重型/危重型新型冠状病毒肺炎患者合并心肌损伤对预后的影响  

Impact of complicated myocardial injury on the clinical outcome of severe or critically ill COVID-19 patients

作　　者：贺行巍 赖金胜 程佳 王孟文 刘玉建 肖志超 徐昶 李树生[2] 曾和松[1] He Xingwei;Lai Jinsheng;Cheng Jia;Wang Mengwen;Liu Yujian;Xiao Zhichao;Xu Chang;Li Shusheng;Zeng Hesong(Department of Cardiology,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Emergency,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心内科,武汉430030 [2]华中科技大学同济医学院附属同济医院急诊科,武汉430030

出　　处：《中华心血管病杂志》2020年第6期456-460,共5页Chinese Journal of Cardiology

摘　　要：目的分析重型/危重型新型冠状病毒肺炎(COVID-19)的临床特征,评估合并心肌损伤对患者预后的影响。方法回顾性分析2020年2月3日至24日于华中科技大学同济医学院附属同济医院中法新城院区收治的54例重型/危重型COVID-19确诊病例,年龄68.0(59.8,74.3)岁,男34例(63.0%),分析其临床特征。并根据是否合并心肌损伤(高敏心肌肌钙蛋白>正常上限3倍以上,并排除急性心肌梗死、心功能不全失代偿、慢性肾功能衰竭)将患者分为合并心肌损伤组和未合并心肌损伤组,比较两组患者临床特征的差异。结果所有患者中合并高血压24例(44.4%),糖尿病13例(24.1%),冠心病8例(14.8%),既往脑梗死3例(5.6%)。住院期间合并心肌损伤24例(44.4%),院内死亡26例(48.1%)。按有无心肌损伤将患者分为合并心肌损伤组(24例)和未合并心肌损伤组(30例)。两组在年龄、性别、合并症等方面差异均无统计学意义(P均<0.05)。但心肌损伤组患者,院内死亡率明显高于未合并心肌损伤组[75.0%(18/24)比26.7%(8/30),P=0.001]。同时心肌损伤组的C反应蛋白[153.6(80.3,240.7)ng/L比49.8(15.9,101.9)ng/L]和氨基末端B型利钠肽原[852.0(400.0,2315.3)ng/L比197.0(115.3,631.0)ng/L]水平也明显高于未合并心肌损伤组(P均<0.01)。结论重型/危重型COVID-19多为老年患者,合并症多,发生心肌损伤的比例高。合并心肌损伤的患者具有更高的院内死亡率。因此,应加强住院期间心肌损伤标志物和心功能的监测,重视合并心肌损伤的治疗。Objective To analyze the clinical characteristics of the severe or critically ill patients with novel coronavirus pneumonia(COVID-19),and evaluate the impact of complicated myocardial injury on the prognosis of these patients.Methods A retrospective study was conducted in 54 patients who admitted to Tongji hospital from February 3,2020 to February 24,2020 and met the criteria of severe or critical conditions of COVID-19.The clinical characteristics and hospital mortality rate were analyzed and compared between the patients with or without myocardial injury,which was defined with 3 times higher serum cardiac troponin value.Results The age of the 54 patients was 68.0(59.8,74.3)years.Among all the patients,24(44.4%)patients were complicated with hypertension,13(24.1%)with diabetes,8(14.8%)with coronary heart disease,and 3(5.6%)with previous cerebral infarction.During hospitalization,24(44.4%)of the patients were complicated with myocardial injury and 26(48.1%)patients died in hospital.In-hospital mortality was significantly higher in patients with myocardial injury than in patients without myocardial injury(14(60.9%)vs.8(25.8%),P=0.013).Moreover,the levels of C-reactive protein(153.6(80.3,240.7)ng/L vs.49.8(15.9,101.9)ng/L)and N-terminal pro-B-type natriuretic peptide(852.0(400.0,2315.3)ng/L vs.197.0(115.3,631.0)ng/L)were significantly higher than patients without myocardial injury(all P<0.01).Conclusions Prevalence of myocardial injury is high among severe or critically ill COVID-19 patients.Severe or critically ill COVID-19 patients with myocardial injury face a significantly higher risk of in-hospital mortality.The study suggests that it is important to monitor and manage the myocardial injury during hospitalization for severe or critically ill COVID-19 patients.

关 键 词：新型冠状病毒肺炎 心肌损伤 肌钙蛋白 

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