对比分析18例重症/危重症新型冠状病毒肺炎心肌损伤患者临床特征

目的回顾性分析伴心肌损伤的重症/危重症新型冠状病毒肺炎(COVID-19)患者临床特征及心肌酶学指标动态变化。方法纳入2020年1月17至3月1日中山大学附属第五医院收治的18例重症/危重症COVID-19患者。依据住院期间心肌酶或肌钙蛋白I检测值,正常范围患者归为非心肌损伤组(n=13),异常升高患者归为心肌损伤组(n=5)。对比分析两组患者入院后的流行病学和临床资料,并分析血常规、肝肾功能、心肌酶、C反应蛋白(CRP)等实验室指标,动态分析肌酸激酶、肌酸激酶同工酶MB、N端脑钠肽前体(NT-proBNP)和肌钙蛋白I变化情况。结果18例重症/危重症患者中,心肌损伤患者占27.8%(5/18)。与非心肌损伤组患者比较,心肌损伤组患者年龄、性别、基础疾病、症状和体征、发病至住院时间、体温、心率、舒张压、住院时间无明显差异,但心肌损伤组患者入院时收缩压明显高于非心肌损伤组(P=0.0171)。两组患者入院时白细胞计数、淋巴细胞计数、单核细胞计数无明显差异;入院时谷丙氨酸氨基转移酶、天冬氨酸氨基转移酶、乳酸脱氢酶、α-羟丁酸脱氢酶、肌酸激酶、肌酸激酶同工酶MB、血肌酐、CRP、N端脑钠肽前体两组患者中也未见明显差异。动态分析发现心肌损伤组重症患者在住院第4~5天左右,肌酸激酶、肌酸激酶同工酶、肌钙蛋白I、N端脑钠肽前体逐渐出现升高,在第9~11天后逐渐恢复正常。结论重症/危重症COVID-19患者收缩压较高可能与容易出现心肌损伤相关,心肌酶谱异常出现在住院的早期,早期发现和干预治疗对心肌损伤患者有益。

Comparative analysis of the clinical characteristics of 18 severe/critical coronavirus disease 2019 patients with myocardial injury

Aim To investigate the clinical characteristics and the dynamic changes of myocardial enzymes in patients with severe/critical coronavirus disease 2019(COVID-19)with cardiac injury.Methods A total of 18 severe/critical COVID-19 patients in our hospital from January 17,2020 to March 1,2020 were retrospectively analyzed.According to the detection value of cardiac enzyme or troponin I during hospitalization,patients in the normal range were classified as nonmyocardial injury group(n=13),and patients with abnormal elevation were classified as myocardial injury group(n=5).The epidemiological and clinical data of the two groups after admission were compared and analyzed,and laboratory indicators such as blood routine,liver and kidney function,myocardial enzyme,C-reactive protein were analyzed,and the changes of creatine kinase,creatine kinase isoenzyme MB,N-terminal pro-brain natriuretic peptide(NT-proBNP)and troponin I were dynamically analyzed.Results Of the 18 severe/critical type patients,27.8%(5/18)had myocardial injury.Compared with the nonmyocardial injury patients,there were no significant differences in age,gender,basic diseases,symptoms and signs,time from onset to hospitalization,body temperature,heart rate,diastolic blood pressure and hospital stay in the myocardial injury group,but the systolic blood pressure in the myocardial injury group was significantly higher than that in the nonmyocardial injury group(P=0.0171).There was no significant difference in white blood cell count,neutrocyte count,lymphocyte count and mononuclear cell count between the two groups upon admission.Similarly,there was no significant difference between the two groups in alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,α-hydroxybutyrate dehydrogenase,creatine kinase,creatine kinase isoenzyme MB,blood urea nitrogen,serum creatinine,C-reactive protein and NT-proBNP.Dynamic analysis found that in patients with myocardial injury,creatine kinase,creatine kinase muscle-brain isoenzyme,troponin I,and NT-proBNP gradually increased during the 4~5 days of hospitalization,and gradually returned to normal after 9~11 days.Conclusions Higher systolic blood pressure in patients with severe/critical COVID-19 may be associated with higher risk of heart injury.Abnormalities in myocardial enzyme spectrum occur in the early stage of hospitalization.Early detection and intervention are beneficial to the prognosis of patients with heart injury.