span><\/p>\n

To vede k doporu\u010den\u00ed, \u017ee by vl\u00e1dy m\u011bly financovat systematick\u00e9 pozorovac\u00ed studie nap\u0159\u00ed\u010d zem\u011bmi, kter\u00e9 by poskytly \u201ep\u0159esn\u011bj\u0161\u00ed posouzen\u00ed pom\u011bru rizika a p\u0159\u00ednosu vakc\u00edn mRNA COVID-19\u201c.<\/span><\/p>\n

Co p\u0159inesla studie Buergina et al.<\/strong><\/span><\/p>\n

Buergin a kolegov\u00e9 publikovali studii v European Journal of Heart Failure, kter\u00e1 uv\u00e1d\u011bla v\u00fdsledky dob\u0159e navr\u017een\u00e9ho prospektivn\u00edho sledov\u00e1n\u00ed zn\u00e1mek myokarditidy po p\u0159eo\u010dkov\u00e1n\u00ed mRNA-1273 (Moderna) u kohorty nemocni\u010dn\u00edch pracovn\u00edk\u016f v Basileji ve \u0160v\u00fdcarsku.<\/span><\/p>\n

Auto\u0159i t\u00e9to nejnov\u011bj\u0161\u00ed studie poznamenali, \u017ee \u201et\u0159i dny po o\u010dkov\u00e1n\u00ed m\u011blo 40 ze 777 o\u010dkovan\u00fdch jedinc\u016f vysoce citliv\u00e9 hladiny srde\u010dn\u00edho troponinu T (hs-TnT) nad horn\u00ed laboratorn\u00ed standard (\u2265 9 ng\/l).\u201c<\/span><\/p>\n

Z t\u00e9to kohorty bylo zji\u0161t\u011bno, \u017ee u 22 (2,8 % v\u0161ech o\u010dkovan\u00fdch jedinc\u016f) se vyvinulo po\u0161kozen\u00ed myokardu spojen\u00e9 s mRNA-1273 a m\u011bli st\u0159edn\u00ed hladiny hs-TnT 13,5 ng\/l (IQR: 9-18,8 ng\/l). \u201c<\/span><\/p>\n

Ale jak mohl Buergin a spol. st\u00e1le obecn\u011b propagujete o\u010dkov\u00e1n\u00ed proti COVID-19?<\/strong><\/span><\/p>\n

Klement a Walach uv\u00e1d\u011bj\u00ed, \u017ee auto\u0159i Buergin et al. ozn\u00e1mil: \u201eNe\u017e byla vakc\u00edna COVID-19 k dispozici, v\u00fdskyt a rozsah po\u0161kozen\u00ed myokardu spojen\u00e9ho s infekc\u00ed COVID-19 byly mnohem vy\u0161\u0161\u00ed ne\u017e ty, kter\u00e9 byly pozorov\u00e1ny po p\u0159eo\u010dkov\u00e1n\u00ed v t\u00e9to aktivn\u00ed pozorovac\u00ed studii.\u201c<\/span><\/p>\n

Pro\u010d je Buergin a spol. \u0161patn\u011b podle Klementa a Walacha?<\/strong><\/span><\/p>\n

Klement a Walach vyvracej\u00ed Buergina a spol. a prohla\u0161uj\u00ed, \u017ee tito auto\u0159i jsou vinni \u201elogickou chybou\u201c, co\u017e znamen\u00e1, \u017ee cel\u00fd jejich postoj je \u0161patn\u00fd ze dvou d\u016fvod\u016f: 1) Buergin et al. porovnali v\u00fdskyt zv\u00fd\u0161en\u00fdch hladin hs-TnT po p\u0159eo\u010dkov\u00e1n\u00ed s v\u00fdskytem po\u0161kozen\u00ed myokardu spojen\u00e9ho s infekc\u00ed COVID-19 pouze u hospitalizovan\u00fdch pacient\u016f; Nezohlednili v\u00fdskyt po\u0161kozen\u00ed myokardu v infikovan\u00e9, ale ne hospitalizovan\u00e9 kohort\u011b, kter\u00e1 zahrnuje mnohem v\u011bt\u0161\u00ed po\u010det infikovan\u00fdch osob, a 2) rozsah po\u0161kozen\u00ed myokardu u o\u010dkovan\u00e9 populace z\u00e1vis\u00ed nejen na incidenci, ale tak\u00e9 na celkov\u00fd po\u010det lid\u00ed, kte\u0159\u00ed dostali vakc\u00ednu; toto \u010d\u00edslo je mnohem vy\u0161\u0161\u00ed ne\u017e po\u010det lid\u00ed naka\u017een\u00fdch SARS-CoV-2.<\/span><\/p>\n

Odkud Klement a Walach z\u00edsk\u00e1vaj\u00ed sv\u00e1 studijn\u00ed data t\u00fdkaj\u00edc\u00ed se infekc\u00ed COVID-19?<\/strong><\/span><\/p>\n

Auto\u0159i uv\u00e1d\u011bj\u00ed v European Journal of Heart, \u017ee vych\u00e1zeli z n\u00e1rodn\u00edch \u00fadaj\u016f Institutu Roberta Kocha v N\u011bmecku (p\u0159\u00edstup 17. b\u0159ezna) jak pro po\u010det lid\u00ed naka\u017een\u00fdch COVID-19, tak pro po\u010det lid\u00ed hospitalizovan\u00fdch pro COVID-19 srpna. 2023) a \u0160v\u00fdcarsk\u00fd feder\u00e1ln\u00ed statistick\u00fd \u00fa\u0159ad (p\u0159\u00edstup 17. srpna 2023).<\/span><\/p>\n

A co zv\u00fd\u0161en\u00e9 hladiny troponinu?<\/strong><\/span><\/p>\n

Klement a Walach hledali ve slu\u017eb\u011b Google Scholar 17. srpna 2023 pomoc\u00ed vyhled\u00e1vac\u00edho v\u00fdrazu \u201enehospitalizovan\u00e1 infekce troponinem COVID-19 SARS-CoV-2\u201c relevantn\u00ed studie, kter\u00e9 m\u011b\u0159ily hladiny troponinu u hospitalizovan\u00fdch i nehospitalizovan\u00fdch pacient\u016f. V sou\u010dasn\u00e9 dob\u011b to uv\u00e1d\u00ed pouze jedna prospektivn\u00ed studie (Ziedziela et al.), kter\u00e1 uv\u00e1d\u00ed zv\u00fd\u0161en\u00e9 hladiny TnT v srdci (>14 ng\/ml) u 7 % (6\/86) hospitalizovan\u00fdch au 1,8 % (2\/114). ) hl\u00e1\u0161en\u00fdch nehospitalizovan\u00fdch pacient\u016f s Covid-19, co\u017e d\u00e1v\u00e1 celkovou incidenci 8\/200 = 0,04 (standardn\u00ed chyba = 0,035) pro zv\u00fd\u0161en\u00e9 hladiny TnT po infekci SARS-CoV-2.<\/span><\/p>\n

Po\u010det lid\u00ed se zv\u00fd\u0161en\u00fdmi hladinami troponinu T po o\u010dkov\u00e1n\u00ed nebo p\u0159irozen\u00e9 infekci SARS-CoV-2 podle \u00fadaj\u016f Buergina et al. a Niedziela a kol.<\/strong><\/span><\/p>\n

\n\n\n\n\n\n
Hladiny troponinu T<\/span><\/strong><\/td>\nO\u010dkovan\u00ed lid\u00e9<\/span><\/strong><\/td>\nSamoz\u0159ejm\u011b infikovan\u00e9<\/span><\/strong><\/td>\n<\/tr>\n
Zv\u00fd\u0161en\u00e1<\/span><\/td>\n40<\/span><\/td>\n8<\/span><\/td>\n<\/tr>\n
Nezv\u00fd\u0161en\u00e9<\/span><\/td>\n737<\/span><\/td>\n192<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/figure>\n

Auto\u0159i poznamen\u00e1vaj\u00ed, \u017ee zv\u00fd\u0161en\u00e9 hladiny c-troponinu jsou potenci\u00e1ln\u00edm markerem po\u0161kozen\u00ed myokardu po o\u010dkov\u00e1n\u00ed proti COVID-19 u zdrav\u00fdch jedinc\u016f, co\u017e je znepokojiv\u00e1 vyhl\u00eddka.<\/span><\/p>\n

Auto\u0159i uv\u00e1d\u011bj\u00ed, \u017ee Niedziela et al. ukazuj\u00ed, \u017ee \u201ehospitalizovan\u00ed infikovan\u00ed jedinci pravd\u011bpodobn\u011bji vykazuj\u00ed zn\u00e1mky po\u0161kozen\u00ed myokardu ne\u017e nehospitalizovan\u00ed infikovan\u00ed jedinci\u201c. V jin\u00e9m \u010dl\u00e1nku, kter\u00fd p\u0159ezkoum\u00e1v\u00e1 publikovan\u00e1 data Buergin et al. \u010detnost zv\u00fd\u0161en\u00fdch hladin troponinu u hospitalizovan\u00fdch pacient\u016f se odhaduje na 20 %.<\/span><\/p>\n

Jak\u00e9 je riziko zv\u00fd\u0161en\u00fdch hladin troponin\u016f u b\u011b\u017en\u00e9 populace po o\u010dkov\u00e1n\u00ed proti COVID-19 v porovn\u00e1n\u00ed s rizikem zv\u00fd\u0161en\u00fdch hladin troponin\u016f v d\u016fsledku infekce COVID-19?<\/span><\/p>\n

Omezen\u00ed<\/strong><\/span><\/p>\n

Auto\u0159i upozor\u0148uj\u00ed na omezen\u00ed studie, jako je \u201enedostatek studi\u00ed, kter\u00e9 prospektivn\u011b m\u011b\u0159\u00ed hladiny troponinu a dal\u0161\u00ed zn\u00e1mky po\u0161kozen\u00ed myokardu u hospitalizovan\u00fdch i nehospitalizovan\u00fdch jedinc\u016f s infekc\u00ed SARS-CoV-2\u201c. Museli se tedy spolehnout na Niedzielu a spol. vynech\u00e1no, i kdy\u017e hladiny troponinu byly nam\u011b\u0159eny jako medi\u00e1n 106 dn\u016f po n\u00e1stupu p\u0159\u00edznak\u016f; v Buergin et al. byly m\u011b\u0159eny t\u0159i dny po o\u010dkov\u00e1n\u00ed.<\/span><\/p>\n

Auto\u0159i poukazuj\u00ed na to, \u017ee Buergin et al. Byly pou\u017eity testy hs-TnT, zat\u00edmco Niedziela et al. byly pou\u017eity konven\u010dn\u00ed TnT testy.<\/span><\/p>\n

Upozor\u0148uj\u00ed v\u0161ak, \u017ee \u00fadaje Moulsona et al. nazna\u010duj\u00ed, \u017ee s pou\u017eit\u00edm \u00fadaj\u016f z Niedziely et al. je pravd\u011bpodobn\u011b nadhodnocena jako zn\u00e1mka po\u0161kozen\u00ed myokardu, co\u017e by tato studie m\u011bla podpo\u0159it.<\/span><\/p>\n

Pro tuto studii auto\u0159i p\u0159edpokl\u00e1daj\u00ed, \u017ee Buergin et al. Odvozen\u00fd v\u00fdskyt po\u0161kozen\u00ed myokardu po p\u0159eo\u010dkov\u00e1n\u00ed mRNA-1273 plat\u00ed i pro dal\u0161\u00ed \u010d\u00edsla o\u010dkov\u00e1n\u00ed a v\u00fdrobce. Podle Klementa a Walacha z\u016fst\u00e1vaj\u00ed v\u00fdsledky vzhledem k velk\u00e9mu po\u010dtu o\u010dkovan\u00fdch st\u00e1le kvalitativn\u011b platn\u00e9.<\/span><\/p>\n

Z\u00e1v\u011bre\u010dn\u00e9 my\u0161lenky<\/strong><\/span><\/p>\n

Buergin a kol. poskytli d\u016fle\u017eit\u00e1 zji\u0161t\u011bn\u00ed o bezpe\u010dnosti vakc\u00edny COVID-19 na b\u00e1zi mRNA, ale kv\u016fli logick\u00e9 chyb\u011b podcenili v\u00fdznam sv\u00fdch vlastn\u00edch zji\u0161t\u011bn\u00ed pro \u201eve\u0159ejn\u00e9 zdrav\u00ed\u201c.<\/span><\/p>\n

Auto\u0159i zd\u016fraz\u0148uj\u00ed nal\u00e9havost prov\u00e1d\u011bn\u00ed systematick\u00fdch pozorovac\u00edch studi\u00ed nap\u0159\u00ed\u010d zem\u011bmi, aby bylo mo\u017en\u00e9 l\u00e9pe porozum\u011bt pom\u011bru p\u0159\u00ednos\u016f a rizik hromadn\u00e9ho o\u010dkov\u00e1n\u00ed proti COVID-19.<\/span><\/p>\n

Vedouc\u00ed v\u00fdzkumu\/vy\u0161et\u0159ovatel<\/strong><\/span><\/p>\n

Dr. Rainer Johannes Klement, l\u00e9ka\u0159sk\u00fd fyzik v nemocnici Leopoldina, odd\u011blen\u00ed radia\u010dn\u00ed onkologie<\/span><\/em><\/p>\n

Prof. Dr. Harald Walach, v\u00fdznamn\u00e1 osobnost v oblasti psychologie, filozofie a komplement\u00e1rn\u00ed medic\u00edny a tak\u00e9 zakladatel a v\u00fdkonn\u00fd \u0159editel Change Health Science Institute.<\/span><\/em><\/p>\n

V\u00fdzva k akci: Viz v\u00fdsledky\u00a0<\/span>studie<\/span><\/a>\u00a0.<\/span><\/p>\n<\/div>\n<\/div>\n

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ZDROJ<\/a><\/span><\/h3>\n<\/div>\n

 <\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

N\u011bmecko-\u0161v\u00fdcarsk\u00e1 anal\u00fdza: Hodnoty marker\u016f po\u0161kozen\u00ed srde\u010dn\u00edho svalu po COVID-19 vax: \u201eZnepokojiv\u00e9 Dr. Rainer Johannes Klement,…<\/p>\n","protected":false},"author":2,"featured_media":17345,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[7],"tags":[23,4561,839,1820],"_links":{"self":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts\/47268"}],"collection":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/comments?post=47268"}],"version-history":[{"count":0,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/posts\/47268\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/media\/17345"}],"wp:attachment":[{"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/media?parent=47268"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/categories?post=47268"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.infokuryr.cz\/n\/wp-json\/wp\/v2\/tags?post=47268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}