新型冠状病毒肺炎患者心脏损伤的临床特征

目的 分析新型冠状病毒肺炎患者的临床特点、心脏损伤特点及发生重型的预警指标,为新型冠状病毒肺炎患者的病情评估、临床救治及预后提供资料。 方法 选择2020年1月在深圳市第三人民医院住院的新型冠状病毒肺炎患者139例,依据国家卫生健康委和广东省卫生健康委的新型冠状病毒肺炎诊断标准,分为2组,第1组26例为（危）重型,第2组113例为普通型,分析两组间临床及实验室指标的差异性,特别是心脏方面的表现。 结果 139例新型冠状病毒肺炎患者中,有心脏基础疾病的患者22例,（危）重型9例（40.91%）;无心脏基础疾病的患者117例,（危）重型17例（14.53%）,差异有统计学意义。（危）重型较普通型患者更易出现咳嗽、咳痰、肌肉酸痛/乏力、腹泻、呼吸困难症状。（危）重型患者的天门冬氨酸氨基转移酶、血清乳酸脱氢酶、D-二聚体、C-反应蛋白、白介素-6比普通型患者高,辅助性T淋巴细胞、杀伤性T淋巴细胞比普通型低,差异有统计学意义（P<0.05）,（危）重型与普通型患者间新型冠状病毒肺炎核酸滴度差异无统计学意义。心脏特异性酶学（肌酸激酶同工酶、肌钙蛋白I）异常、心脏彩超异常的例数均较少,心电图以P波振幅增高、PTfV1值异常、T波低平或倒置改变为主。 结论 新型冠状病毒肺炎患者可出现多种血清酶学、细胞因子、炎症因子的改变,（危）重型患者天门冬氨酸氨基转移酶、血清乳酸脱氢酶、D-二聚体、C-反应蛋白、白介素-6比普通型患者高,辅助性T淋巴细胞、杀伤性T淋巴细胞低于普通型患者。有心脏基础疾病的患者更易进展为（危）重型。心脏特异性酶学、心电图、心脏彩超异常病例少,但部分患者进展快、可发展为暴发性心肌炎。

Clinical characteristics of cardiac injury in patients with COVID-19

Objective To analyze the clinical characteristics, cardiac injury characteristics and early warning indexes of severe type in patients with COVID-19, so as to provide data for the evaluation, clinical treatment and prognosis of COVID-19 patients. Methods A total of 139 patients with COVID-19 hospitalized in The third People's Hospital of Shenzhen in January 2020 were divided into two groups, according to the COVID-19 diagnostic criteria of National Health Commission and Guangdong Provincial Health Commission. The first group (n = 26) was severe type, and the second group (n = 113) was moderate type. The differences of clinical and laboratory indexes between the two groups, especially the cardiac manifestations, were analyzed. Results Among the 139 patients with COVID-19, there were 22 patients with basic heart disease, 9 patients with severe type(40.91%), and there were 117 patients without basic heart disease, 17 patients with severe type(14.53%). The difference was statistically significant. Severe patients were more likely to have cough, expectoration,myalgia / fatigue , diarrhea and dyspnea than moderate patients. Aspartate aminotransferase, lactate dehydrogenase, D-dimer, C-reactive protein and interleukin-6 of severe patients were higher than those of moderate patients, while T-helper lymphocyte subsets and T-killer lymphocyte subsets of severe patients were lower than those of moderate patients. The difference was statistically significant (P <0.05). There was no significant difference in COVID-19 nucleic acid titer between severe patients and moderate patients. There were few cases of abnormal cardiac specific enzymes (creatine kinase-MB, troponin I) and ultrasonic cardiogram, and the electrocardiogram mainly showed increased amplitude of P wave, abnormal value of PTFV1, low flat or inverted T wave. Conclusion There are many changes of serum enzymes, cytokines and inflammatory factors in patients with COVID-19. Aspartate aminotransferase, lactate dehydrogenase, D-dimer, C-reactive proteinand interleukin-6 in severe patients are higher than those in patients with moderate type, while T-helper lymphocyte subsets and T-killer lymphocyte subsets are lower than those in patients with moderate type. Patients with basic heart disease are more likely to progress to severe type. There are few cases of abnormal cardiac specific enzymes, electrocardiogram and ultrasonic cardiogram, but some patients progress rapidly and develop into fulminant myocarditis.