新冠患者心肌损伤并非心肌炎!武汉一线医生研究称,表明病情严重

2020-04-22 朱朱 中国循环杂志

近期,来自武汉大学人民医院的一线医生发表的一项研究表明,在新冠肺炎患者中出现的心肌损伤,更可能是新冠病毒对整个机体影响的后果,而不是其对心肌的直接损伤。

近期,来自武汉大学人民医院的一线医生发表的一项研究表明,在新冠肺炎患者中出现的心肌损伤,更可能是新冠病毒对整个机体影响的后果,而不是其对心肌的直接损伤。
 
这些患者心脏损伤标志物的升高很有可能继发于全身功能障碍,可考虑作为近期预后不良的警示指标。
 
该研究回顾性收集了112例新冠肺炎患者资料。患者平均年龄为65岁,52%有基础疾病,其中32%合并高血压,17%合并糖尿病,13.4%合并冠心病。60%的患者为重症患者。
 
研究者发现,新冠肺炎患者中确实存在心肌损伤的证据,12.5%的患者出现类似心肌炎的异常表现,包括CK-MB和NT-proBNP水平升高。但超声心动图和心电图没有发现心肌炎的典型征象。
 
大多数新冠肺炎患者入院时心肌肌钙蛋白是正常的,但住院期间有37.5%的患者肌钙蛋白水平升高,且死亡患者中多见,在他们去世前一周肌钙蛋白I水平升高明显,平均在去世前2天达到峰值。
 
13.4%的患者有肺动脉高压的体征。
 
研究者指出,新冠肺炎患者去世前出现心肌损伤和心衰表现,可能与严重缺氧诱导心肌缺血、机械通气或体外膜肺氧合(ECMO)治疗、需要肾脏或肝脏替代治疗的多器官功能衰竭、严重水电解质紊乱或不可逆转的代谢性酸中毒、凝血系统功能障碍等有关。
 
这些因素可能会心脏产生严重影响,从而导致继发性的心肌损伤和心衰。
 
为了改善新冠患者的治疗和预后,一旦其病情变重,比如血氧饱和度下降,就应该监测心脏损伤标志物水平。
 
来源:Suspected myocardial injury in patients with COVID-19: Evidence from front-line clinical observation in Wuhan, China. Int J Cardiol, 2020 Apr 7.

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    2020-04-22 公卫新人

    新冠肺炎,疫情何时才能消失

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