实用医学杂志 ›› 2021, Vol. 37 ›› Issue (1): 6-10.doi: 10.3969/j.issn.1006⁃5725.2021.01.002

• 新型冠状病毒肺炎专栏 • 上一篇    下一篇

危重型新型冠状病毒肺炎心肌损伤与死亡的关系

李伶芝,何兵,张淑娣, 王世红, 张明霞, 赵庆彦   

  1. 武汉大学人民医院 1 儿科,2 神经外科,3 心内科(武汉 430060)
  • 出版日期:2021-01-10 发布日期:2021-01-10
  • 通讯作者: 赵庆彦 E⁃mail:ruyan71@163.com
  • 基金资助:
    国家自然科学基金项目(编号:81970277)

Association of myocardial damage with death in critical coronavirus disease 2019

LI Lingzhi,HE Bing,ZHANG Shudi,WANG Shihong,ZHANG Mingxia,ZHAO Qingyan
  

  1. Department of Pediatrics,Renmin Hospital,Wuhan University,Wuhan 430060,China
  • Online:2021-01-10 Published:2021-01-10
  • Contact: ZHAO Qingyan E⁃mail:ruyan71@163.com

摘要:

目的 分析危重型新型冠状病毒肺炎(corona virus disease 2019,COVID⁃19)患者心肌损伤与 死亡的关系。方法 选取 2020 2 1 日至 3 25 日武汉大学人民医院东院确诊的 113 例危重型 COVID⁃ 19 病例。根据预后将患者分为死亡组与存活组。采用单因素分析比较两组患者各临床特征的差异。 采用受试者工作特征曲线(ROC)分析心肌损伤标志物对危重症 COVID⁃19 患者死亡的预测能力。结果 113 例危重型 COVID⁃19 患者中男 68 例,女 45 例。平均年龄(67.25 ± 14.06)岁(29 ~ 95 岁)。在单因素分析 中,年龄> 70 岁、高血压、冠心病、体温> 39 ℃,在死亡组的比例明显高于存活组,差异有统计学意义(P < 0.05)。多因素Cox回归分析显示,超敏肌钙蛋白I(Hs⁃TnI)> 0.04 μg/L(HR = 2.10,95% CI:1.13 ~ 3.91)、肌红 蛋白(MYO)> 100 μg/L(HR = 2.14,95% CI:1.15 ~ 3.97),白细胞计数(WBC)> 9.5 × 109 /L(HR = 2.18,95% CI 1.20 ~ 3.98)是危重症COVID⁃19患者死亡的独立危险因素。ROC曲线分析显示心肌损伤标志物Hs⁃TnI、CK⁃ MB、MYO对危重症COVID⁃19患者死亡风险评估具有较好的预测作用(P < 0.05)。结论 危重型COVID⁃19 患者合并心肌损伤时病死率更高。心肌损伤标志物 Hs⁃TnI、CK⁃MB、MYO 对危重症 COVID⁃19 患者死亡风

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Abstract:

Objective To analyze the relationship between myocardial damage and death in critical coronavirus disease 2019(COVID⁃19). Methods A total of 113 critical COVID⁃19 patients were selected in our hospital from February 1,2020 to March 25,2020. Univariate analyses were used to compare two groups(death group and survival group). Then,the receiver operating characteristic curve(ROC)was performed to assess the predictive value of myocardial injury markers for death. Results A total of 113 critical patients with COVID ⁃19 were recruited,including 68 male and 45 female. The mean age was(67.25 ± 14.06)years,ranging from 29 to 95 years. In univariate analysis,the following factors had significant differences between death group and survival group(P < 0.05):Age > 70 years,hypertension,coronary heart disease and body temperature > 39℃. Multivariate analysis showed hypersensitive troponin I(Hs⁃TnI)greater than 0.04 μg/L(HR = 2.10,95% CI:1.13 ~ 3.91), myoglobin(MYO)greater than 100 μg/L(HR = 2.14,95% CI:1.15 ~ 3.97),and white blood cell count(WBC greater than 9.5 × 109 /L(HR = 2.18,95% CI:1.20 ~ 3.98)were the independent predictors of mortality in COVID⁃19. ROC curve showed myocardial injury markers Hs⁃TnI,CK⁃MB,and MYO had excellent predictive significance for the risk of death in critical COVID ⁃ 19(P < 0.05). Conclusions Critical COVID ⁃ 19 patients with myocardial damage had a high fatality. The myocardial injury markers Hs⁃TnI,CK⁃MB,and MYO had excellent predictive significance for the risk of death in critical COVID⁃19. It is of important significance in early discovering predictive information,assessing risks of death,

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