新型冠状病毒肺炎患者急性心肌损伤分析及其危险因素研究

Analysis of acute myocardial injury and its risk factors in patients with COVID-19

目的探讨新型冠状病毒肺炎(新冠肺炎)患者急性心肌损伤发病情况,并分析其危险因素。方法该研究是一项回顾性横断面研究,共纳入了武汉市黄陂区人民医院和黄陂方舱医院2020年1—2月收治的150例新冠肺炎确诊病例。收集所有患者的一般资料、生命体征、心肌酶谱和影像学等资料,比较分析新冠肺炎合并急性心肌损伤患者的特点,同时应用多因素logistic回归分析对急性心肌损伤的危险因素进行分析。绘制受试者工作特征曲线(ROC曲线)评估回归方程对新冠肺炎患者发生急性心肌损伤的效能。结果新冠肺炎合并急性心肌损伤患者与未发生急性心肌损伤患者比较,年龄、呼吸次数、血氧饱和度、白细胞数、中性粒细胞百分比、淋巴细胞百分比、淋巴细胞数、尿素氮、肝功能、心肌损伤标志物、N末端B型利钠肽原(NT-proBNP)、临床分型、合并糖尿病比例、合并心律失常比例、合并心绞痛比例、合并脑血管疾病比例和死亡率差异均有统计学意义(P<0.05)。Logistic回归分析显示,白细胞数、临床分型和是否合并心绞痛是新冠肺炎患者发生急性心肌损伤的危险因素(P<0.05)。回归方程评估新冠肺炎患者发生急性心肌损伤的Youden指数最大值为0.784,曲线下面积为0.943,灵敏度为0.913,特异度为0.881。结论白细胞数、临床分型和是否合并心绞痛是新冠肺炎患者发生急性心肌损伤的危险因素。

Objective To investigate the incidence of acute myocardial injury in patients with COVID-19 and analyze its risk factors.Methods The study was a retrospective cross-sectional study,a total of 150 patients with COVID-19 were included in the Huangpi District People′s Hospital of Wuhan and Wuhan Fang Cabin Hospital from January to February 2020.General information,vital signs,myocardial enzymes and imaging data of all patients were collected.The characteristics of COVID-19 patients with acute myocardial injury were compared and analyzed.The risk factors of acute myocardial injury were analyzed by multivariate logistic regression analysis.The receiver operating characteristic curve(ROC curve)was drawn to evaluate the efficacy of the regression equation for acute myocardial injury in patients with COVID-19.Results Compared with the patients without acute myocardial injury,there were statistically significant differences in age,breathing,blood oxygen saturation,percentage of white cell count,neutrophils percentage,lymphocytes percentage,lymphocyte count,urea nitrogen,liver function,myocardial injury markers,N-terminal pro-B-type natriuretic peptide(NT-proBNP),clinical classification,the proportion of diabetes,the combining arrhythmia rate,proportion of arrhythmia,proportion of angina pectoris and cerebrovascular disease and mortality between COVID-19 patients with acute myocardial injury and without acute myocardial injury(P<0.05).Logistic regression analysis showed that white cell count,clinical classification and with and without coronary heart disease were the risk factors of acute myocardial injury in patients with COVID-19(P<0.05).The maximum Youden index and areas under curve of COVID-19 patients with acute myocardial injury were 0.784,0.943,and the sensitivity and specificity were 0.913,0.881,respectively.Conclusion White cell count,clinical classification and with and without coronary heart disease are risk factors for acute myocardial injury in patients with COVID-19.