人民卫生出版社系列期刊
ISSN 2096-2738 CN 11-9370/R

中国科技核心期刊（中国科技论文统计源期刊）
2020《中国学术期刊影响因子年报》统计源期刊

新发传染病电子杂志

新发传染病电子杂志 ›› 2020, Vol. 5 ›› Issue (3): 159-164.doi: 10.19871/j.cnki.xfcrbzz.2020.03.004

• 论著 • 上一篇    下一篇

血清心肌损伤指标变化与新型冠状病毒肺炎重症风险的 相关性研究

林绿1, 刘夏2, 吴念宁2, 邹俊3, 蓝健2, 黄金萍2, 陈薪宇4, 黄妹青2   

  1. 1.南宁市第四人民医院,广西艾滋病临床治疗中心,广西医科大学附属南宁市传染病医院综合内科,南宁 530023;
    2.南宁市第四人民医院临床治疗中心,广西医科大学附属南宁市传染病医院感染科,南宁 530023;
    3.南宁市第四人民医院临床治疗中心,广西医科大学附属南宁市传染病医院院士工作站,南宁 530023;
    4.南宁市第四人民医院临床治疗中心,广西医科大学附属南宁市传染病医院肝病科,南宁 530023
  • 收稿日期:2020-08-15 出版日期:2020-03-20 发布日期:2020-10-12
  • 通讯作者: 刘夏,Email：m15296535011@163.com
  • 基金资助:
    1.“十三五”国家科技重大专项（2018ZX10302104-001）；2.中国工程院咨询研究项目（2020-XY-61-01）

Studies on the relationship between the changes in serum myocardial injury indicators and the risk of severe COVID-19

Lin Lyu1, Liu Xia2, Wu Nianning2, Zou Jun3, Lan Jian2, Huang Jinping2, Chen Xinyu4, Huang Meiqing2   

  1. 1. Department of General Medicine,the Fourth People's Hospital of Nanning, Guangxi AIDS Clinical Treatment Center, Infectious Disease Hospital affiliated to Guangxi Medical University, Nanning 530023, China;
    2. Department of Academician Workstation, the Fourth People's Hospital of Nanning, Guangxi AIDS Clinical Treatment Center, Infectious Disease Hospital affiliated to Guangxi Medical University, Nanning 530023, China;
    3. Department of Infectious Disease, the Fourth People's Hospital of Nanning, Guangxi AIDS Clinical Treatment Center, Infectious Disease Hospital affiliated to Guangxi Medical University, Nanning 530023, China;
    4. Department of Hepatology, the Fourth People's Hospital of Nanning, Guangxi AIDS Clinical Treatment Center, Infectious Disease Hospital affiliated to Guangxi Medical University, Nanning 530023, China
  • Received:2020-08-15 Online:2020-03-20 Published:2020-10-12

PDF

797

摘要： 目的 探讨新型冠状病毒肺炎（COVID-19）重症风险与乳酸脱氢酶（LDH-L）、肌酸激酶（CK）、肌酸激酶MB同工酶（CK-MB）、α羟基丁酸脱氢酶（α-HBDH）变化的相关性。方法 分析广西南宁市第四人民医院2020年1月18日至3月2日收治的58例COVID-19确诊患者的血清LDH-L、CK、CK-MB、α-HBDB与临床资料,根据《新型冠状病毒肺炎诊疗方案（试行第七版）》,将患者分为普通型（含轻型)、重型及危重型两组,收集患者心率与LDH-L、CK、CK-MB、HBDH各项生化指标及基本情况、临床资料,构建Logistic回归模型,分析上述指标对COVID-19是否构成的独立危险因素。结果 共有普通型（含轻型）51例、重型及危重型7例（其中重型4例,危重型3例）,单因素分析结果显示普通型（含轻型）与重型及危重型在男女比例上相近（86.21%比89.66%、13.79%比10.34%,χ2=0.162,P=0.687）,普通型（含轻型）以青壮年为主,而重型及危重型则年龄较大[（41.48±17.49）岁比（68.86±17.49）岁,t=-9.936, P<0.001];普通型（含轻型）少有心脑血管及糖尿病等并发症（占其23.53%）,而重型及危重型则占其85.71%,差异有统计学意义（P<0.001);两组在心率（t=-0.180,P=0.858）、CK-MB（t=-1.531,P=0.131）、CK（t=-1.449, P=0.197）方面差异均无统计学意义。在LDH[（200.67±49.44）U/L比（385.02±86.33）U/L,t=-5.527,P=0.001]、α-HBDH[（149.43±34.85）U/L比（289.15±56.70）U/L,t=-6.357,P<0.001]均具有统计学意义。单因素分析有意义的变量及临床判别为重要因素,经共线性检验分析、Spearman相关性分析选取可疑危险因素纳入多因素二元Logistic回归分析,经回归分析得出LDH-L为COVID-19重症的独立危险因素,其OR为1.037（95%CI=1.010~1.065,P=0.006）,预测的准确率为93.1%。结论 LDH-L是评估COVID-19的严重程度的独立危险因素,能够指导临床进行早期有效治疗。

关键词: 新型冠状病毒肺炎, 心肌酶, 临床分型, 独立危险因素

Abstract: Objective To investigate the relationship between the severity of COVID-19 and the changes of lactate dehydrogenase (LDH-L), creatine kinase (CK), creatine kinase MB isoenzyme (CK-MB), α-hydroxybutyrate dehydrogenase (α-HBDH) in vitro. Methods Retrospective analysis of serum LDH-L, CK, CK-MB, α-HBDB and clinical characteristics of 58 patients with confirmed COVID-19 admitted to the Fourth People's Hospital of Nanning, Guangxi from January 18th to March 2nd in 2020. According to COVID-19 diagnosis and treatment program (trial 7th edition), the patients were classified into two groups: common type (including mild type) group, severe type and critical type group. with following information obtained, including heart rate, LDH-L, CK, CK-MB, α-HBDH biochemical indexes, basic information, and clinical characteristics. A logistic regression model was built to analyze the independent risk factors for COVID-19. Results There were 51 cases of mild and common type, 7 cases of heavy and critical type (4 cases of heavy type and 3 cases of critical type). A single-factor analysis showed that the gender ratio of control group was similar between the common type (including mild type) and the heavy and critical type (86.21% vs 89.66%,13.79% vs 10.34%, χ2=0.162, P=0.687), The common type and mild type are mainly young adults, while the heavy and critical types are elders [(41.48±17.49)years old vs (68.86±17.49)years old, t=-9.936, P<0.001]; Fewer complications of cardiovascular and cerebrovascular diseases and diabetes were present in common and mild cases than that in heavy and critical types with significant difference by Fisher precision test (23.53 vs 85.71%, P<0.001).However, no significant difference was found in heart rate (t=-0.180, P=0.858), CK-MB (t=1.531, P=0.131), and CK (t=-1.449, P=0.197), but not for LDH [(200.67±49.44)U/L vs (385.02±86.33)U/L, t=-5.527, P=0.001], and α-HBDH [(149.43±34.85)U/L vs (289.15±56.70)U/L, t=-6.357, P<0.001]. The suspicious risk factors with significance selected by single factor analysis and clinical important discriminators were analyzed by collinearity analysis and spearman correlation analysis to select the suspicious risk factors for multivariate logistic regression analysis, which showed that LDH-L was an independent risk factor for the occurrence of COVID-19 with odds ratio of 1.037 (95% CI=1.010-1.065, P=0.006)and accuracy in prediction of 93.1%. Conclusion LDH-L is an independent risk factor for assessing the severity of the COVID-19, which can guide early effective treatment in the clinical scenarios.

Key words: Coronavirus disease 2019, Myocardial enzyme, Clinical classification, Independent risk factor

本系统由北京玛格泰克科技发展有限公司设计开发 技术支持：support@magtech.com.cn