新冠肺炎临床轻症患者冠心病及其危险因素临床特征

张权宇; 杨哲然; 李毅; 彭程飞; 于浩; 唐裕福; 滕玥; 史亮; 马壮; 韩雅玲

doi:10.12125/j.chj.202004025

新冠肺炎临床轻症患者冠心病及其危险因素临床特征

Coronary heart disease and its risk factors in COVID-19 patients with mild symptoms: clinical characteristics summary

摘要

摘要:
目的了解武汉火神山医院首批次诊断为新型冠状病毒肺炎普通型及重型患者，入院时临床表现为轻症患者冠心病病史及相关危险因素情况分析。
方法回顾性分析2020年2月武汉火神山医院开诊后首批次由外院转入的新型冠状病毒肺炎确诊患者共计65人的病史及检验资料。患者转入我院前确诊的临床分型为普通型（34例）及重型（31例），全部患者临床症状表现均为轻症患者。通过问诊及电子病历系统收集患者的现病史、既往病史以及实验室化验资料，包括了肌酸激酶（Creatine Kinase，CK）、肌酸激酶同工酶（creatine kinase isoenzymes，CK-MB）、D-二聚体、血浆白蛋白及总蛋白等。
结果 65位入选患者早期出现症状到入院的中位数时间为14 d，年龄(54 ± 12)岁，其中男性39例；我们分析了患者中冠心病、糖尿病、高血压、吸烟等4项指标，将其命名为“冠心病及危险因素综合定义”。共有27例患者符合至少其中一条定义，占全部患者的42%，其中诊断为重型的患者中符合上述综合定义有15例，普通症12例。高血压患者治疗药物中使用钙通道阻滞剂11例（占61%），使用血管紧张素转换酶抑制剂（ACEI）/血管紧张II受体拮抗剂（ARB）8例（44%）。糖尿病患者为7例。入院后16例检测CK及CK-MB的患者中，CK异常率为25%，CK-MB未见异常。27例检测D-二聚体患者中11例异常升高（占41%）。17例测定了脑钠尿肽（Brain natriuretic peptide，BNP），均无异常。28例获得血浆白蛋白及总蛋白结果，其中白蛋白24例异常降低（占86%），总蛋白21例异常降低（占75%）。全部65例患者经住院期治疗后均治愈出院。
结论首批入院武汉火神山医院诊断为普通型及重型，表现为临床轻症的新型冠状病毒肺炎患者，虽冠心病及其危险因素疾病负担较重，但住院期未观察到较严重的不良事件，与既往文献报道的危重型新冠肺炎患者并发心血管疾病的预后情况有所不同。

Abstract:
AIM To analyze coronary heart disease and risk factors of initial COVID-19 patients admitted in Wu Han Huo Shen-Shan hospital. To evaluate cardiovascular diagnosis types in patients with COVID-19 patients and outcomes.
METHODS Medical history and laboratory data of a total of 65 initial COVID-19 patients admitted in Wu Han Huo Shen-Shan hospital were retrospectively analyzed. All patients had mild symptoms whose type of diagnosis were common (34 patients) and severe (31 patients). Current and past medical histories were collected by inquiry and electronic medical record systems. Laboratory data included CK, CK-MB, D-dimers, plasma albumin and total rotein.
RESULTS of the 65 total patients, the median time from early symptoms to hospitalization was 14 days. Demographics included age 54±12 years with 39 males. The present investigation defined “comprehensive definition of coronary heart disease and risk factors” as to evaluate cardiovascular risk in patients, which was a composite of coronary heart disease or diabetes mellitus or hypertension or smoking. There were 27 patients who met the definition with a ratio of 42%. 15 patients were severe type and 12 patients were common. In hypertensive patients, utilization of calcium antagonists was 11 patients (61%), ACEI/ARB was 8 patients (44%). 7 patients had diabetes mellitus. Among the 16 patients who tested CK and CK-MB after admission, CK abnormal rate was 25% and normal in CK-MB. Among the 27 patients who tested D-dimers, 11 patients were abnormal, the rate was 41%. There were 17 patients tested BNP with no abnormal. Among the 27 patients who tested plasma albumin and total protein, 24 patients’ plasma albumin were abnormal, the rate was 86%, 21 patients’ plasma total protein were abnormal, the rate was 75%. All 65 patients recovered and were discharged.
CONCLUSION There were a high level of “comprehensive definition of coronary heart disease and risk factors” in the 65 first group COVID-19 patients admitted in Wu Han Huo Shen-Shan hospital, and all patients recovered. The results of this investigation suggest that COVID-19 patients with common or severe diagnose type complicated with coronary heart disease and its risk factors overall have a good prognosis once hospitalized.

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