2019型冠状病毒病之心肌损害述评

Coronavirus Disease 2019 with Myocardial Damage

2019型冠状病毒病患者的全身代谢和脏器功能紊乱加重了原发心脏疾病的负担,导致基础心脏病恶化。患者心脏可能存在急性病毒感染及持续病毒感染的病毒直接损伤,病毒介导的免疫损伤,主要是T细胞免疫可能造成的心肌细胞损伤,多种细胞因子和一氧化氮等介导的心肌损害及微血管损伤,从而导致心脏功能迅速下降或心脏功能衰竭。2019型冠状病毒病合并心功能不全的诊断是在确诊2019型冠状病毒病的基础上加上由心脏超声及利钠肽等指标构成的心力衰竭诊断标准。2019型冠状病毒病合并心功能不全的治疗是在治疗2019型冠状病毒病的基础上加上包括血管活性药物、IABP、改善心衰预后药物、改变生活方式等措施的抗心衰治疗。一部分无症状人群及治愈出院人群仍然是新型冠状病毒的携带者,不能掉以轻心。

Coronavirus disease 2019 patients’ systemic metabolism and organ dysfunction aggravate the burden of primary heart disease, leading to the deterioration of underlying heart disease. The patient’s heart may have virus direct damage caused by acute virus infection and persistent virus infection. The virus-mediated immune damage is mainly the myocardial cell damage caused by T-cell immunity,the myocardial damage and microvascular damage mediated by a variety of cytokines and nitric oxide, which leads to the rapid decline of heart function or heart failure.The diagnosis of type 2019 coronavirus disease with cardiac insufficiency is based on the diagnosis of type 2019 coronavirus disease and the criteria of heart failure, which is composed of echocardiography and natriuretic peptide. The treatment of type 2019 coronavirus disease combined with cardiac insufficiency is based on the treatment of type 2019 coronavirus disease plus measures such as vasoactive drugs,IABP,drugs to improve the prognosis of heart failure,and lifestyle changes. Novel coronavirus carriers are still a part of asymptomatic people and those who are cured and let down.