心脏生物标志物与 COVID-19：系统评价和荟萃分析。
Cardiac biomarkers and COVID-19: A systematic review and meta-analysis.
机构信息
Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
Department of Central China Research Institute of Health, Xinxiang Medical University, Xinxiang, China.
出版信息
J Infect Public Health. 2021 Sep;14(9):1191-1197. doi: 10.1016/j.jiph.2021.07.016. Epub 2021 Jul 29.
OBJECTIVE
To systematically investigate the relationship between cardiac biomarkers and COVID-19 severity and mortality.
METHODS
We performed a literature search using PubMed, Web of Science, and Google Scholar. The standardized mean difference (SMD) and 95% confidence interval (CI) were applied to estimate the combined results of 67 studies. A meta-analysis of cardiac biomarkers was used to evaluate disease mortality and severity in COVID-19 patients.
RESULTS
A meta-analysis of 7812 patients revealed that patients with high levels of cardiac troponin I (SMD = 0.81 U/L, 95% CI = 0.14-1.48, P = 0.017), cardiac troponin T (SMD = 0.78 U/L, 95% CI = 0.07-1.49, P = 0.032), high-sensitive cardiac troponin I (SMD = 0.66 pg/mL, 95% CI = 0.51-0.81, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.93 U/L, 95% CI = 0.21-1.65, P = 0.012), creatine kinase-MB (SMD = 0.54 U/L, 95% CI = 0.39-0.69, P < 0.001), and myoglobin (SMD = 0.80 U/L, 95% CI = 0.57-1.03, P < 0.001) were associated with prominent disease severity in COVID-19 infection. Moreover, 9532 patients with a higher serum level of cardiac troponin I (SMD = 0.51 U/L, 95% CI = 0.37-0.64, P < 0.001), high-sensitive cardiac troponin (SMD = 0.51 ng/L, 95% CI = 0.29-0.73, P < 0.001), high-sensitive cardiac troponin I (SMD = 0.51 pg/mL, 95% CI = 0.38-0.63, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.85 U/L, 95% CI = 0.63-1.07, P < 0.001), creatine kinase-MB (SMD = 0.48 U/L, 95% CI = 0.32-0.65, P < 0.001), and myoglobin (SMD = 0.55 U/L, 95% CI = 0.45-0.65, P < 0.001) exhibited a prominent level of mortality from COVID-19 infection.
CONCLUSION
Cardiac biomarkers (cardiac troponin I, cardiac troponin T, high-sensitive cardiac troponin, high-sensitive cardiac troponin I, high-sensitive cardiac troponin T, creatine kinase-MB, and myoglobin) should be more frequently applied in identifying high-risk COVID-19 patients so that timely treatment can be implemented to reduce severity and mortality in COVID-19 patients.
目的
系统研究心脏生物标志物与 COVID-19 严重程度和死亡率之间的关系。
方法
我们使用 PubMed、Web of Science 和 Google Scholar 进行文献检索。应用标准化均数差（SMD）和 95%置信区间（CI）来估计 67 项研究的综合结果。心脏生物标志物的荟萃分析用于评估 COVID-19 患者的疾病死亡率和严重程度。
结果
对 7812 名患者的荟萃分析表明，心肌肌钙蛋白 I 水平较高的患者（SMD=0.81 U/L，95%CI=0.14-1.48，P=0.017）、心肌肌钙蛋白 T（SMD=0.78 U/L，95%CI=0.07-1.49，P=0.032）、高敏心肌肌钙蛋白 I（SMD=0.66 pg/mL，95%CI=0.51-0.81，P<0.001）、高敏心肌肌钙蛋白 T（SMD=0.93 U/L，95%CI=0.21-1.65，P=0.012）、肌酸激酶-MB（SMD=0.54 U/L，95%CI=0.39-0.69，P<0.001）和肌红蛋白（SMD=0.80 U/L，95%CI=0.57-1.03，P<0.001）与 COVID-19 感染的显著疾病严重程度相关。此外，在 9532 名血清心肌肌钙蛋白 I 水平较高的患者中（SMD=0.51 U/L，95%CI=0.37-0.64，P<0.001）、高敏心肌肌钙蛋白（SMD=0.51 ng/L，95%CI=0.29-0.73，P<0.001）、高敏心肌肌钙蛋白 I（SMD=0.51 pg/mL，95%CI=0.38-0.63，P<0.001）、高敏心肌肌钙蛋白 T（SMD=0.85 U/L，95%CI=0.63-1.07，P<0.001）、肌酸激酶-MB（SMD=0.48 U/L，95%CI=0.32-0.65，P<0.001）和肌红蛋白（SMD=0.55 U/L，95%CI=0.45-0.65，P<0.001）表现出 COVID-19 感染死亡率的显著水平。
结论
心脏生物标志物（心肌肌钙蛋白 I、心肌肌钙蛋白 T、高敏心肌肌钙蛋白、高敏心肌肌钙蛋白 I、高敏心肌肌钙蛋白 T、肌酸激酶-MB 和肌红蛋白）应更频繁地用于识别高危 COVID-19 患者，以便及时实施治疗，降低 COVID-19 患者的严重程度和死亡率。
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