新型冠状病毒肺炎患者并发心肌损伤的实验室及临床相关研究

目的 回顾性分析新型冠状病毒肺炎(COVID-19)并发心肌损伤的临床特点及独立危险性因素,探讨病毒直接损伤心肌组织的可能性.方法 选取2020年2月13日～3月30日收治于泰康同济(武汉)医院确诊为COVID-19的患者381例.通过超敏肌钙蛋白T水平将其分为心肌损伤组及非心肌损伤组,并对比两组患者的临床统计资料及实...

Laboratory and Clinical Study on COVID-19 Patients with Myocardial Injury

Objective The clinical characteristics and independent risk factors of COVID-19 with myocardial injury were analyzed retrospectively,and the possibility of direct injury of myocardial tissue by virus was discussed.Methods A total of 381 patients with COVID-19 were admitted to Taikang Tongji(Wuhan)Hospital from February 13,2020 to March 30,2020.According to the level of hypersensitive troponin T,they were divided into myocardial injury group and non-myocardial injury group,and the basic clinical data of the two groups were compared to analyze the risk factors of myocardial injury.The possibility of direct myocardial injury caused by virus was understood by analyzing the abnormalities of different myocardial injury markers.Results Compared with the nonmyocardial injury group,the myocardial injury group was older(t=10.522,P=0.000),and more people were≥60 years old and complicated with underlying diseases(χ^2=46.559,P=0.000).In terms of clinical classification,there were mainly severe patients in the myocardial injury group and ordinary patients in the non-myocardial injury group,accounting for 53.38%and 72.98%,respectively.The abnormal degree of all kinds of laboratory indexes in the myocardial injury group was higher than that in the myocardial injury group(t=-11.571~4.881,χ^2=19.551585~186.858,U=-10.729~16.120,P=0.000).Chronic heart disease,D-Dimer≥500 ng/ml and procalcitonin≥0.05 ng/ml were independent risk factors for myocardial injury in COVID-19 patients(P<0.05).The proportion of abnormal myocardial injury markers of HSTNT,MYO and CK-MB was 34.91%,11.02%and 5.25%,respectively.The abnormal situation of myocardial injury markers in critical patients was more prominent,and most of them were patients with underlying diseases.The patients with abnormal myocardial injury markers were stratified according to the course of disease on admission.The number of abnormal HSTNT reached the peak at 41~60 days,while the number of abnormal MYO and CK-MB showed a downward trend as a whole.Conclusion SARS-CoV-2 is less likely to attack myocardial tissue directly.However,COVID-19 patients with myocardial injury are mainly elderly men over 60 years old,often complicated with hypertension,chronic cardiac,cerebrovascular and pulmonary diseases.At the same time,chronic heart disease,D-dimer and abnormal increase of procalcitonin are independent risk factors for myocardial injury,which can effectively evaluate the possibility of myocardial injury in patients with COVID-19 and take preventive protective treatment for heart,lung and other important organs,so as to effectively reduce mortality.