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Objective

To assess the global burden of myocarditis among individuals aged 15-49 years from 1990 to 2021 and to project disease trends up to 2050, providing a basis for prevention and control.

Methods

Based on the Global Burden of Disease (GBD) 2021 database, the assessment employed age-standardized rates, joinpoint regression, correlation analysis with the Socio-demographic Index (SDI), and a Bayesian prediction framework.

Results

In 2021, the global age-standardized prevalence rate (ASPR) of myocarditis in this population showed an upward trend, while the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate decreased significantly. The burden was higher among males. The highest ASPR was observed in high-SDI regions, and the most significant mortality risk was found in middle-high SDI regions. The number of cases is projected to potentially increase by 2050, although the standardized rates are expected to continue declining.

Conclusion

Targeted intervention strategies for high-risk populations and regions are necessary, along with improving medical standards in low-SDI areas and reducing health inequalities through global cooperation.

, authors=Chi YAN1, 3, Xue-fang LI1, Xia-yan ZANG1, Fei LIN1, 2, Guang-jian LU3, authorsList=Chi YAN, Xue-fang LI, Xia-yan ZANG, Fei LIN, Guang-jian LU, authorCompany=null, correspAuthors=Fei LIN, Guang-jian LU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324044663941898422, articleId=1324044662729744556, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=1990—2021年15至49岁中青年心肌炎的全球、区域及国家负担及其至2050年趋势预测, columnId=1228016573844226129, journalTitle=现代预防医学, columnName=疾病预防控制, runingTitle=null, highlight=null, articleAbstract=
目的

评估1990—2021年全球15~49岁中青年心肌炎的负担,并预测到2050年的疾病趋势,为防控提供依据。

方法

基于2021年全球疾病负担(GBD)数据库,采用年龄标准化率、连接点回归、社会经济指标(SDI)相关性分析及贝叶斯预测框架进行评估。

结果

2021年,全球15~49岁中青年心肌炎的年龄标准化患病率呈上升趋势,但年龄标准化发病率、年龄标准化死亡率和年龄标准化伤残调整寿命年率却出现了显著下降。男性负担更重。高SDI地区患病率最高,中高SDI地区死亡风险最显著。预测至2050年病例数可能增加,但标准化率将继续下降。

结论

需针对高危人群和地区制定干预策略,提升低SDI地区医疗水平,并通过全球合作减少健康不平等。

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燕驰(2000—),男,硕士在读,研究方向:心脏电生理、心律失常发病机制

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林飞与鲁广建为共同通信作者。林飞,E-mail:
鲁广建,E-mail:
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International Journal of Nursing Studies, 2025, 161: 104924., articleTitle=Educational programmes for improving medication adherence among older adults with coronary artery disease: A systematic review and meta-analysis, refAbstract=null)], funds=[Fund(id=1324044671013495023, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, awardId=252102311285, language=CN, fundingSource=河南省科技攻关项目(252102311285), fundOrder=null, country=null), Fund(id=1324044671109964016, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, awardId=25B360015, language=CN, fundingSource=河南省高等学校重点科研项目计划(25B360015), fundOrder=null, country=null), Fund(id=1324044671437119729, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, awardId=232102310425, language=CN, fundingSource=河南省重点研发与推广专项(232102310425), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1324044664172585143, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, xref=1., ext=[AuthorCompanyExt(id=1324044664185168056, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, companyId=1324044664172585143, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=The Life Science Research Center of the First Affiliated Hospital of Henan Medical University, Xinxiang, Henan 453100, China), AuthorCompanyExt(id=1324044664193556665, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, companyId=1324044664172585143, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.河南医药大学第一附属医院生命科学研究中心,河南 新乡 453100)]), AuthorCompany(id=1324044665766420668, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, xref=2., ext=[AuthorCompanyExt(id=1324044665795780797, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, companyId=1324044665766420668, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.河南医药大学第一附属医院中医科)]), AuthorCompany(id=1324044665929998526, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, xref=3., ext=[AuthorCompanyExt(id=1324044665938387135, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, companyId=1324044665929998526, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.河南医药大学第一附属医院检验科)])], figs=[ArticleFig(id=1324044667859378401, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=EN, label=Fig. 1, caption=Jointpoint regression analysis, figureFileSmall=ZiRNIVqwVMtrTfMylQHVEw==, figureFileBig=q6bnbIwf7WURRez9+CrfRQ==, tableContent=null), ArticleFig(id=1324044667943264482, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=CN, label=图1, caption=Joinpoint回归分析

注:A、B、C、D分别为ASPR、ASIR、ASMR、DALYs。

, figureFileSmall=ZiRNIVqwVMtrTfMylQHVEw==, figureFileBig=q6bnbIwf7WURRez9+CrfRQ==, tableContent=null), ArticleFig(id=1324044668157173987, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=EN, label=Fig. 2, caption=The correlation between myocarditis burden and SDI, figureFileSmall=enjwX+fi7kQ6p2weVGu1IQ==, figureFileBig=TMlCMpCi7WN1xXPFb4VYjA==, tableContent=null), ArticleFig(id=1324044668228477156, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=CN, label=图2, caption=心肌炎负担与SDI之间的相关性

注:A、B、C、D分别为ASPR、ASIR、ASMR、DALYs。

, figureFileSmall=enjwX+fi7kQ6p2weVGu1IQ==, figureFileBig=TMlCMpCi7WN1xXPFb4VYjA==, tableContent=null), ArticleFig(id=1324044668299780325, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=EN, label=Fig. 3, caption=Analysis of health inequality and frontier analysis of DALYs, figureFileSmall=mbeJ+LCztimtb8rolKZ5Sg==, figureFileBig=uy2At+EaWzhqOyTz4UFk1A==, tableContent=null), ArticleFig(id=1324044668429803750, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=CN, label=图3, caption=DALYs的健康不平等分析和前沿分析

注:A和B分别为DALYs健康不平等分析的SII和CII;C为DALYs的前沿分析。

, figureFileSmall=mbeJ+LCztimtb8rolKZ5Sg==, figureFileBig=uy2At+EaWzhqOyTz4UFk1A==, tableContent=null), ArticleFig(id=1324044668509495527, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=EN, label=Fig. 4, caption=Future prediction of myocarditis burden, figureFileSmall=L0H8qAtz7cHNZGyrlEFCOw==, figureFileBig=fXOm33WTMF5x+u7UFDLfBQ==, tableContent=null), ArticleFig(id=1324044668580798696, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=CN, label=图4, caption=心肌炎负担的未来预测

注:A、B、C、D分别为ASPR、ASIR、ASMR、DALYs。

, figureFileSmall=L0H8qAtz7cHNZGyrlEFCOw==, figureFileBig=fXOm33WTMF5x+u7UFDLfBQ==, tableContent=null), ArticleFig(id=1324044670250131691, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=EN, label=Table 1, caption=

The burden of myocarditis among the young and middle-aged population aged 15 to 49 in global and different SDI regions

, figureFileSmall=null, figureFileBig=null, tableContent=
分类ASPRASIR
2021年(1/10万,95%UI)EAPC(%/年,95%CI)2021年(1/10万,95%UI)EAPC(%/年,95%CI)
全球4.25(2.79~6.31)0.15(0.05~0.25)12.35(6.88~19.94)-0.18(-0.20~-0.16)
性别
男4.76(3.06~7.18)0.073(-0.010~0.157)14.97(8.48~24.14)-0.209(-0.229~-0.189)
女3.73(2.46~5.44)0.263(0.138~0.389)9.67(5.23~15.68)-0.132(-0.158~-0.106)
SDI
高SDI6.97(4.99~9.51)0.58(0.35~0.81)14.13(8.36~22.05)-0.19(-0.26~-0.11)
中高SDI4.75(3.16~6.89)0.48(0.33~0.63)12.41(6.96~19.89)-0.20(-0.22~-0.17)
中SDI4.15(2.67~6.21)0.34(0.26~0.41)12.28(6.79~19.91)-0.17(-0.20~-0.15)
中低SDI3.46(2.07~5.46)0.07(0.07~0.08)12.05(6.57~19.78)-0.02(-0.02~-0.02)
低SDI3.34(1.98~5.28)-0.09(-0.10~-0.08)11.70(6.34~19.23)-0.02(-0.02~-0.02)
全球0.14(0.11~0.18)-0.86(-1.13~-0.58)7.83(6.13~10.30)-0.86(-1.13~-0.58)
性别
男0.18(0.13~0.26)-0.778(-1.033~-0.523)10.00(7.18~14.45)-0.806(-1.060~-0.552)
女0.10(0.07~0.13)-0.976(-1.316~-0.634)5.61(4.24~7.28)-0.934(-1.266~-0.601)
SDI
高SDI0.14(0.13~0.15)-0.81(-1.32~-0.30)8.12(7.52~8.80)-0.76(-1.26~-0.25)
中高SDI0.19(0.14~0.22)-0.03(-0.34~0.29)10.42(8.04~12.50)-0.07(-0.39~0.25)
中SDI0.14(0.10~0.18)-1.17(-1.44~-0.89)8.22(5.70~10.41)-1.15(-1.41~-0.88)
中低SDI0.12(0.07~0.20)-0.73(-0.84~-0.61)6.50(4.06~10.89)-0.66(-0.78~-0.54)
低SDI0.11(0.05~0.24)-1.25(-1.34~-1.15)6.29(3.17~13.23)-1.18(-1.28~-1.09)
), ArticleFig(id=1324044670342406380, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=CN, label=表1, caption=

全球和不同SDI区域15至49岁中青年人群心肌炎的负担

, figureFileSmall=null, figureFileBig=null, tableContent=
分类ASPRASIR
2021年(1/10万,95%UI)EAPC(%/年,95%CI)2021年(1/10万,95%UI)EAPC(%/年,95%CI)
全球4.25(2.79~6.31)0.15(0.05~0.25)12.35(6.88~19.94)-0.18(-0.20~-0.16)
性别
男4.76(3.06~7.18)0.073(-0.010~0.157)14.97(8.48~24.14)-0.209(-0.229~-0.189)
女3.73(2.46~5.44)0.263(0.138~0.389)9.67(5.23~15.68)-0.132(-0.158~-0.106)
SDI
高SDI6.97(4.99~9.51)0.58(0.35~0.81)14.13(8.36~22.05)-0.19(-0.26~-0.11)
中高SDI4.75(3.16~6.89)0.48(0.33~0.63)12.41(6.96~19.89)-0.20(-0.22~-0.17)
中SDI4.15(2.67~6.21)0.34(0.26~0.41)12.28(6.79~19.91)-0.17(-0.20~-0.15)
中低SDI3.46(2.07~5.46)0.07(0.07~0.08)12.05(6.57~19.78)-0.02(-0.02~-0.02)
低SDI3.34(1.98~5.28)-0.09(-0.10~-0.08)11.70(6.34~19.23)-0.02(-0.02~-0.02)
全球0.14(0.11~0.18)-0.86(-1.13~-0.58)7.83(6.13~10.30)-0.86(-1.13~-0.58)
性别
男0.18(0.13~0.26)-0.778(-1.033~-0.523)10.00(7.18~14.45)-0.806(-1.060~-0.552)
女0.10(0.07~0.13)-0.976(-1.316~-0.634)5.61(4.24~7.28)-0.934(-1.266~-0.601)
SDI
高SDI0.14(0.13~0.15)-0.81(-1.32~-0.30)8.12(7.52~8.80)-0.76(-1.26~-0.25)
中高SDI0.19(0.14~0.22)-0.03(-0.34~0.29)10.42(8.04~12.50)-0.07(-0.39~0.25)
中SDI0.14(0.10~0.18)-1.17(-1.44~-0.89)8.22(5.70~10.41)-1.15(-1.41~-0.88)
中低SDI0.12(0.07~0.20)-0.73(-0.84~-0.61)6.50(4.06~10.89)-0.66(-0.78~-0.54)
低SDI0.11(0.05~0.24)-1.25(-1.34~-1.15)6.29(3.17~13.23)-1.18(-1.28~-1.09)
), ArticleFig(id=1324044670602453229, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324044662729744556, language=EN, label=Table 2, caption=

Joinpoint regression analysis of the slopes of each curve and the P-values

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指标分段APC(%/年,95%CI)AAPC(%/年,95%CI)
ASPR分段1-0.136(-0.236~-0.035)0.004(0.003~0.005)
分段21.004(0.957~1.050)
分段3-0.506(-0.552~-0.460)
分段4-0.132(-0.232~-0.031)
ASIR分段1-0.200(-0.207~-0.193)-0.018(-0.019~-0.018)
分段2-0.534(-0.633~-0.434)
分段3-0.032(-0.065~0.002)
分段40.137(0.103~0.171)
ASMR分段11.205(1.018~1.393)-0.001(-0.001~-0.001)
分段20.114(-0.416~0.648)
分段3-2.336(-2.589~-2.083)
分段4-1.764(-1.977~-1.550)
DALYs分段11.129(0.942~1.317)-0.063(-0.067~-0.059)
分段20.181(-0.351~0.716)
分段3-2.304(-2.558~-2.050)
分段4-1.800(-2.013~-1.586)
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Joinpoint回归分析各曲线斜率

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指标分段APC(%/年,95%CI)AAPC(%/年,95%CI)
ASPR分段1-0.136(-0.236~-0.035)0.004(0.003~0.005)
分段21.004(0.957~1.050)
分段3-0.506(-0.552~-0.460)
分段4-0.132(-0.232~-0.031)
ASIR分段1-0.200(-0.207~-0.193)-0.018(-0.019~-0.018)
分段2-0.534(-0.633~-0.434)
分段3-0.032(-0.065~0.002)
分段40.137(0.103~0.171)
ASMR分段11.205(1.018~1.393)-0.001(-0.001~-0.001)
分段20.114(-0.416~0.648)
分段3-2.336(-2.589~-2.083)
分段4-1.764(-1.977~-1.550)
DALYs分段11.129(0.942~1.317)-0.063(-0.067~-0.059)
分段20.181(-0.351~0.716)
分段3-2.304(-2.558~-2.050)
分段4-1.800(-2.013~-1.586)
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1990—2021年15至49岁中青年心肌炎的全球、区域及国家负担及其至2050年趋势预测
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燕驰 1, 3 , 李雪芳 1 , 臧夏炎 1 , 林飞 1, 2 , 鲁广建 3
现代预防医学 | 疾病预防控制 2026,53(8): 1501-1507
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现代预防医学 |疾病预防控制 2026 , 53 (8) : 1501 -1507
1990—2021年15至49岁中青年心肌炎的全球、区域及国家负担及其至2050年趋势预测
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燕驰(2000—),男,硕士在读,研究方向:心脏电生理、心律失常发病机制

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燕驰1, 3, 李雪芳1, 臧夏炎1, 林飞1, 2 , 鲁广建3
作者信息
  • 1.河南医药大学第一附属医院生命科学研究中心,河南 新乡 453100
  • 2.河南医药大学第一附属医院中医科
  • 3.河南医药大学第一附属医院检验科
通讯作者:
林飞与鲁广建为共同通信作者。林飞,E-mail:
鲁广建,E-mail:
作者简介:

燕驰(2000—),男,硕士在读,研究方向:心脏电生理、心律失常发病机制

Global, regional and national burden of myocarditis in young and middle-aged people aged 15-49 years from 1990 to 2021 and trend prediction by 2050
Chi YAN1, 3, Xue-fang LI1, Xia-yan ZANG1, Fei LIN1, 2 , Guang-jian LU3
Affiliations
  • The Life Science Research Center of the First Affiliated Hospital of Henan Medical University, Xinxiang, Henan 453100, China
出版时间: 2026-04-25 doi: 10.20043/j.cnki.MPM.202511224
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目的

评估1990—2021年全球15~49岁中青年心肌炎的负担,并预测到2050年的疾病趋势,为防控提供依据。

方法

基于2021年全球疾病负担(GBD)数据库,采用年龄标准化率、连接点回归、社会经济指标(SDI)相关性分析及贝叶斯预测框架进行评估。

结果

2021年,全球15~49岁中青年心肌炎的年龄标准化患病率呈上升趋势,但年龄标准化发病率、年龄标准化死亡率和年龄标准化伤残调整寿命年率却出现了显著下降。男性负担更重。高SDI地区患病率最高,中高SDI地区死亡风险最显著。预测至2050年病例数可能增加,但标准化率将继续下降。

结论

需针对高危人群和地区制定干预策略,提升低SDI地区医疗水平,并通过全球合作减少健康不平等。

心肌炎  /  中青年  /  疾病负担
Objective

To assess the global burden of myocarditis among individuals aged 15-49 years from 1990 to 2021 and to project disease trends up to 2050, providing a basis for prevention and control.

Methods

Based on the Global Burden of Disease (GBD) 2021 database, the assessment employed age-standardized rates, joinpoint regression, correlation analysis with the Socio-demographic Index (SDI), and a Bayesian prediction framework.

Results

In 2021, the global age-standardized prevalence rate (ASPR) of myocarditis in this population showed an upward trend, while the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate decreased significantly. The burden was higher among males. The highest ASPR was observed in high-SDI regions, and the most significant mortality risk was found in middle-high SDI regions. The number of cases is projected to potentially increase by 2050, although the standardized rates are expected to continue declining.

Conclusion

Targeted intervention strategies for high-risk populations and regions are necessary, along with improving medical standards in low-SDI areas and reducing health inequalities through global cooperation.

Myocarditis  /  Young and middle-aged people  /  Disease burden
燕驰, 李雪芳, 臧夏炎, 林飞, 鲁广建. 1990—2021年15至49岁中青年心肌炎的全球、区域及国家负担及其至2050年趋势预测. 现代预防医学, 2026 , 53 (8) : 1501 -1507 . DOI: 10.20043/j.cnki.MPM.202511224
Chi YAN, Xue-fang LI, Xia-yan ZANG, Fei LIN, Guang-jian LU. Global, regional and national burden of myocarditis in young and middle-aged people aged 15-49 years from 1990 to 2021 and trend prediction by 2050[J]. Modern Preventive Medicine, 2026 , 53 (8) : 1501 -1507 . DOI: 10.20043/j.cnki.MPM.202511224
心肌炎是全球性的健康挑战,是中青年猝死和严重心脏疾病的主要原因之一[1],心肌炎还会引发心律失常和心力衰竭等严重的心脏疾病[2-3]。其病因除病毒、自身免疫等传统因素外[2],社会经济发展水平作为潜在的影响因素日益受到关注。一项前瞻性队列研究表明与高社会经济地位的人群相比,低经济社会地位的人群患心血管疾病的风险更高[4],同时,社会经济发展水平较高的地区心肌炎病因以病毒感染为主,而在社会经济发展水平较低的地区,心肌炎的病因可能更复杂,并且除病毒外,风湿性心脏病、克氏锥虫感染等病因占据相当比例[5]。这种差异提示社会经济因素可能通过影响医疗可及性及病因暴露在心肌炎的流行病学特征中扮演着重要角色。此外,在接种新型冠状病毒肺炎疫苗后,与接种疫苗相关的中青年心肌炎病例数量有所增加[6]进一步凸显了针对该人群研究的紧迫性。
最近研究显示,2021年全球心肌炎发病率和死亡率较1990年下降[7]。虽然已有研究对全人群心肌炎负担进行了分析,但针对15~49岁中青年这一特定群体的系统性评估仍较为缺乏。该年龄段不仅是社会经济发展的中坚力量,也是心肌炎导致猝死和长期残疾的高风险人群。因此,本研究基于全球疾病负担(GBD)2021数据,旨在系统评估1990年至2021年期间15至49岁中青年的心肌炎负担,并预测至2050年的趋势,为针对中青年人群实施预防措施和及时临床干预提供基于证据的策略指导。
数据来源于GBD 2021数据库,涵盖1990至2021年全球204个国家和地区371种疾病的流行病学资料[8]。提取15~49岁人群心肌炎数据,病例定义基于临床诊断综合判断[9]。同时纳入社会人口指数(SDI)以分析疾病负担差异。SDI根据人均收入、教育水平和生育率计算,SDI的排名范围从0(最低发展水平)到1(最高发展水平),并根据其五等分被分为低SDI(<0.466)、低中SDI(≥0.466且<0.619)、中SDI(≥0.619且<0.720)、高中SDI(≥0.720且<0.810)和高SDI(≥0.810)。
研究采用年龄标准化患病率(Age-Standardized Prevalence Rate,ASPR)、年龄标准化发病率(Age-Standardized Incidence Rate,ASIR)、年龄标准化死亡率(Age-Standardized Mortality Rate,ASMR)、以及年龄标准化伤残调整寿命年率(Disability-Adjusted Life Years,DALYs)四大核心年龄标准化指标系统评估疾病心肌炎的疾病负担。所有输出值均带有95%的不确定性区间(Uncertainty Interval,UI)
采用估计年度百分比变化(Annual Percent Change Estimation,EAPC)通过对数线性回归计算出带有95%置信区间(Confidence Interval,CI)的EAPC,EAPC的计算公式为EAPC=[exp(β)-1]×100%,EAPC及其95%CI上限为负,表明呈下降趋势;EAPC及其95%CI下限为正,表明呈上升趋势;若95%CI包含0,则视为趋势稳定,即变化不显著。采用Joinpoint回归模型计算年度百分比变化(Annual Percentage Change,APC)、平均年度百分比变化(Average Annual Percentage Change,AAPC)以及相应的置信区间,该分析使用美国国家癌症研究所提供的Joinpoint Regression Program(版本4.9.1.0)完成,且趋势的统计学意义判断标准与EAPC相同。模型选择基于网格搜索法,并通过贝叶斯信息准则(BIC)确定最佳连接点数量及位置,最终选择具有最小BIC值的模型。使用斜率不平等指数(Slope Index of Inequality,SII)和集中度指数(Concentration Index of Inequality,CII)分析健康不平等。基于贝叶斯年龄—时期—队列(BAPC)框架预测2022—2050年的发病趋势,所有分析均使用R软件完成,检验水准α=0.05。
2021年,全球15~49岁人群心肌炎的ASPR、ASIR、ASMR和DALYs见表1。1990—2021年间,全球的ASPR呈上升趋势(EAPC=0.15),而ASIR(EAPC=-0.18)、ASMR(EAPC=-0.86)和DALYs(EAPC=-0.86)均下降;男性的ASPR、ASIR、ASMR和DALYs均高于女性。
在5个SDI区域中,2021年高SDI区域的ASPR(6.9/10万)和ASIR(14.13/10万)最高,而中高SDI区域的ASMR(0.19/10万)和DALYs(10.42/10万)最高。低SDI区域的各项指标均为最低。在时间趋势上,除低SDI区域的ASPR有所下降(EAPC=-0.09)外,多数SDI区域ASPR呈上升趋势,以高SDI区域增最大(EAPC=0.58)。所有区域的ASIR均下降,中高SDI区域降幅较显著(EAPC=-0.20)。除中高SDI区域的ASMR与DALYs变化不显著外,其他区域均呈下降趋势,其中低SDI区域降幅最大(ASMR EAPC=-1.25,DALYs EAPC=-1.18)(表1)。
Joinpoint回归分析发现,ASPR呈上升趋势(AAPC=0.004),而ASIR(AAPC=-0.018)、ASMR(AAPC=-0.001)和DALYs(AAPC=-0.063)均呈下降趋势(图1,表2)。ASPR在1996、2005和2015年出现显著转折点,于2005年达峰值后转为下降(图1A)。ASIR在2006、2009和2015年出现转折点,自1990年起总体下降,其中2009—2015年下降趋缓,但该趋势在统计学上不显著(CI包含0),2015年后略有回升(图1B)。ASMR与DALYs变化趋势相似,转折点出现在2000、2005和2013年,2000—2005年间波动无统计学意义(CI包含0),2005年后持续下降(图1C、D)。各曲线斜率详见表2。
在全球204个国家和地区中,ASPR与ASIR随SDI升高而逐渐上升(图2A,B)。ASMR与DALYs随SDI升高呈现先升后降的趋势,在SDI约0.75时达到峰值,随后转为下降(图2C,D)。
健康不平等分析显示,DALYs与SDI之间存在绝对与相对不平等,但均不显著。1990至2021年间,最高与最低SDI国家间的DALYs绝对差异由-1.41(95%UI:-3.52~0.70)/10万增至0.73(95%UI:-1.14~2.59)/10万(图3A)。相对不平等指数显示DALYs由1990年的0.03(95%CI:-0.04~0.11)升至2021年的0.06(95%CI:-0.01~0.12)(图3B)。前沿分析表明15个国家的现状距最佳疾病负担前沿差距最大,其潜在改善幅度在17.12至81.70之间(图3C)。
预计2022至2050年间,ASPR预计呈上升趋势,ASIR、ASMR、DALYs均预计下降。具体而言,预计至2025年,ASPR将升至4.37/10万,ASIR、ASMR与DALYs则分别降至11.62/10万、0.08/10万和4.81/10万。至2050年,预计患者将达194 774.24例,新发病例518 582.42例,死亡3 561.19例,DALYs将达214 752.92年(图4)。
本研究基于GBD 2021数据,首次系统评估了全球15~49岁中青年心肌炎的疾病负担。结果显示,1990至2021年间,该人群ASPR上升,而ASIR、ASMR和DALYs下降。负担分布存在显著不平等,男性及45~49岁人群负担更重;高SDI地区患病率最高,而中高SDI地区死亡风险最突出。连接点回归分析进一步揭示了各项指标在不同时期的具体转折变化。其中ASPR的上升归因于诊断技术的进步和主动监测加强,使以往难以确诊的心肌炎病例得以发现[10],这在医疗发达国家的表现尤为明显[11]。此外,新型冠状病毒疫苗接种后相关心肌炎报告病例的增加也是极其重要的影响因素[12]。而ASIR、ASMR与DALYs的下降正是反映了全球在心肌炎防控方面取得的成效[13]。值得注意的是,低SDI地区的“低负担”可能受限于诊断能力和监测体系,存在漏报[14]。
疾病负担存在显著的性别差异,男性负担普遍高于女性。这种性别差异与生理(睾酮可能通过增强促炎因子表达而加重心肌损伤[15],而雌激素具有抗炎保护作用[16])、职业暴露以及生活方式等因素密切相关[17],强调了针对特定人口学特征群体制定精准预防策略的必要性。此外,本研究发现ASMR与DALYs在中高SDI区域(SDI约0.75)达到峰值,这揭示了一个关键防控窗口期,在这些地区,诊断能力已有相当提升,能够发现更多病例,但治疗体系与长期随访管理可能尚未完善,导致病例发现增加但预后改善不足,从而出现较高的死亡率负担。相比之下,高SDI地区尽管患病率最高,但由于更完善的医疗体系,死亡率负担相对较低。
健康不平等分析显示,1990至2021年间,不同SDI水平国家间的DALYs绝对差异和相对不平等均有所增加,尽管未达到统计学显著水平。这一趋势提示全球范围内心肌炎疾病负担的分布不均问题仍需关注。前沿分析进一步识别出疾病负担与最优水平差距最大的国家和地区,为资源优先配置提供了科学依据。基于贝叶斯年龄-时期-队列框架的预测显示,至2050年,中青年心肌炎患者绝对数量预计将继续增长,但各项年龄标准化率预计保持下降趋势。这一方面反映了人口增长和结构变化对疾病绝对负担的影响,肯定了当前防控措施的方向有效性,为未来防控策略的制定提供了信心。
基于1990—2021年的GBD数据及至2050年的预测,本研究系统揭示了全球15~49岁中青年人群心肌炎的疾病负担,其呈现患病率上升,而发病率、死亡率及健康损失率下降的总体趋势,存在显著的性别和地区差异。基于以上发现,未来应实施差异化精准防控。针对疾病负担更重的男性人群,需加强筛查与健康教育,且研究表明系统的指导教育能显著提高依从性[18-19]。其次,在区域策略上,中高SDI地区重点是建设诊疗中心以改善临床预后;而高SDI地区应优化长期管理;低SDI地区则需提升基层诊断能力。未来的研究应着重提高数据质量,构建更全面的预测模型,为心肌炎的精准防控提供更有力的科学依据。
  • 河南省科技攻关项目(252102311285)
  • 河南省高等学校重点科研项目计划(25B360015)
  • 河南省重点研发与推广专项(232102310425)
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2026年第53卷第8期
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doi: 10.20043/j.cnki.MPM.202511224
  • 接收时间:2025-11-14
  • 首发时间:2026-11-02
  • 出版时间:2026-04-25
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  • 收稿日期:2025-11-14
基金
河南省科技攻关项目(252102311285)
河南省高等学校重点科研项目计划(25B360015)
河南省重点研发与推广专项(232102310425)
作者信息
    1.河南医药大学第一附属医院生命科学研究中心,河南 新乡 453100
    2.河南医药大学第一附属医院中医科
    3.河南医药大学第一附属医院检验科

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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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