武汉地区1743例COVID-19患者生化常规项目分析

Analysis of routine biochemical indicators in 1743 patients with corona virus disease 2019 in Wuhan

目的探讨生化常规项目在判断新型冠状病毒肺炎(COVID-19)患者病情严重程度中的价值。方法收集1743例COVID-19患者,按病情严重程度分为非重症组(1684例)和重症组(59例),检测所有对象的生化常规项目,包括高敏心肌肌钙蛋白T(hs-cTnT)、心肌肌钙蛋白I(cTnI)、肌酸激酶(CK)、肌酸激酶MB同工酶(CK-MB)、肌红蛋白(MYO)、乳酸脱氢酶(LDH)、白蛋白(Alb)、白蛋白/球蛋白(A/G)比值、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、直接胆红素(DBil)、间接胆红素(IBil)、总胆红素(TB)、肌酐(Cr)、尿素、尿酸(UA)、K+和Na+。采用受试者工作特征(ROC)曲线评价各项指标判断COVID-19严重程度的价值。结果重症组血清hs-cTnT、cTnI、CK-MB、MYO、LDH、AST、DBil、IBil、TB和尿素水平显著高于非重症组(P<0.05),血清Alb、A/G比值、UA和Na+水平低于非重症组(P<0.05),血清CK、ALT、Cr和K+水平2个组之间差异无统计学意义(P>0.05)。重症组hs-cTnT、cTnI、CK、CK-MB、MYO、LDH、Alb、A/G比值、AST、DBil、IBil、TB、Cr、尿素、K+和Na+的阳性率高于非重症组(P<0.05),ALT和UA的阳性率2个组之间差异无统计学意义(P>0.05)。ROC曲线分析结果显示,18项生化常规指标中,诊断COVID-19的曲线下面积(AUC)居前3位的指标分别是hscTnT(0.881)、LDH(0.880)和Alb(0.867),敏感性分别为90.5%、76.3%和84.7%,特异性分别为71.9%、91.8%和81.6%。Logistic回归分析结果显示,hs-cTnT越高、Alb越低,重症的危险性越大。结论hs-cTnT、LDH和Alb对于区分COVID-19重症与非重症有较好的效能,可作为判断疾病严重程度的潜在标志物。

Objective To investigate the roles of routine biochemical indicators for evaluating the severity of corona virus disease 2019(COVID-19).Methods A total of 1743 patients with COVID-19 were enrolled and classified into non-severe group(1684 cases)and severe group(59 cases)according to the severity of COVID-19.Routine biochemical indicators,including high-sensitivity cardiac troponin T(hs-cTnT),cardiac troponin I(cTnI),creatine kinase(CK),creatine kinase-MB isoenzyme(CK-MB),myoglobin(MYO),lactate dehydrogenase(LDH),albumin(Alb),albumin to globulin ratio(A/G),aspartate aminotransferase(AST),alanine aminotransferase(ALT),direct bilirubin(DBil),indirect bilirubin(IBil),total bilirubin(TB),creatinine(Cr),urea(Urea),uric acid(UA),K+and Na+,of all the patients were determined.Receiver operating characteristic(ROC)curve was used to evaluate the roles of routine biochemical indicators for evaluating the severity of COVID-19.Results The levels of hs-cTnT,cTnI,CK-MB,MYO,LDH,AST,DBil,IBil,TB and Urea in severe group were higher than those in non-severe group(P<0.05).The levels of Alb,A/G,UA and Na+in severe group were lower than those in non-severe group(P<0.05).There was no statistical significance in CK,ALT,Cr and K+levels between the 2 groups(P>0.05).The positive rates of hs-cTnT,cTnI,CK,CK-MB,MYO,LDH,Alb,A/G,AST,DBil,IBil,TB,Cr,Urea,K+and Na+in severe group were higher than those in non-severe group(P<0.05).There was no statistical significance in the positive rates of ALT and UA between the 2 groups(P>0.05).ROC curve analysis showed that among the 18 biochemical indicators,the top 3 area under curve(AUC)indicators for the diagnosis of COVID-19 were hs-cTnT(0.881),LDH(0.880)and Alb(0.867),the sensitivities were 90.5%,76.3%and 84.7%,and the specificities were 71.9%,91.8%and 81.6%,respectively.Logistic regression analysis showed that the higher the hs-cTNT and the lower the Alb were,the higher the risk of severe disease was.Conclusions Biochemical indicators,hs-cTnT,LDH and Alb,have good diagnostic performance for evaluating severe and non-severe COVID-19,which can be used as potential biomarkers for evaluating the severity of COVID-19.