新型冠状病毒肺炎合并急性心肌损伤的临床特点和预后分析

Clinical characteristics and prognosis of COVID-19 with acute myocardial injury

目的了解新型冠状病毒肺炎(COVID-19)合并急性心肌损伤的临床特点和预后分析.方法回顾性分析2020年2月10日至2020年3月4日华中科技大学附属同济医院光谷院区收住入院的确诊为COVID-19患者361例.通过电子病历收集患者入院时的临床资料,分别根据病情轻重分为危重型组和非危重型组,根据预后分为生存组和死亡组,根据是否发生急性心肌损伤分为急性心肌损伤组和无急性心肌损伤组.结果纳入的361例患者中,危重型患者55例(17.97%),合并急性心肌损伤患者36例(9.97%),死亡患者43例(11.91%).危重型患者中心肌损伤发生率明显高于非危重型(45.45%vs.3.59%,P<0.01),死亡组高于生存组(58.14%vs.3.46%,P<0.01).危重型患者中男性显著高于女性(P<0.01),在是否发生急性心肌损伤和预后分组之间性别差异不明显(P>0.05).急性心肌损伤组年龄、血白细胞计数(WBC)、中性粒细胞计数(N)、中性粒细胞/淋巴细胞比值(NLR)、超敏C-反应蛋白(hs-CRP)、谷草转氨酶(AST)、尿素氮(BUN)、血肌酐(Cr)均明显高于无急性心肌损伤组(P<0.05).基础有高血压患者更易发生急性心肌损伤.多因素Logistics回归分析发现,年龄、血小板计数(PLT)和高血压病是发生急性心肌损伤的独立危险因素(P<0.05).结论COVID-19危重型和死亡组的患者中,急性心肌损伤发生率较高,年龄、PLT和高血压病是发生急性心肌损伤的独立危险因素.

Objective To explore clinical characteristics and prognosis of coronavirus disease 2019(COVID-19)with acute myocardial injury.Methods This retrospective analysis included 361 patients with COVID-19 admitted to Guanggu district of Tongji Hospital,Huazhong University of Science and Technology,from February 10,2020 to March 4,2020.They were divided into eritically severe group and non-critically severe group,survival group and non-survival group,acute myocardial injury group and non-acute myocardial injury group.Results Among the 361 patients,55 were critically severe(17.97%),36 had acute myocardial injury(9.97%),and 43 were dead(11.91%).Myocardial injury was significantly higher in critically severe patients than in non-critically severe patients(45.45%vs.3.59%,P<0.01),and was higher in the non-survival group than in the survival group(58.14%vs.3.46%,P<0.01).Male patients in critically severe group were.significantly higher than female patients(P<0.01),but there was no significant difference in gender among the other groups(P>0.05).The age,white blood cell count,neutrophil count,neutrophil/lymphocyte ratio(NLR),high sensitivity C-reactive protein(hs-CRP),aspartate aminotransferase(AST),urea nitrogen(BUN),serum creatinine(Cr)were significantly higher in the acute myocardial injury group than in the control group(P<0.05).Patients with hypertension were more likely to have acute myocardial injury.Multivariate Logistic regression analysis showed that the age,platelet count and hypertension were independent risk factors for acute myocardial injury(P<0.05).Conclusion The incidence of acute myocardial injury was higher in the critically severe and non-survival groups,and the age,platelet count and hypertension were independent risk factors for acute myocardial injury.