摘要
目的检测新型冠状病毒肺炎(COVID-19)患者血清心肌损伤标志物、凝血指标及炎性标志物的表达水平,探讨其在患者预后中的预测价值。方法回顾性分析2020年2月1日至3月31日收入华中科技大学同济医院中法新城院区的COVID-19患者67例,按照病情严重程度分为普通组(n=20)、重型组(n=20)及危重组(n=27),根据患者出院情况将危重组分为治愈(n=12)和死亡(n=15)。以患者好转出院或住院期间死亡作为观察终点。收集患者的临床资料,采集患者静脉血并检测其血液中超敏肌钙蛋白I(hs-cTnI)、肌红蛋白(MYO)、肌酸激酶同工酶MB(CK-MB)、N末端B型利钠肽原(NT-proBNP)、D-二聚体、凝血酶原时间(PT)、活化部分凝血活酶时间(APPT)、纤维蛋白原(FIB)、白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、铁蛋白水平,比较3组间的水平差异。采用多元logistic回归模型分析COVID-19住院患者死亡相关危险因素。结果3组患者的红细胞、血小板(PLT)、FIB、血红蛋白差异均无统计学意义(P>0.05),而普通组、重型组和危重组的WBC、hs-CRP、铁蛋白、PT、APPT及D-二聚体水平比较,差异有统计学意义(P<0.05),危重组高于重型组和普通组(P<0.05)。危重组患者NT-proBNP、CK-MB、MYO、hs-cTnI明显高于普通组及重型组,且危重型组中死亡患者NT-proBNP、CK-MB、MYO、hs-cTnI高于治愈患者(P均<0.05)。多元logistic回归分析结果显示,hs-cTnI(OR=1.053,95%CI 1.010~1.098,P=0.016)、D-二聚体(OR=1.253,95%CI 1.026~1.531,P=0.005)是COVID-19患者死亡的独立危险因素。结论COVID-19危重型患者在入院治疗过程中伴随着凝血功能障碍及炎症因子的升高并且存在着不同程度的心肌损伤,hs-cTnI、D-二聚体升高是COVID-19危重型患者死亡的独立危险因素。
Objective To study the novel coronavirus pneumonia(COVID-19)patients′serum myocardial injury markers,coagulation markers and inflammatory markers,and to explore their value in prognosis.Methods A retrospective study was performed on 67 patients with covid-19 admitted to Tongji Hospital of Huazhong University of Science and Technology from February 1,2020 to March 31,2020.According to the severity of the disease,they were divided into general group(n=20),severe group(n=20)and critical group(n=27).According to the discharge condition of the patients,the patients were divided into cure group(n=12)and death group(n=15),and the end point of observation was patients′improvement and discharge or death during hospitalization.The clinical data of the patients were collected,the venous blood was collected and the serum levels of hs-cTnI,MYO,CK-MB,NT-proBNP,D-dimer,WBC,PT,APPT,FIB,hs-CRP and ferritin were detected.The differences of the above indexes were compared among the three groups.Results There was no significant difference in Red Blood Cell,Platelet(PLT),FIB and hemoglobin among the three groups(P>0.05).However,the levels of WBC,hs-CRP,ferritin,PT,APPT and D-dimer in the normal group,the severe group and the critical recombination group were significantly different(P<0.05),and the critical recombination group was higher than that of the severe group and the ordinary group(P<0.05).NT-proBNP,CK-MB,MYO,hs-cTnI of critical patients were significantly higher than those of normal group and severe group,and pro BNP,CK-MB,MYO,hs-cTnI of death patients in critical severe group were higher than those of cured patients(all P<0.05).Multivariate logistic regression analysis showed that the increase of hs-cTnI(OR=1.053,95%CI 1.010-1.098,P=0.016)and D-dimer(OR=1.253,95%CI 1.026-1.531,P=0.005)were the risk factors of death in patients with COVID-19.Conclusion COVID-19 critical and severe patients were accompanied with coagulation dysfunction and the increase of inflammatory factors.There were different degrees of myocardial inju
作者
汤庆
李松
钟元锋
李晨
刘沛
田学文
蒋亚勇
刘为勇
孙自镛
管青
Tang Qing;Li Song;Zhong Yuanfeng;Li Chen;Liu Pei;Tian Xuewen;Jiang Yayong;Liu Weiyong;Sun Ziyong;Guan Qing(Department of Clinical Laboratory,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2020年第12期1212-1216,共5页
Chinese Journal of Laboratory Medicine
