心肌损伤对新型冠状病毒肺炎危重型患者预后的影响及其原因分析  

Outcomes and risk factors for critically ill COVID- 19 patients with myocardial injury

作　　者：汪璐芸 陈鹏[1] 余波[1] 李陈泽 周宁[1] 汪道文[1] WANG Lu-yun;CHEN Peng;YU Bo;LI Chen-ze;ZHOU Ning;WANG Dao-wen(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院,武汉430030

出　　处：《内科急危重症杂志》2020年第6期446-451,共6页Journal of Critical Care In Internal Medicine

基　　金：国家自然科学基金青年项目(No:81600236);国家自然科学基金面上项目(No:81570261,No:81630010)。

摘　　要：目的:探讨心肌损伤对新型冠状病毒肺炎(COVID-19)危重型患者预后的影响并分析其原因。方法:回顾性分析2787例COVID-19重症、危重症患者的临床资料。结果:2787例患者中,危重型患者392例,其中死亡236例(8.47%)。死亡患者中,78.81%的患者在入院时心肌损伤标志物血清心肌高敏肌钙蛋白(hs-cTnI)水平升高。根据入院时血清hs-cTnI水平分为hs-cTnI升高组(>34.2 pg/mL)210例,hs-cTnI正常组(≤34.2 pg/mL)182例。血清hs-cTnI升高组患者机械通气治疗的构成比更高(92.86%vs 64.29%,P<0.01)。血清hs-cTnI升高组14 d和30 d院内病死率明显高于正常组(65.71%vs 26.37%;84.28%vs 32.42%,均P<0.01)。患者血清hs-cTnI升高与14 d和30 d院内病死率相关(OR=2.34、3.15)。与hs-cTnI正常组比较,血清hs-cTnI升高组外周血淋巴细胞计数更低,而血清降钙素原、C-反应蛋白、白介素-2R、白介素-6、白介素-8、白介素-10及肿瘤坏死因子-α水平更高,提示病毒引发的炎症因子风暴可能是导致心肌损伤的原因。结论:心肌损伤是COVID-19危重型患者院内死亡的重要危险因素,其潜在机制可能是新型冠状病毒感染诱发的细胞因子风暴介导的炎症损伤。Objective:To explore the impact of myocardial injury induced by SARS-CoV-2 virus on the outcomes and risk factors for critically ill COVID-19 patients.Methods:In this study,we retrospectively analyzed 2787 patients with COVID-19.Results:Among these 2787 patients,there were 392 critically ill patients,including 236 deceased cases.In the deceased patients(8.47%),78.81%had elevated serum levels of hs-cTnI,a biomarker of myocardial injury at admission.A total of 392 critically ill cases were divided into hs-cTnI elevated(>34.2 pg/mL)and normal(≤34.2 pg/mL)groups according to the serum levels at admission.It was found the mechanical ventilation was more frequently required for patients in hs-cTnI elevated group(92.86%vs.64.29%,P<0.01).The 14-day and 30-day in-hospital mortality was higher in elevated than normal groups(65.71%vs.26.37%,and 84.28%vs.32.42%,P<0.01).The hs-cTnI level was related to 14-day and 30-day in-hospital mortality with hazard ratios of 2.34 and 3.15,respectively.Attribution analysis revealed significantly declined peripheral immune cells but increased serum levels of procalcitonin,C-reactive protein,IL-2R,IL-6,IL-8,IL-10,and TNFαin hs-cTnI elevated as compared with normal groups,indicating that the virus-triggering inflammatory storm was the underlying mechanism of myocardial injury.Conclusions:Our data suggested that elevated serum hs-cTnI level indicated a high risk of in-hospital mortality in critically ill patients with COVID-19.The myocardial injury was associated with SARS-CoV-2 virus-triggering cytokine inflammatory storm.

关 键 词：新型冠状病毒 COVID-19危重型 心肌损伤 炎症风暴 预后 

分 类 号：R563.14[医药卫生—呼吸系统]