新型冠状病毒肺炎合并心血管疾病患者临床特征与预后影响因素分析

doi:10.3969/j.issn.1006-6233.2020.06.004

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摘要目的:总结分析我院收治的新型冠状病毒肺炎(COVID-19)合并心血管疾病(CVD)患者的临床特征。方法:回顾性分析首都医科大学附属北京佑安医院感染科2020年1月21日至2020年2月24日期间收治的COVID-19合并CVD患者的临床资料,收集并分析一般人口学资料、流行病学、临床特点、实验室检测指标、治疗和转归情况,最后随访日期为3月5日。结果:普通型11例,重型9例,危重型10例。男14例、女16例,年龄46~94岁,平均年龄(71.1±13.2)岁,危重型患者的平均年龄显著高于普通型及重型患者(P<0.05)。40.0%的患者至少存在一种基础疾病,危重组患者合并脑血管疾病、慢性阻塞性肺疾病的比例显著高于普通型及重型患者(P均<0.05)。发热是最常见的临床表现,大部分患者有咳嗽咳痰、呼吸困难,本组病例肌肉酸痛、鼻塞流涕症状较少。实验室检查80.0%的患者出现淋巴细胞计数(L)减少,大部分患者出现不同程度的白蛋白(ALB)下降、C反应蛋白(CRP)升高和凝血酶原活动度(PTA)的下降,危重型患者L、动脉氧分压(PaO₂)、血氧饱和度(SPO₂)显著低于普通型患者,而中性粒细胞/淋巴细胞比值(NLR)、CRP、心肌酶谱则显著高于普通型患者(P均<0.05)。本组30例患者中并发急性呼吸窘迫综合征7例、休克5例。重型、危重型患者接受糖皮质激素、抗生素、白蛋白治疗以及各种合并症的发生率均明显高于普通型患者(P均<0.05)。截止2020年3月5日治愈出院23例,在院3例,死亡4例。死亡组患者年龄、NLR、血钠(Na)、肌钙蛋白I(TNI)以及并发急性呼吸窘迫综合征、休克、急性心肌损伤的比例显著高于存活组(P均<0.05)。结论:COVID-19合并CVD病情重、预后欠佳,高龄、高NLR、高钠血症和合并症可能是预后不良的危险因素。

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关键词 ：新型冠状病毒肺炎, 心血管疾病, 临床特征

Abstract：Objective: To summarize and analyze the clinical characteristics of patients with COVID-19 combined with cardiovascular disease (CVD) treated in our hospital. Methods: Retrospective analysis of the clinical data of COVID-19 patients with CVD admitted to the Department of Infectious Diseases, Beijing You'an Hospital, Capital Medical University from January 21, 2020 to February 24, 2020. General demographic data, epidemiology, clinical characteristics, laboratory testing indicators, treatment and outcomes were collected and analyzed. The last follow-up date was March 5. Results: There were 11 cases of common type, 9 cases of severe type, and 10 cases of critical type. 14 males and 16 females, aged 46~94 years, with an average age of (71.1±13.2) years, the mean age of critically ill patients was significantly higher than that of common and severe patients (P<0.05). 40.0% of patients had at least one underlying disease, and the proportion of critically ill patients with cerebrovascular disease and chronic obstructive pulmonary disease was significantly higher than that of common and severe patients (all P<0.05). Fever was the most common clinical manifestation. Most patients had cough, sputum, and dyspnea. In this group of patients, there were fewer symptoms of muscle soreness and nasal congestion. Laboratory tests showed that 80.0% of patients had a decrease in lymphocyte count (L), and most patients experienced varying degrees of albumin (ALB) decline, increased C-reactive protein (CRP), and decreased prothrombin activity (PTA). L, arterial oxygen pressure (PaO₂), and blood oxygen saturation (SPO₂) of critically ill patients were significantly lower than those of common patients, while neutrophil / lymphocyte ratio (NLR), CRP, and myocardial enzymes were significantly higher in common patients (all P<0.05). Of the 30 patients in this group, 7 with acute respiratory distress syndrome and 5 with shock. Severe and critically ill patients receiving glucocorticoids, antibiotics, albumin, and the incidence of various comorbidities were significantly higher than that of common patients (all P<0.05). As of March 5, 2020, 23 patients have been discharged from hospital, 3 have been hospitalized, 4 have died. The age, NLR, serum sodium (Na), troponin I (TNI) and the proportion of patients with acute respiratory distress syndrome, shock and acute myocardial injury in the death group were significantly higher than those in the survival group (all P<0.05). Conclusion: COVID-19 with CVD is severe and has a poor prognosis. Old age, high NLR, hypernatremia, and comorbidities may be risk factors for poor prognosis.

Key words： COVID-19 Cardiovascular diseases Clinical characteristics

基金资助:中国初级卫生保健基金会佑安医学发展基金,(编号:BJYAYY-2020PY-03)

通讯作者: 黄晓婕

引用本文:

李爱新, 梁连春, 李侗曾, 潘闻, 黄晓婕. 新型冠状病毒肺炎合并心血管疾病患者临床特征与预后影响因素分析[J]. 河北医学, 2020, 26(6): 897-904.
LI Aixin, LIANG Lianchun, LI Tongzeng, et al. Analysis of Clinical Characteristics and Prognostic Factors in COVID-19 Patients with Cardiovascular Disease. HeBei Med, 2020, 26(6): 897-904.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2020.06.004 或 http://www.hbyxzzs.cn/CN/Y2020/V26/I6/897

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