新冠肺炎相关心肌损伤患者临床特征与危险因素

Clinical characteristics and risk factors of patients with Coronavirus Disease 2019 related Myocardial Injury

目的分析新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)相关心肌损伤患者的临床特征及发生的危险因素,为临床早期预防和治疗提供依据。方法收集2023年1月1日-2023年9月30日期间新疆医科大学第一附属医院感染病·肝病中心收治的COVID-19患者共89例,据是否合并心肌损伤分为心肌损伤组28例,非心肌损伤组(对照组)61例,比较两组患者的临床特征、实验室检查,分析COVID-19合并心肌损伤的危险因素。结果两组患者在年龄、危重型、体温T>39℃、心率、最低动脉血氧饱和度(SpO_(2))<93%、外周血白细胞计数(WBC)、白介素-6(IL-6)、D-二聚体、及肺部病变范围>50%上,差异均有统计学意义(P<0.05),而性别、吸烟、糖尿病、高血压、脑血管病、外周血淋巴细胞计数(L)、白细胞与淋巴细胞比值(WBC/L)、血红蛋白(HB)、血小板(PLT)、降钙素原(PCT)、血浆凝血酶原时间(PT)及血清白蛋白(ALB),两组比较均无统计学意义(P>0.05)。多因素Logistic回归分析比较,心率(OR=1.240,95%CI:1.001-1.536,P<0.05)、危重型(OR=909.017,95%CI:1.694-487769.364,P<0.05)、IL-6(OR=1.117,95%CI:1.008-1.238,P<0.05)及D二聚体水平(OR=1.010,95%CI:1.000-1.019,P<0.05),是COVID-19患者发生心肌损伤的独立危险因素。结论心率快、危重型、IL-6及D-二聚体高的COVID-19患者,更易出现心肌损伤。

Objective To analyze the clinical features and risk factors of patients with novel coronavirus disease(COVID-19)related myocardial injury,and provide evidence for early clinical prevention and treatment.Methods A total of 89 COVID-19 patients admitted to the Center for Infectious Diseases and Liver Diseases of the First Affiliated Hospital of Xinjiang Medical University from January 1,2023 to September 30,2023 were collected.According to whether combined with myocardial injury or not,they were divided into myocardial injury group(28 cases)and non-myocardial injury group(control group,61 cases).The clinical basic characteristics and laboratory tests of the two groups were compared,and the risk factors of COVID-19 complicated with myocardial injury were analyzed.Results There were significant differences between the two groups in age,critical type,body temperature T>39℃,heart rate,minimum arterial oxygen saturation(SpO_(2))<93%,peripheral white blood cell count(WBC),interleukin-6(IL-6),D dimer and lung lesion range>50%(P<0.05).However,there were no significant differences in sex,smoking,diabetes,hypertension,cerebrovascular disease,peripheral blood lymphocyte count(L),ratio of white blood cells to lymphocytes(WBC/L),hemoglobin(HB),platelet(PLT),procalcitonin(PCT),plasma prothrombin time(PT)and serum albumin(ALB)between the two groups(P>0.05).Multivariate Logistic regression analysis showed that heart rate(OR=1.240,95%CI:1.001-1.536,P<0.05),critical type(OR=909.017,95%CI:1.694-487,769.364,P<0.05)and IL.P<0.05)and D-dimer level(OR=1.010,95%CI:1.000-1.019,P<0.05)are independent risk factors for myocardial injury in COVID-19 patients.Conclusion COVID-19 patients with fast heart rate,critical illness and high levels of IL-6 and D dimer are more prone to myocardial injury.