低氧状态及炎症反应是新型冠状病毒肺炎患者发生急性心肌损伤的危险因素  

Hypoxia and inflammation are risk factors for acute myocardial injury in patients with coronavirus disease 2019

作　　者：杨林承[1] 张瑞涛[1] 郭丽君[1] 肖晗[1] 祖凌云[1] 张幼怡[1] 程秦 赵志伶[3] 葛庆岗[3] 高炜[1] YANG Lin-cheng;ZHANG Rui-tao;GUO Li-jun;XIAO Han;ZU Ling-yun;ZHANG You-yi;CHENG Qin;ZHAO Zhi-ling;GE Qing-gang;GAO Wei(Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital & NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides & Key Laboratory of Molecular Cardiovascular Science, Ministry of Education & Beijing Key Laboratory of Cardiovascular Receptors Research, Beijing 100191, China;Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China;Department of Intensive Care Medicine, Peking University Third Hospital, Beijing 100191, China)

机构地区：[1]北京大学第三医院心内科,国家卫生健康委员会心血管分子生物学与调节肽重点实验室,分子心血管学教育部重点实验室,心血管受体研究北京市重点实验室,北京100191 [2]北京大学第三医院呼吸与危重医学科,北京100191 [3]北京大学第三医院危重医学科,北京100191

出　　处：《北京大学学报（医学版）》2021年第1期159-166,共8页Journal of Peking University:Health Sciences

基　　金：北京大学第一医院;北京大学人民医院;华中科技大学同济医学院附属同济医院

摘　　要：目的:寻找新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者发生急性心肌损伤的危险因素。方法:本研究为单中心COVID-19住院患者的回顾性队列研究,共纳入149例COVID-19确诊患者,依据2018年欧洲心脏病学会年会发布的第四版心肌梗死全球统一定义中关于心肌损伤的诊断标准,将患者分为心肌损伤组(19例)及非心肌损伤组(130例)。收集全部入组患者的临床信息及实验室化验结果,并分析COVID-19患者发生急性心肌损伤的危险因素。结果:与非心肌损伤组患者相比,心肌损伤组患者年龄更大,危重症患者比例更高(P<0.05),入院时呼吸频率更快,未吸氧状态外周血氧饱和度(percutaneous oxygen saturation,SpO2)偏低(P<0.05)。心肌损伤组患者除肿瘤坏死因子α(tumor necrosis factorα,TNF-α)外,其余炎症因子水平均高于非心肌损伤组(P<0.05)。多因素Logistic回归分析发现,入院时未吸氧状态SpO2水平偏低(OR=0.860,95%CI:0.779~0.949,P=0.003)及血白细胞介素-6(interleukin-6,IL-6)水平升高(OR=1.068,95%CI:1.019~1.120,P=0.006)为COVID-19患者发生急性心肌损伤的独立危险因素。结论:低氧状态及炎症在COVID-19患者发生急性心肌损伤的病理生理过程中起到了重要作用。Objective:To investigate the risk factors for acute myocardial injury in coronavirus disease 2019(COVID-19)patients.Methods:This is a retrospective analysis of a COVID-19 cohort,in which 149 confirmed COVID-19 patients enrolled were divided into the group of myocardial injury(19 cases)and the group of non-myocardial injury(130 cases).Myocardial injury was defined according to Fourth universal definition of myocardial infarction released by European Society of Cardiology(ESC)in 2018,that cardiac troponin(cTn)was above 99th percentile of the reference level.Clinical information and results of laboratory tests of the eligible patients were collected.Factors associated with myocardial injury in COVID-19 patients were evaluated.Results:Compared with the group of non-injury,the patients in the group of injury were older and had a larger proportion of severe or critical cases(P<0.05),higher respiratory rate and lower percutaneous oxygen saturation(SpO2)without oxygen therapy on admission(P<0.05).All inflammatory indexes except for tumor necrosis factorα(TNF-α)showed significant elevation in the patients of the group of injury(P<0.05).Analyzed by Spearman correlation test,we showed that the levels of circulatory cTnI were in positive correlation with the levels of high-sensitivity C-reactive protein(hs-CRP),ferritin,receptor of interleukin-2(IL-2R),interleukin-6(IL-6)and interleukin-8(IL-8)(ρ>0,P<0.05).Lower SpO2 without oxygen therapy on admission(OR:0.860,95%CI:0.779-0.949,P=0.003)and higher plasma IL-6 levels(OR:1.068,95%CI:1.019-1.120,P=0.006)were independent risk factors for acute myocardial injury in the patients with COVID-19 by multivariate Logistic regression analyses.Conclusion:Hypoxic state and inflammation may play a key role in the pathogenesis of acute myocardial injury in COVID-19 patients.

关 键 词：β冠状病毒 急性心肌损伤 白细胞介素-6 炎症 

分 类 号：R542.2[医药卫生—心血管疾病]