新型冠状病毒肺炎患者心肌损伤的临床分析  

Clinical analysis of the myocardial injury of coronavirus disease 2019

作　　者：汪成[1] 黎笔熙 李波 李福祥 王加利[1] Wang Cheng;Li Bixi;Li Bo;Li Fuxiang;Wang Jiali(Department of Cardiovascular Surgery,General Hospital of Chinese People Liberation Army,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心心血管外科,北京100853 [2]解放军中部战区总医院,武汉430010 [3]解放军西部战区总医院,成都610083

出　　处：《中国体外循环杂志》2020年第3期171-174,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的研究分析新型冠状病毒肺炎(COVID-19)患者是否有病毒直接攻击心肌引起损伤,为COVID-19患者的诊治和预防提供依据。方法收集2020年2月12日至2020年3月14日间,从解放军中部战区总医院感染科出院的227例COVID-19确诊患者的入院临床资料和心脏相关实验室检查结果,并进行回顾性分析。结果 19.4%患者肌红蛋白(MB)异常,7.5%患者有肌钙蛋白(cTn)异常升高,4.8%患者有肌酸激酶同工酶(CKMB)异常,5.7%患者有脑钠肽(BNP)异常升高;患者平均年龄为55岁(17~88岁),其中75岁以上的患者占比13.2%,60~75岁占比29.5%,60岁以下占比57.3%,且75岁以上患者心肌标志物异常较其他两组多,有明显统计学意义(P<0.05);不同的临床分型中,"危重型组"较"轻型及普通型组"心肌标志物明显升高,有明显统计学意义(P<0.05);院前时间≥14 d患者的心肌标志物明显高于<14 d者,有明显统计学意义(P<0.05);有合并症患者的心肌标志物明显高于无合并症者,有明显统计学意义(P<0.05)。结论 COVID-19患者发生严重心肌损伤的情况不多,新型冠状病毒直接攻击心肌导致损伤的可能性较小。但有合并症的老年患者,如不及时就诊,可能会因原发病导致的缺氧而影响心肌,导致预后不佳。Objective To analyse the relationship between coronavirus disease 2019(COVID-19)and viral myocardial injury to improve the prevention and treatment.Methods A total of 227 patients with COVID-19 were enrolled in this study,who were dis⁃charged from our unit from February 12 to March 14,2020.The collected information including clinical data and biomakers of myocar⁃dial injury on admission were analysed retrospectively.Results There were 19.4%of patients with abnormally elevated myoglobin,7.5%with abnomally elevated troponin,4.8%with abnomally elevated CKMB and 5.7%with abnomally elevated BNP.The average age was 55 years(17 to 88 years),of which 13.2%were over 75 years old and 29.5%were between 60-75 years old.Compared with oth⁃ers,patients over 75 years old had obviously abnomal biomakers of myocardial injury,and the difference was statistically significant(P<0.05).Among different clinical classifications,biomakers of the severe patients increased more than those of the mild and moder⁃ate patients,and the difference was statistically significant(P<0.05).Patients with pre-hosital time of longer than 14 days had higher abnomal biomakers of myocardial injury than the others,and the difference was statistically significant(P<0.05).Patients with cardi⁃ac complications had higher abnomal biomakers of myocardial injury than the others,and the difference was statistically significant(P<0.05).Conclusion COVID-19 patients with severe myocardial injury are rare.SARS-CoV-2 infections are less likely to directly attack the myocardium.Aged patients with complications and delayed hospitalization are inclined to have myocadial injury due to hypox⁃ia resulting from aggravated primary disease,and the prognosis is poor.

关 键 词：新型冠状病毒肺炎 心肌损伤 心肌标志物 

分 类 号：R563.1[医药卫生—呼吸系统] R542.2[医药卫生—内科学]