重型/危重型新冠病毒奥密克戎变异株感染合并心房颤动临床分析  

Clinical analysis of severe/critical 2019 novel coronavirus Omicron variant infection combined with atrial fibrillation

作　　者：赵志宏 王赛华 朱珞宁 郇强 田蓓 郝舒雯 宁忠平[1] 宋湘 李新明[1] Zhao Zhihong;Wang Saihua;Zhu Luoning;Huan Qiang;Tian Bei;Hao Shuwen;Ning Zhongping;Song Xiang;Li Xinming(Department of Cardiology,Zhoupu Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China)

机构地区：[1]上海健康医学院附属周浦医院心血管内科,上海201318

出　　处：《中华危重病急救医学》2022年第9期900-904,共5页Chinese Critical Care Medicine

基　　金：上海市浦东科技发展基金项目(PKJ2021-Y33);上海市浦东新区卫健委临床高峰学科建设计划项目(PWYgf2021-04)。

摘　　要：目的分析新型冠状病毒奥密克戎突变株感染合并心房颤动(房颤)患者的临床特征及预后。方法选择2022年3月23日至5月15日上海市新冠肺炎定点医院周浦医院收治的2675例年龄≥50岁的本土新型冠状病毒肺炎(新冠肺炎)病例,将合并房颤患者分为轻型组、普通型组和重型/危重型组。收集3组患者的临床资料、影像学检查和实验室检查结果及预后并进行比较。结果2675例新冠肺炎患者中位年龄69.0(60.0,81.0)岁,其中135例合并房颤,房颤发生率为5.05%。合并房颤患者的年龄为55~101岁,中位年龄84.0(74.0,89.0)岁;轻型组68例,普通型组30例,重型/危重型组37例(包括重型9例、危重型28例)。重型/危重型组患者年龄55~75岁比例为43.2%,新冠疫苗接种率为32.4%;新发房颤比例在3组中最高,长程持续性房颤比例则以轻型组最高(58.8%)。重型/危重型组伴发热(29.7%)、肝功能不全(13.5%)、肾功能不全(46.0%)、2型糖尿病比例(46.0%)及心功能不全NYHA分级高〔与轻型和普通型比较分别为(分):1.8±1.1比1.1±0.8、1.2±0.7,均P<0.05〕。实验室检查方面,与轻型组和普通型组比较,重型/危重型患者的C-反应蛋白(CRP)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平均明显升高〔CRP(mg/L):27.2(6.0,60.8)比7.6(3.1,19.3)、12.8(4.9,26.3),ALT(U/L):31.3±15.4比15.4±9.3、19.3±11.7,AST(U/L):78.0±21.7比34.7±15.6、38.1±24.4,均P<0.05〕,血红蛋白(Hb)、白蛋白(ALB)水平均明显降低〔Hb(g/L):105.3±22.5比125.8±25.4、123.0±20.4,ALB(g/L):33.7±6.0比39.0±5.5、39.6±13.1,均P<0.05〕;另外,重型/危重型组肌酸激酶同工酶(CK-MB)明显高于轻型组〔μg/L:2.5(1.5,3.4)比2.2(1.2,2.8),P<0.05〕。治疗方面,3组间使用抗血小板药物和低分子肝素比例比较差异均有统计学意义,其中重型/危重型组使用抗血小板药物比例最低(27.0%),使用低分子肝素比例则高于轻型组〔81.1%(30/37)比51.5%(35/68),P<0.05〕。新冠肺Objective To investigate the clinical characteristics and prognosis of coronavirus disease 2019(COVID-19)patients with Omicron variant combined with atrial fibrillation(AF).Methods From March 23,2022 to May 15,2022,2675 aged≥50 years old COVID-19 patients with AF were admitted to Zhoupu Hospital,the designated hospital for COVID-19 in Shanghai.Patients were divided into mild symptoms group,normal group,and serious/critical group according to the symptoms.The clinical data,imaging examination and laboratory results and prognosis of the three group patients were compared.Results The median age of 2675 COVID-19 patients was 69.0(60.0,81.0)years old,the incidence of AF was 5.05%(135/2675),the age range of AF patients were from 55 to 101 years old,with a median age of 84.0(74.0,89.0),and the number of mild symptoms,normal,serious/critical patients were 68,30,37,respectively,including 9 of serious and 28 of critical patients.In the serious/critical patients,aged 55-75 years old accounted for 43.2%,the rate of 2019 novel coronavirus vaccination was 32.4%.The identified new-onset AF was the highest among the three groups,but the rate of persistent AF was the highest in the mild symptoms group(58.8%).The severe/critical group complicated with fever(29.7%),hepatic insufficiency(13.5%),renal insufficiency(46.0%),type 2 diabetes(46.0%),and heart failure were higher in NYHA classification[compared with the mild symptoms and normal group(score):1.8±1.1 vs.1.1±0.8,1.2±0.7,respectively,all P<0.05].In term of laboratory examinations,C-reactive protein(CRP),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)levels were significantly higher in serious/critical patients compared to the mild symptoms and normal groups[CRP(mg/L):27.2(6.0,60.8)vs.7.6(3.1,19.3),12.8(4.9,26.3),ALT(U/L):31.3±15.4 vs.15.4±9.3,19.3±11.7,AST(U/L):78.0±21.7 vs.34.7±15.6,38.1±24.4,all P<0.05].The hemoglobin(Hb)and albumin(ALB)levels were significantly lower than those in the mild symptoms and normal groups[Hb(g/L):105.3±22.5 vs.125.8�

关 键 词：新型冠状病毒肺炎 奥密克戎变异株 心房颤动 临床特征 

分 类 号：R563.1[医药卫生—呼吸系统] R541.75[医药卫生—内科学]