原來心真會“碎”，心碎綜合徵是種什麼病？

當一個人感到傷心時，通常會說"我的心都碎了"。雖然這只是一種比喻，人的心臟並不會因爲悲傷的情緒碎裂成片，但是卻可能出現“心碎綜合徵”。

心碎綜合徵是指人在經歷重大外部事件打擊時，會產生極其哀傷、悲痛或憤怒的心理，同時出現了類似於心臟疾病的症狀，比如會有胸痛、憋氣、呼吸急促等症狀表現。

The syndrome, formally known as takotsubo cardiomyopathy, is characterized by weakening of the heart’s main pumping chamber and was first identified in 1990 in Japan. It looks and sounds like a heart attack and is consequently often confused for one.

心碎綜合徵學名爲takotsubo心肌病，最早於1990年在日本被發現，其特徵是心臟的主泵區功能減弱。症狀與心臟病相似，因此經常被混淆。

Affecting an estimated 2,500 people in the UK each year, the syndrome also carries a risk of complications similar to that of an actual heart attack. It is unclear what causes takotsubo, but sharp spikes in adrenaline caused by acute stress like bereavement, car accidents, earthquakes and even happy events such as weddings are understood to drive loss of movement in part of the heart wall, which then precipitates the acute heart failure.

據估算，英國每年有2500人患上心碎綜合徵，這種綜合徵還可能引發與心臟病併發症類似的病症。目前尚不清楚是什麼導致了心碎綜合徵，但據瞭解，喪親之痛、車禍、地震甚至婚禮等喜事急性應激引起的腎上腺素急劇飆升，會導致部分心壁運動喪失，進而誘發急性心衰。

Notes:

adrenaline [əˈdrenəlɪn] 腎上腺素

bereavement [bɪˈriːvmənt] 喪親之痛

Photo by Monstera from Pexels

近日，英國《衛報》報道稱，研究發現兩種與高應激水平相關的分子與心碎綜合徵的發生有關。

Two molecules – called microRNA-16 and microRNA-26a — that are linked to depression, anxiety and increased stress levels had previously been detected in the blood of takotsubo patients. Researchers assessed the impact of exposing cells from human hearts (taken from organs that were unsuitable for transplants) and rat hearts to the two molecules.

此前在心碎綜合徵患者的血液中檢測到兩種名爲微小核糖核酸-16和微小核糖核酸-26a的分子，這兩種分子與抑鬱、焦慮和壓力水平升高有關。研究人員評估了將人類心臟（取自不適合移植的器官）和大鼠心臟的細胞暴露於這兩種分子的影響。

Afterwards, both sets of heart cells were more sensitive to adrenaline, they wrote in the journal Cardiovascular Research.

他們在《心血管研究》雜誌發表的文章中稱，隨後發現，這兩組心臟細胞對腎上腺素更敏感。

In patients with takotsubo, the bottom of the heart stops beating, and the top of the heart beats more, said the lead study author, Dr Liam Couch from Imperial College London. “Basically, we found the exact same thing happens when we increase the exposure to the molecules [in an experimental setting]. It reproduced exactly what happens in takotsubo, so it made it more likely for the takotsubo to occur.”

該研究的主要作者、倫敦帝國理工學院的利亞姆·考奇博士稱，心碎綜合徵患者的心臟底部停止跳動，頂部跳動更多。“基本上，我們發現（在實驗環境中）當我們增加心臟對這兩種分子的暴露時，會發生完全相同的情況。它準確地再現了心碎綜合徵發生的情況，因此使心碎綜合徵發生的可能性更大。”

Overall, the findings appeared to link long-term stress and the dramatic takotsubo response to a sudden shock.

總的來說，研究結果似乎顯示了長期的壓力與因意外打擊引發的突發性心碎綜合徵之間的關聯。

However, the problem is that it is not possible, for now, to diagnose takotsubo in patients before it happens, making it difficult to test whether these molecules are elevated in real-life cases, Couch explained.

然而，考奇解釋稱，問題是，目前還不能在心碎綜合徵發生之前對患者進行診斷，這使得在現實中很難檢測這些分子是否升高。

“But if we know someone’s had takotsubo, theoretically we can measure these molecules, and then predict if they’re likely to have it again, because there’s a one in five chance that they could have it again,” he said.

他說：“但如果我們知道有人患上心碎綜合徵，理論上我們可以檢測這些分子，然後預測他們是否可能再次發病，因爲他們有五分之一的可能再次發病。”

Joel Rose, chief executive of the charity Cardiomyopathy UK, said the study provided important insights on a less well known and poorly understood form of cardiomyopathy. “It has the potential to improve our understanding of who may be more susceptible to developing the condition and subsequent improve our ability to manage its impact,” he said.

慈善機構“英國心肌病（Cardiomyopathy UK）”首席執行官喬爾·羅斯稱，這項研究對一種鮮爲人知、缺乏瞭解的心肌病提供了重要見解，有可能提高我們對這種疾病易見於哪些人羣的認識，進而增強我們控制其影響的能力。”

Further research is needed, said Prof Metin Avkiran, the associate medical director at the British Heart Foundation, to “determine if drugs that block these microRNAs could be the key to avoiding broken hearts”.

英國心臟基金會醫學副主任梅廷•阿夫基蘭教授表示，還需要進一步的研究，以“確定阻斷這些微小核糖核酸分子的藥物是否是避免心碎綜合徵的關鍵”。