老年重症新型冠状病毒肺炎合并冠心病患者的临床特点和预后  

Clinical characteristics and prognosis of severe coronal virus disease 2019 pneumonia combined with coronary artery disease in the elderly

作　　者：徐瑞金[1] 刘格[1] 苏玉莹 陈娟[2] 葛云洁[1] 高俊杰[1] 刘柳[1] Xu Ruijin;Liu Ge;Su Yuying;Chen Juan;Ge Yunjie;Gao Junjie;Liu Liu(Department of the Cadre Health Care,Qingdao Municipal Hospital,Qingdao 266071,China;Department of Respiratory,Tongji Hospital Affiliated to Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]青岛市市立医院干部保健科,青岛266071 [2]华中科技大学附属同济医院呼吸科,武汉430030

出　　处：《中华老年医学杂志》2022年第8期961-964,共4页Chinese Journal of Geriatrics

摘　　要：目的研究老年重症新型冠状病毒(COVID-19)肺炎合并冠心病患者的临床表现及预后。方法选择2020年2月10日至2020年3月20日入武汉同济医院的351例老年重症COVID-19肺炎患者(≥60岁), 分为冠心病组(52例)和非冠心病(299例), 对患者的一般临床资料、并发症和实验室检查结果进行回顾性分析。结果 (1)和非冠心病组患者相比, 冠心病组患者的住院时间明显延长[(12.3±2.6)d和(9.3±2.1)d, t=3.24, P=0.002], 心肌梗死(7.7%和0.0%, χ^(2)=21.6, P<0.001)、心力衰竭(15.4%和0.3%, χ^(2)=34.7, P<0.001)和心律失常(50.0%和12.4%, χ^(2)=24.45, P<0.001)等心血管并发症发生率增高, 全因死亡率(15.4%和4.3%, χ^(2)=7.94, P=0.005)升高;(2)冠心病组患者血清白细胞介素2受体、白细胞介素6、肌酸激酶同2酶、肌钙蛋白Ⅰ、氨基酸末端脑钠肽前体、D-二聚体、纤维蛋白原均较非冠心病组明显升高;(3)冠心病组患者动脉血PaO_(2)/FiO2较非冠心病组明显下降, 血乳酸水平升高。结论老年重症COVID-19肺炎合并冠心病患者炎症反应明显, 心血管并发症发生率高, 病死率较高。Objective To investigate the clinical manifestations and prognosis of severe coronal virus disease 2019(COVID-19)pneumonia combined with coronary artery disease(CAD)in the elderly.Methods A total of 351 old patients(≥60 years)with severe COVID-19 pneumonia combined with CAD admitted to Tongji Hospital of Wuhan from February 2020 to March 2020 were enrolled in this retrospective study.The patients were divided into CAD group(n=52)and non-CAD group(n=299).The clinical data,the changes of blood tests and cardiovascular complications were observed.Results Compared with non-CAD group,CAD group showed a longer time of stay in hospital[(12.3±2.6)d and(9.3±2.1)d,t=3.24,P=0.002],and higher incidence of cardiovascular complications,such as myocardial infarction(7.7%and 0.0%,χ^(2)=21.6,P<0.001),heart failure(15.4%and 0.3%,χ^(2)=34.7,P<0.001),arrhythmia(50.0%and 12.4%,χ2=24.45,P<0.001)and all-cause mortality(15.4%and 4.3%,χ^(2)=7.94,P=0.005).The serum levels of interleukin-2 receptor,interleukin 6,CK-MB,cTnI,NT-proBNP,D-dimer and fibrinogen were higher in CAD group than in non-CAD group.The oxygenation index was significantly lower and the blood lactic acid level was higher in CAD group than in non-CAD group.Conclusions The aged patients with severe COVID-19 pneumonia combined with CAD show obvious inflammatory reaction,high incidence of cardiovascular complications and high mortality.

关 键 词：老年人 新型冠状病毒肺炎 冠心病 炎症 

分 类 号：R563.1[医药卫生—呼吸系统] R541.4[医药卫生—内科学]