心肌损伤对新型冠状病毒肺炎患者临床预后的影响  

Prognostic value of myocardial injury in patients with COVID-19

作　　者：王朗[1] 何文博[1] 余小梅[1] 刘华芬[1] 周文杰[1] 江洪[1] Wang Lang;He Wenbo;Yu Xiaomei;Liu Huafen;Zhou Wenjie;Jiang Hong(Department of Cardiology,Renmin Hospital of Wuhan University,Hubei Province,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院心血管内科,430060

出　　处：《中华心血管病杂志》2020年第6期461-466,共6页Chinese Journal of Cardiology

摘　　要：目的分析心肌损伤对新型冠状病毒肺炎(COVID-19)患者临床预后的影响。方法回顾性分析2020年1月31日至2月5日在武汉大学人民医院入院确诊为COVID-19患者,根据入院5周后的临床转归,分为死亡组(33例)和生存组(169例),分析两组患者的人口统计学、合并症、入院生命体征和实验室检查结果。心肌损伤界定为血清超敏心肌肌钙蛋白I(hs-cTnI)水平>0.04μg/L。采用单因素和多因素Cox回归分析COVID-19患者临床预后的预测因素,采用Kaplan-Meier生存曲线比较心肌损伤和无心肌损伤患者的生存率。结果共纳入202例患者,年龄为63(51,70)岁,其中男性88例(43.6%),85例(42.1%)患者具有临床合并症,125例(61.9%)为重型/危重型患者。截至3月11日死亡33例,全部为危重型患者。死亡组患者年龄、男性及合并基础病比例、呼吸频率、入院时hs-cTnI水平以及心功能不全发生率均高于生存组(P均<0.05)。死亡组住院时间显著短于生存组[6(4,9)d比32(23,36)d,P<0.001]。多因素Cox回归分析显示,心肌损伤是COVID-19患者临床预后的重要预测因子(HR=5.382,95%CI 2.404~12.050,P<0.001)。Kaplan-Meier生存分析显示心肌损伤患者的生存率明显低于无心肌损伤患者(P<0.001)。结论心肌损伤是新型冠状病毒肺炎患者临床预后的重要预测因子,发生了心肌损伤的患者面临更高的死亡风险。Objective To analyze the prognostic value of myocardial injury in patients with COVID-19.Method Confirmed cases of COVID-19 patients admitted from January 31st to February 5th at isolation ward of Renmin Hospital of Wuhan University were divided into non-survival group(33 cases)and survival group(169 cases)according to the clinical outcomes 5 weeks after admission.Data including demographics,comorbidities,vital signs,laboratory results were obtained.Cardiac injury was defined as serum concentration of high sensitivity cardiac troponin I(hs-cTnI)above 0.04μg/L.Univariate and multivariate Cox regression were used to analyze the prognostic value of myocardial injury in patients with COVID-19.Kaplan-Meier analysis was used to plotted survival curve and analyze the impact of myocardial injury on the survival outcome of COVID-19 patients.Results A total of 202 patients were included,the age was 63(51,70)years old,88(43.6%)of them were male,85(42.1%)of them had comorbidities,125(61.9%)of them were severely to critically ill.Till March 11,33 patients died,all of them were critically ill patients.The age,proportion of males,comorbidities,respire rate,serum levels of hs-cTnI and incidence of heart failure in the non-survival group were significantly higher than those in the survival group(all P<0.05).The hospitalization time of non-survival group was significantly shorter than that of survival group(6(4,9)vs.32(23,36),P<0.001).Myocardial injury was an important prognostic factor of COVID-19(HR=5.382,95%CI 2.404-12.050,P<0.001).Kaplan-Meier survival analysis showed that the presence of myocardial injury was significantly associated with the reduced survival rate among COVID-19 patients(P<0.001).Conclusion Myocardial injury is an important prognostic factor of COVID-19,COVID-19 patients with myocardial injury face a significantly higher risk of death.

关 键 词：COX回归分析 肺炎患者 心功能不全 新型冠状病毒 危重型 死亡风险 临床转归 心肌损伤 

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