COVID-19重型患者心肌损伤及心脏功能变化的初步观察

目的分析新型冠状病毒肺炎(COVID-19)重型患者心肌损伤及心脏功能的变化。方法回顾性分析36例COVID-19患者的临床资料。根据临床分型将患者分为重型组(n=4)和轻症组(n=32,包括轻型和普通型)。收集患者一般临床资料及合并心血管基础疾病的情况,测定并比较每组患者血清肌酐、肌红蛋白、乳酸脱氢酶(LDH)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、心肌肌钙蛋白T(cTnT)、N末端B型利钠肽原(NT-ProBNP)、C反应蛋白(CRP)水平,以及床旁超声心动图测量左心室和右心室功能。结果COVID-19重型组住院时间显著长于轻症组(Z=-3.183,P=0.001),糖尿病患病率(χ^2=13.056,P<0.001)、血清肌红蛋白(t=5.284,P<0.001)、CK(Z=-2.267,P=0.029)、CK-MB(Z=-2.140,P=0.032)、cTnT(Z=-2.134,P=0.037)、CRP(Z=-1.892,P=0.041)、NT-ProBNP水平(Z=-2.467,P=0.014)和右心室Tei指数(t=5.256,P=0.023)均显著高于轻症组。两组左心室舒张末内径(LVDd)、左心室收缩末内径(LVSd)、左心室射血分数(LVEF)及左心室Tei指数差异无显著性。结论COVID-19重型患者心肌存在一定的损伤,右心功能减退。重型COVID-19患者中糖尿病患病率显著高于轻症患者。

Observation of myocardial injury and cardiac function in severe COVID-19 patients

Aim To investigate the changes of myocardial injury and cardiac function in severe patients with coronavirus disease 2019(COVID-19).Methods Retrospective analysis was performed on the clinical datas of 36 COVID-19 patients.According to clinical classification,the patients were divided into severe group(n=4)and mild group(n=32).Collect the patients’s general clinical datas and the status of the consolidated basis of cardiovascular disease,the patients’serum creatinie,myoglobin,lactic dehydrogenase(LDH),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),troponin T(cTnT),N end of B-type natriuretic peptide(NT-ProBNP),c-reactive protein(CRP)levels,and echocardiography measurements of left ventricular and right ventricular function.Results The in-hospital time in the severe group was significantly longer than that in the mild group(Z=-3.183,P=0.001),the incidence of diabetes(χ^2=13.056,P<0.001),the serum levels of myoglobin(t=5.284,P<0.001),CK(Z=-2.267,P=0.023),CK-MB(Z=-2.140,P=0.032),cTnT(Z=-2.134,P=0.037),CRP(Z=-1.892,P=0.041),NT-ProBNP(Z=-2.467,P=0.014)and right ventricular Tei index(t=5.256,P=0.023)were significantly higher than those in the mild group.There were no significant differences in LVDd,LVSd,LVEF and left ventricular Tei index between the two groups.Conclusion The morbidity of diabetes in patients with severe COVID-19 was significantly higher than that of patients with mild COVID-19,while patients with severe COVID-19 had some extend of myocardiol injury and impaired right ventricular function.