严重急性呼吸综合征患者心脏损伤的临床特征观察

Clinical features and mechanism of heart injury in patients suffered from severe acute respiratory syndrome

目的 分析严重急性呼吸综合征 (SARS)并发心脏损伤的临床表现 ,探讨其可能的原因及机理。方法 选择 2 0 0 3年 3月至 5月在北京佑安医院住院的SARS患者 14 3例 ,按有无基础疾病将患者分为两组 ,第 1组 11例为原有心血管疾病者 ;第 2组 13 2例为无心血管疾病患者 ;观察其临床表现特点 ,常规检测血常规、血气分析和心肌酶谱等实验室指标和心电图 ,采用双抗体夹心ELISA法测定 3 2例患者血清白介素 (IL) 1β ,IL 2 ,IL 4,IL 6,IL 8,IL 10和肿瘤坏死因子 α水平 ,以 15例健康医护人员作为对照。 3例患者行尸检心脏病理学检查。结果 14 3例SARS患者中 ,118例存在一项以上血清酶异常 ,以α 羟丁酸脱氢酶 (α HBDH)和乳酸脱氢酶 (LDH )升高最常见 ,其次为天门冬氨酸氨基转移酶 (AST) ;分别有 3 4例和 19例患者出现短暂的血清肌酸激酶 (CK )和肌酸激酶同工酶(CK MB)轻度升高 ,主要见于重型患者和第 1组患者 ;心肌酶和炎症因子升高多出现于病程最初 2周 ,并随病情好转而下降 ;第 1组患者LDH和CK升高程度显著高于第 2组 ;最常见的心电图异常为窦性心动过速 ,其次为ST T动态改变及窦性心动过缓、房室传导阻滞等 ;病理学检查显示心肌及心肌间质水肿、间质细胞轻度增生、少量淋巴细胞浸润等非特异性炎性改变。

Objective To summarize the clinical features of heart injury in patients with severe acute respiratory syndrome (SARS) and analyze its probable mechanisms Methods We collected and analyzed clinical and some laboratory data of 143 patients suffered from SARS, who were admitted to the isolation wards of Beijing You′an Hospital from March to June, 2003 Eleven patients with original cardiovascular diseases were included in group 1, others served as group 2 32 cases′ serum IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10,TNF-α were detected by ELISA method and autopsy were performed in 3 cases A group of 15 healthy medical workers served as control Results Elevation of more than one kind of heart enzymes were seen in most SARS patients, among them increasing of α-HBDH and LDH were most often observed Heart enzymes and inflammatory factors or markers began to increase mainly in the first two weeks of the disease and then decreased during recovery CK and CK-MB elevation were found in 34 cases and 19 cases respectively, most of them were in severe condition or had original cardiovascular diseases LDH and CK level of group 1 were significantly higher than those of group 2 ECG examination was performed in 37 individuals The most common abnormalities were sinus tachycardia ST-T dynamic changes and arrhythmias such as sinus bradycardia,conduction block were also seen in SARS patients Autopsy showed non-specific inflammatory changes of the hearts Conclusion Various kinds of heart-related enzymes tended to rise in SARS patients, especially in patients with primary cardiovascular diseases The increase of CK-MB and ECG abnormalities indicated heart injury in earlier stage Heart injury was most likely the results of various kinds of factors