Tong Yuwei, Xie Zhiwei, Li Yueping, Lyu Mingfang, Deng Xilong, Zhang Fuchun, Lei Chunliang
Department of Internal Medicine, the Eighth People's Hospital of Guangzhou, Guangzhou 510000, Guangdong, China.
Department of Intensive Care Unit, the Eighth People's Hospital of Guangzhou, Guangzhou 510000, Guangdong, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Feb;33(2):229-232. doi: 10.3760/cma.j.cn121430-20200527-00415.
To investigate the cardiac presentations and the possible influencing factors of severe and critical coronavirus disease 2019 (COVID-19).
A retrospective study was conducted. Patients with severe and critical COVID-19 admitted to the Eighth People's Hospital of Guangzhou from January 21st to February 24th 2020 were enrolled. According to the clinical classification, the patients were divided into severe group and critical group. The myocardial injury markers, such as lactate dehydrogenase (LDH), aspartate aminotransferase (AST), creatine kinase (CK), cardiac troponin I (cTnI), myoglobin (MYO), MB isoenzyme of creatine kinase (CK-MB), B-type natriuretic peptide (BNP) and electrocardiogram (ECG) changes were compared between the two groups.
A total of 55 COVID-19 patients were selected, including 15 critical cases and 40 severe cases. The patients with severe and critical COVID-19 were male-dominated (61.8%), the average age was (61.2±13.0) years old, 83.6% (46 cases) of them had contact history of Hubei, 38.2% (21 cases) of them were complicated with hypertension. There was no significant difference in baseline data between the critical group and the severe group. Myocardial injury markers of critical and severe COVID-19 patients were increased in different proportion, LDH increased in most patients (20 severe cases and 7 critical cases), followed by AST (16 severe cases and 5 critical cases). There was significant difference in the number of patients with elevated CK between severe group and critical group (cases: 1 vs. 4, P = 0.027). Abnormal ECG was found in 39 of 42 patients with ECG examination. Nonspecific change of T wave was the most common. Before and after treatment, 9 of 15 patients with changes of ECG and myocardial injury markers had oxygenation index less than 100 mmHg (1 mmHg = 0.133 kPa), and the prominent changes of ECG were heart rate increasing and ST-T change.
The increase of myocardial injury markers and abnormal ECG were not specific to the myocardial injury of severe and critical COVID-19 patients. At the same time, the dynamic changes of myocardial injury markers and ECG could reflect the situation of myocardial damage.
探讨重型和危重型新型冠状病毒肺炎（COVID-19）的心脏表现及可能的影响因素。
进行一项回顾性研究。纳入2020年1月21日至2月24日在广州市第八人民医院收治的重型和危重型COVID-19患者。根据临床分类，将患者分为重型组和危重组。比较两组患者的心肌损伤标志物，如乳酸脱氢酶（LDH）、天门冬氨酸氨基转移酶（AST）、肌酸激酶（CK）、心肌肌钙蛋白I（cTnI）、肌红蛋白（MYO）、肌酸激酶同工酶MB（CK-MB）、B型利钠肽（BNP）以及心电图（ECG）变化。
共入选55例COVID-19患者，其中危重症15例，重症40例。重型和危重型COVID-19患者以男性为主（61.8%），平均年龄为（61.2±13.0）岁，83.6%（46例）有湖北接触史，38.2%（21例）合并高血压。危重组与重型组的基线资料无显著差异。重型和危重型COVID-19患者的心肌损伤标志物不同程度升高，多数患者LDH升高（重症20例，危重症7例），其次为AST（重症16例，危重症5例）。重型组与危重组CK升高患者数量有显著差异（例数：1比4，P = 0.027）。42例行心电图检查的患者中39例心电图异常。T波非特异性改变最为常见。治疗前后，15例心电图和心肌损伤标志物有变化的患者中9例氧合指数低于100 mmHg（1 mmHg = 0.133 kPa），心电图的显著变化为心率增快和ST-T改变。
心肌损伤标志物升高和心电图异常并非重型和危重型COVID-19患者心肌损伤所特有。同时，心肌损伤标志物和心电图的动态变化可反映心肌损伤情况。
