新型冠状病毒肺炎患者心肌损伤与炎症相关性分析

Correlation analysis of myocardial injury and inflammation in patients with COVID⁃19

目的探讨新型冠状病毒肺炎(COVID⁃19)患者心肌损伤与炎症的相关性。方法回顾性分析我院收治的120例COVID⁃19确诊病例。根据临床分型分为轻症组(普通型)和重症组(重型及危重型);比较其临床特征;记录高敏肌钙蛋白I(hs⁃TNI)、肌酸激酶⁃MB同工酶(CK⁃MB)、乳酸脱氢酶(LDH),C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)、中性粒细胞计数(NEUT)、淋巴细胞计数(LYM)等;对其进行统计学分析。结果(1)三种临床分型患者在年龄、性别、高血压、冠心病、心律失常病史间差异有统计学意义(P<0.05)。(2)重症组CK⁃MB、LDH和CRP表达升高,WBC、NEU明显升高,LYM显著下降,且各项指标峰值变化的比例亦较明显(P<0.05)。(3)重症组组内分析,危重型患者hs⁃TNI及PCT表达升高,其峰值升高的比例亦较大(P<0.05)。(4)logistic回归分析病情程度表明:hs⁃TNI、LDH和CRP、PCT升高与病情危重程度呈正相关(P<0.05)。(5)心肌损伤指标hs⁃TNI与CRP(r=0.49)及PCT(r=0.318)呈正相关;CK⁃MB与CRP(r=0.388)及PCT(r=0.264)呈正相关;LDH与CRP(r=0.349)呈正相关。结论重型/危重型COVID⁃19患者高龄、合并心血管疾病病史较常见,发生心肌损伤和炎症反应的程度重、比例高,而且心肌损伤的程度与炎症反应密切相关。

Objective To explore the correlation between myocardial injury and inflammation in patients with new coronavirus pneumonia(COVID⁃19).Methods A retrospective study was conducted in 120 COVID⁃19 patients who admitted to Wuhan First Hospital from January 20,2020 to March 20,2020.According to the clinical classification of COVID⁃19,these patients were divided into mild group(common type)and severe group(severe and critical type).The clinical characteristics and Laboratory test,such as high⁃sensitivity troponin I(hs⁃TNI),creatine kinase⁃MB isoenzyme(CK⁃MB),lactate dehydrogenase(LDH),C⁃reactive protein(CRP),procalcitonin(PCT),white blood cell(WBC),neutrophil Cell(NEUT)and lymphocyte(LYM),were analyzed and compared between the two groups.Furthermore,the difference and correlation were analyzed and compared.Results Firstly,among the three clinical types,the differences were statistically significant in age,gender,hypertension,coronary heart disease and arrhythmia(all P<0.05).Secondly,the expressionof CK⁃MB,LDH and CRP and the proportions of those abnormal indicators in the severe group were significantly increased,the same with the WBC and NEU,but opposite to the LYM(all P<0.05).Further more,in the severe group,the expressionof hs⁃TNI and PCT and the proportions of those abnormal indicators in critical patients were significantly higher than those in severe patients(all P<0.05).Lastly,logistic regression analysis showed that the severity of COVID⁃19 was positively correlated with the increase of hs⁃TNI,LDH,CRP,and PCT(P<0.05).Correlation analysis showed that hs⁃TNI was positively correlated with CRP(r=0.49,P<0.001)and PCT(r=0.318,P=0.033),CK⁃MB was positively correlated with CRP(r=0.388,P=0.002)and PCT(r=0.264,P=0.047),LDH was positively related to CRP(r=0.349,P=0.005).Conclusions Among patients with Severe/critical COVID⁃19,old age and a history of cardiovascular diseases are common,the severity of myocardial injury and inflammatory response are serious,and the proportion is large.Moreover,the severity of myocardial injury is closely related to inflammatory response.