新型冠状病毒肺炎危重型患者心肌损伤及患有心血管基础疾病的情况分析

Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19

目的分析新型冠状病毒肺炎(COVID-19)危重型患者心肌损伤及患有心血管基础疾病的情况。方法回顾性分析2020年1月19日至2月13日华中科技大学同济医学院附属同济医院发热病房住院的咽拭子样本2019新型冠状病毒(2019-nCoV)核酸检测阳性的COVID-19患者的临床资料。根据临床分型将患者分为危重型组和非危重型(包括重型)组。通过电子病历系统收集入选者的一般临床资料以及患有基础疾病的情况。收集入选患者住院期间实验室检查结果,包括血清N末端B型利钠肽原(NT-proBNP)、心肌肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)和血肌酐的最高值,血红蛋白的最低值。采用单因素和多因素logistic回归模型分析COVID-19危重型的相关因素。结果共入选COVID-19患者150例,其中危重型患者24例(危重型组)、非危重型患者126例(非危重型组),年龄(59±16)岁,男性84例(56%)。危重型组患者的年龄、hs-CRP和血肌酐水平均高于非危重型组(P均<0.05)。危重型组患者中男性、NT-proBNP升高、cTnI升高以及患有高血压、既往冠心病史的比例均高于非危重型组(P均<0.05)。而且,危重型组患者NT-proBNP和cTnI水平均明显高于非危重型组(P均<0.05)。两组患者患有糖尿病的比例及血红蛋白水平差异均无统计学意义(P均>0.05)。单因素logistic回归分析结果显示,年龄、男性、NT-proBNP升高、cTnI升高、hs-CRP升高、血肌酐升高、患有高血压、既往冠心病史是COVID-19危重型的相关因素(P均<0.05)。多因素logistic回归分析结果显示,cTnI升高(OR=26.909,95%CI 4.086~177.226,P=0.001)、既往冠心病史(OR=16.609,95%CI 2.288~120.577,P=0.005)是COVID-19危重型的独立相关因素。结论心肌损伤及既往冠心病史是COVID-19危重型患者重要的临床特征。

ObjectiveTo evaluate the cardiovascular damage of patients with COVID-19,and determine the correlation of serum N-terminal pro B-type natriuretic peptide(NT-proBNP)and cardiac troponin-I(cTnI)with the severity of COVID-19,and the impact of concomitant cardiovascular disease on severity of COVID-19 was also evaluated.MethodsA cross-sectional study was designed on 150 consecutive patients with COVID-19 in the fever clinic of Tongji Hospital in Wuhan from January 19 to February 13 in 2020,including 126 mild cases and 24 cases in critical care.Both univariate and multivariate logistic regression were used to analyze the correlation of past medical history including hypertension,diabetes and coronary heart disease(CHD),as well as the levels of serum NT-proBNP and cTnI to the disease severity of COVID-19 patients.ResultsAge,hypersensitive C-reactive protein(hs-CRP)and serum creatinine levels of the patients were higher in critical care cases than in mild cases(all P<0.05).Prevalence of male,elevated NT-proBNP and cTnI,hypertension and coronary heart disease were significantly higher in critical cases care patients than in the mild cases(all P<0.05).Univariate logistic regression analysis showed that age,male,elevated NT-proBNP,elevated cTnI,elevated hs-CRP,elevated serum creatinine,hypertension,and CHD were significantly correlated with critical disease status(all P<0.05).Multivariate logistic regression analysis showed that elevated cTnI(OR=26.909,95%CI 4.086-177.226,P=0.001)and CHD(OR=16.609,95%CI 2.288-120.577,P=0.005)were the independent risk factors of critical disease status.ConclusionsCOVID-19 can significantly affect the heart function and lead to myocardial injury.The past medical history of CHD and increased level of cTnI are 2 independent determinants of clinical disease status in patients with COVID-19.