新型冠状病毒感染心血管后遗症患者的临床特征分析

Clinical Characteristics of Cardiovascular Sequelae of Coronavirus Disease-2019

目的:分析新型冠状病毒感染心血管后遗症患者的临床特征。方法:纳入2022年12月至2023年8月因新型冠状病毒感染后主诉“反复胸闷、心悸、乏力”而就诊于本院心血管内科的48例患者为后遗症组,同时期住院拟行外科心脏瓣膜手术且有新型冠状病毒感染史的非冠心病患者32例作为对照组。分析两组患者的临床资料及冠状动脉造影和24小时动态心电图心率变异性资料。结果:后遗症组和对照组的性别构成比、年龄差异均无统计学意义(P均>0.05)。后遗症组肺部CT检查显示无炎症浸润,且白细胞计数、血沉、C反应蛋白、白细胞介素-6、D二聚体、B型利钠肽水平均正常。后遗症组中所有患者心肌肌钙蛋白I检测为阴性,超声心动图检查未发现局部或整体心肌收缩和舒张功能异常,同时排除心包积液。后遗症组中19例(39.6%)患者经肺动脉CT血管造影(CTA)检查排除肺栓塞。后遗症组9例(18.8%)患者接受3T心脏磁共振钆增强检查,仅2例(22.2%)钆延迟增强(LGE)阳性。后遗症组14例(29.2%)患者接受冠状动脉造影检查,其中12例(85.7%)存在冠状动脉慢血流现象,对照组32例患者接受冠状动脉造影检查,其中6例(18.8%)存在冠状动脉慢血流现象,差异有统计学意义(P<0.001)。后遗症组8例(16.7%)患者在冠状动脉造影结束时接受左肱二头肌动脉造影,其中7例(87.5%)患者存在肱二头肌动脉慢血流现象。后遗症组心率变异性指标均较对照组显著降低[全部窦性心搏RR间期标准差(SDNN):(67.20±14.41)ms vs.(93.03±22.19)ms,P<0.01;相邻RR间期差值的均方根(rMSSD):(22.33±13.69)ms vs.(41.18±17.52)ms,P<0.01;相差大于50 ms的相邻RR间期总数占RR间期总数的百分比(pNN50):(5.8±4.9)%vs.(8.8±6.8)%,P<0.05]。结论:新型冠状病毒感染心血管后遗症患者存在多组织微血管功能障碍和长期自主神经失衡,可能是后遗症的发生原因。

Objectives:To analyze the clinical characteristics of patients with cardiovascular sequelae post coronavirus disease-2019.Methods:The clinical profile was retrospectively analyzed in patients who complained of"repeated chest tightness,palpitations and fatigue"after coronavirus disease-2019(sequelae group,n=48)between December 2022 and August 2023,compared hospitalized patients with coronavirus disease-2019 history and no above symptoms during the same period(control group,n=32).Results:Proportion of sex and mean age were similar between the two groups.In sequela group,pulmonary CT showed no inflammatory infiltrates,and the results of white blood cell count,erythrocyte sedimentation rate,C-reactive protein,interleukin-6,D-dimer,and brain natriuretic peptide were all in the normal range.Cardiac troponin I was also negative in sequela group.Echocardiography examination showed that there were no left ventricular systolic and diastolic abnormalities and pericardial effusion in the sequela group.19 patients(39.6%)of them underwent pulmonary artery CT angiography(CTA)to exclude pulmonary embolism,and 9 patients(18.8%)underwent 3T cardiac magnetic resonance gadolinium enhancement examination,late gadolinium enhancement(LGE)was positive in 2 patients(22.2%).Coronary angiography was performed in 14 patients in the sequelae group and in all patients in the control group,coronary slow flow was found in 12 patients(85.7%)in the sequelae group and 6 patients(18.8%)in the control group(P<0.001).Left biceps brachii artery angiography was performed in 8 patients post coronary angiography in the sequelae group,7 patients(87.5%)exhibited slow flow.Heart rate variability was lower in the sequelae group than in the control group(standard deviation of the RR intervals[SDNN]:[67.20±14.41]ms vs.[93.03±22.19]ms,P<0.01;root mean square of the successive differences of inter-beat intervals[rMSSD]:[22.33±13.69]ms vs.[41.18±17.52]ms,P<0.01;percentage of R-R intervals that are by at least 50 ms different from the previous interval[pNN50]:[5.8±4.9]%vs.[8.8±6.8]%,P<0.05).Conclusions:Our study identifies multi-tissue microcirculation disorder and long-term autonomic imbalance in patients with cardiovascular sequelae post coronavirus disease-2019,which may represent as a potential reason and therapeutic target for long coronavirus disease-2019.