新型冠状病毒肺炎相关心肌损伤的临床观察

Clinical observation of heart damage caused by coronavirus disease 2019

目的:观察新型冠状病毒肺炎(COVID-19,简称新冠肺炎)相关心肌损伤的特点,分析其危险因素及预后。方法:回顾性分析2019年12月25日—2020年2月18日江汉大学附属医院收治的785例新冠肺炎患者的临床资料,按超敏肌钙蛋白(cTNI/cTNT)升高是否超过第99百分位上限(URL)分为心肌损伤组和非心肌损伤组,比较两组患者的一般资料、实验室检查及预后,进一步将肌钙蛋白增高的新冠肺炎患者按"死亡组"和"非死亡组"进行分类,观察两组患者临床表现、实验室检查、心电图、影像学检查、临床转归等,分析新冠肺炎相关心肌损伤的特点及预后。结果:(1)785例患者中,肌钙蛋白增高患者90例。(2)新冠肺炎相关心肌损伤与年龄、基础疾病史有关,多为高龄[(71.64±16.42)岁],伴有高血压、冠心病、糖尿病等基础疾病。(3)主要临床表现有心悸(76.7%)、胸闷(60.0%)、胸痛(6.7%),但死亡组和非死亡组相比无统计学差异(P>0.05);实验室检查:心肌酶学(CK、CK-MB、LDH)、肌红蛋白、超敏肌钙蛋白、NT-ProBNP均有不同程度升高,死亡组患者增高更明显,两组相比有统计学差异(P<0.001),且超敏肌钙蛋白和NT-ProBNP为心肌损伤患者死亡独立危险因素。(4)90例心肌损伤患者中,84例心电图异常,表现为:房/室性早搏、ST段上抬、ST段下移、传导阻滞及异常Q波,两组相比,传导阻滞有统计学意义(P<0.05)。结论:新冠肺炎可导致心肌损伤,肌钙蛋白是判断心肌损伤的重要指标,且肌钙蛋白和NT-ProBNP为预测死亡的独立危险因素。

Objective: To investigate the heart damage of coronavirus disease 2019(COVID-19) patients.Methods: A total of 785 cases of COVID-19 treated in the Affiliated Hospital of Jianghan University from December 25, 2019 to February 18, 2020 were retrospectively studied. Patients with myocardial injury were screened out and then were divided into survival and non-survival groups. The clinical manifestations, laboratory examinations, electrocardiograms, imaging examinations, and clinical outcomes of the two groups were observed, and the characteristics and prognosis of myocardial injury related to COVID-19 were analyzed. Results:(1) Of the 785 patients, 90 had elevated serum troponin and were identified as myocardial injury patients.(2) COVID-19 related myocardial injury correlated to age and history of underlying diseases. Most of them were elderly(mean age 71. 64±16. 42 years),accompanied by basic diseases such as hypertension, coronary heart disease, and diabetes.(3) The main clinical manifestations in COVID-19 with myocardial injury were palpitations(76. 7%), chest tightness(60%), and chest pain(6. 67%). There was no statistical difference between survival and non-survival groups(P>0. 05);Laboratory examinations showed that myocardial enzymes(CK, CKMB, and LDH), myoglobin, hypersensitive troponin, and NT-ProBNP all increased in varying degrees, especially in non-survivors(P<0. 001). Hypersensitive troponin and NT-ProBNP were independent risk factors for death in COVID-19 patients with myocardial injury.(4) Of the 90 patients with myocardial injury, 84 showed abnormal electrocardiograms, including atrial/ventricular premature beats, ST-segment elevation, ST-segment shift, conduction block, and abnormal Q waves.There were significant difference in conduction block rate between survival and non-survival groups(P<0. 05). Conlusion: COVID-19 can cause myocardial damage. Troponin is an important indicator for myocardial damage. Troponin and NT-ProBNP are independent risk factors for predicting death of COVID-19.