适龄人群感染新型冠状病毒Delta变异株后心肌损伤发病率及疫苗保护作用的研究

目的通过分析接种新型冠状病毒疫苗对普通适龄人群感染Delta变异株后心肌损伤发病率的影响，明确其临床价值。 方法采用回顾性病例对照研究的方法，依据确诊病例是否发生心肌损伤，将2021年7月至8月收治于南京市公共卫生医疗中心的288例新型冠状病毒Delta变异株感染确诊病例分为心肌损伤组（40例）和对照组（248例）。比较两组患者的临床资料，通过多因素Logistic回归分析明确相关因素对患者发生心肌损伤的影响程度，并对可能出现的重要风险因素建立受试者工作特征（ROC）曲线模型，进一步分析其临床意义。 结果心肌损伤组和对照组患者在性别构成（χ² = 5.810，P = 0.016）、年龄（t = 2.850，P = 0.005）、体质量指数（t = 2.316，P = 0.021）、患有高血压（χ² = 11.782，P = 0.001）、患有糖尿病（χ² = 6.921，P = 0.009）、完成疫苗接种（χ² = 7.196，P = 0.007）、超敏C反应蛋白（Z = 3.745，P < 0.001）、白细胞介素6（IL-6）（Z = 3.649，P < 0.001）、肺部CT有炎症表现（χ² = 4.140，P = 0.042）、合并肝功能损伤（χ² = 9.454，P = 0.002）比较，差异均有统计学意义。多因素Logistic回归分析结果显示，高血压[风险比（HR）= 2.872，95%置信区间（CI）（1.104，7.471），P = 0.031]、IL-6升高[HR = 1.024，95%CI（1.005，1.043），P = 0.014]和合并肝功能损伤[HR = 2.680，95%CI（1.046，6.865），P = 0.040]为Delta变异株感染患者发生心肌损伤的危险因素，而完成疫苗接种[HR = 0.246，95%CI（0.097，0.623），P = 0.003]是其保护因素。ROC曲线分析结果显示，IL-6[曲线下面积（AUC）= 0.680，95%CI（0.586，0.773），P < 0.001]对Delta变异株感染患者发生心肌损伤具有预测价值，其最佳预测阈值为3.69 ng/L，敏感度87.5%，特异度46.0%。 结论高血压、IL-6升高和合并肝功能损伤可显著增加普通适龄人群感染Delta变异株后心肌损伤的发病率，其中IL-6可作为一项早期识别心血管系统并发症的预测因子，而完成疫苗接种是此类人群有效的保护性因素。

Effect of severe acute respiratory syndrome coronavirus 2 vaccine on the incidence of myocardial injury after infecting Delta variant in people of appropriate age

ObjectiveTo analyze the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine on the incidence of myocardial injury after infecting Delta variant in people of appropriate age. MethodsA total of 288 patients with SARS-CoV-2 Delta variant infection, who admitted to Nanjing Public Health Medical Center from July to August 2021, were divided into two groups according to whether or not the cases had myocardial injury: the myocardial injury group (n = 40) and the control group (n = 248). The differences of clinical data between the two groups were analyzed using the method of retrospective case-control study. The multivariate Logistic regression analysis was performed to determine the influence of related factors on the occurrence of myocardial injury in these patients. The receiver operating charac teristic (ROC) curve model was established to further analyze the clinical significance of the possible important risk factors. ResultsThere were significant differences in gender (χ² = 5.810, P = 0.016), age (t = 2.850, P = 0.005), body mass index (t = 2.316, P = 0.021), hypertension (χ² = 11.782, P = 0.001), diabetes (χ² = 6.921, P = 0.009), completion of vaccination (χ² = 7.196, P = 0.007), hypersensitive C-reactive protein (Z = 3.745, P < 0.001), interleukin-6 (IL-6) (Z = 3.649, P < 0.001), CT manifestations of inflammatory lung disease (χ² = 4.140, P = 0.042), and concomitant liver dysfunction (χ² = 9.454, P = 0.002) in two groups. The results of multivariate Logistic regression analysis showed that hypertension[hazard ratio (HR) = 2.872, 95% confidence interval (CI) (1.104, 7.471), P = 0.031], increased IL-6 [HR = 1.024, 95%CI (1.005, 1.043), P = 0.014], and concomitant liver dysfunction [HR = 2.680, 95%CI (1.046, 6.865), P = 0.040] were risk factors for myocardial injury in patients with Delta variant infection, while completion of vaccination[HR = 0.246, 95%CI (0.097, 0.623), P = 0.003] was its protective factor. The ROC curve model showed that the level of IL-6 [area under the curve (AUC) = 0.680, 95%CI (0.586, 0.773), P < 0.001] had a predictive value for myocardial injury in patients with Delta variant infection, and the optimal threshold of IL-6 was 3.69 ng/L (sensitivity 87.5%, specificity 46.0%). ConclusionsHypertension, increased IL-6 and concomitant liver dysfunction significantly raise the incidence of myocardial injury after infecting Delta variant in people of appropriate age. IL-6 can be used as a predictor for early identification of cardiovascular complications, and completion of vaccination is an effective protective factor in such population.