【摘要】 目的 评估中性粒细胞与淋巴细胞比值(NLR)是否可以作为感染新型冠状病毒(COVID-19)住院患者心肌损伤的预测指标。方法 连续选取141例确诊的感染COVID-19住院患者,依据肌钙蛋白是否升高分为心肌损伤组(21例)和非心肌损伤组(120例)。收集患者临床、实验室检查等资料,通过多元Logistic回归模型评估感染COVID-19住院患者心肌损伤的危险因素,绘制受试者工作特征曲线(ROC),评估COVID-19感染患者预后的独立预测因子。结果 本研究最终共入选141例COVID-19感染患者,男75例(53.2%)；平均年龄(56.1±17.8)岁；发生心肌损伤21例(14.9%),构成心肌损伤组,其余120例(85.1%)构成非心肌损伤组。心肌损伤组患者年龄(70.6±19.7)岁显著高于非心肌损伤组的(53.5±16.3)岁,差异有统计学意义(P<0.05)。心肌损伤组白细胞计数为8.45(4.96, 11.96)×10~9/L、中性粒细胞计数为6.95(5.03, 9.20)×10~9/L、NLR为6.38(5.12, 8.33)、C反应蛋白(CRP)水平为63.7(21.6,98.5)mg/L、脑钠肽(BNP)水平为786.8(302.1, 1238.4)pg/ml、肌酸激酶(CK)水平为122.7(105.8, 135.1)mmol/L、肌酸激酶同工酶(CK-MB)水平为54.3(50.2, 80.1)mmol/L、肾小球滤过率(GFR)<60 ml/min比例为14.3%,显著高于非心肌损伤组的4.76(3.66, 6.37)×10~9/L、3.88(2.65, 5.37)×10~9/L、2.08(1.25, 3.25)、31.5(12.2,71.2)mg/L、343.7(279.7, 408.3)pg/ml、25.6(11.1, 37.7)mmol/L、16.3(9.7, 21.4)mmol/L、1.7%,血红蛋白水平(116.1±2.5)g/L显著低于非心肌损伤组的(120.4±2.7)g/L,差异有统计学意义(P<0.05)。两组患者性别、糖尿病、高血压、高血脂、吸烟及既往脑血管疾病(CVD)、Ⅰ型呼吸衰竭、Ⅱ型呼吸衰竭比例比较,差异无统计学意义(P>0.05)。两组患者肌酐、淋巴细胞计数、血小板计数、甘油三酯(TC)、总胆固醇(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P>0.05)。两组患者使用血管紧张素Ⅱ受体拮抗剂(ARB)、二氢吡啶类钙通道阻滞剂(CCB)、β受体阻滞剂、他汀、利尿药、阿司匹林、抗病毒药比例比较差异无统计学意义(P>0.05)。心肌损伤组重症肺炎和死亡率比例高于非心肌损伤组,但差异无统计学意义(P>0.05)。通过多元Logistic回归模型评估NLR与心肌损伤的关系,结果显示,年龄、NLR、CRP和BNP是COVID-19感染患者心肌损伤的独立预测因子。进一步通过ROC曲线显示, NLR对COVID-19感染患者心肌损伤具有良好预测效能[ROC曲线下面积(AUC)为0.756, 95%CI=(1.238, 14.345)]。结论 心肌损伤在COVID-19感染患者中并不少见,提示不良预后。NLR有望作为评估COVID-19住院患者心肌损伤简单易行的预测因子。更多还原

【Abstract】 Objective To evaluate whether neutrophil-to-lymphocyte ratio(NLR) can be used as a predictor of myocardial injury in hospitalized patients with Corona Virus Disease 2019(COVID-19) infection.Methods A total of 141 hospitalized patients diagnosed with COVID-19 infection were divided into myocardial injury group(21 cases) and non-myocardial injury group(120 cases) according to whether troponin was elevated.The clinical and laboratory data of the patients were collected, and risk factors for myocardial injury in hospitalized patients with COVID-19 infection were evaluated by multivariate Logistic regression models, and the receiving operating characteristic curves(ROCs) were drawn to assess independent predictors of prognosis of patients with COVID-19 infection. Results A total of 141 patients with COVID-19 infection were finally enrolled in this study, 75 cases(53.2%) were male; the mean age was(56.1±17.8) years; 21 cases(14.9%) had myocardial injury and were included as the myocardial injury group, and the remaining 120 cases(85.1%) were included in the non-myocardial injury group. The age of patients in the myocardial injury group was(70.6±19.7) years,which was significantly higher than(53.5±16.3) years in the non-myocardial injury group, and the difference was statistically significant(P<0.05). In the myocardial injury group, the leukocyte count was 8.45(4.96, 11.96)×10~9/L,neutrophil count was 6.95(5.03, 9.20)×10~9/L, NLR was 6.38(5.12, 8.33), C-reactive protein(CRP) level was 63.7(21.6, 98.5) mg/L, brain natriuretic peptide(BNP) level was 786.8(302.1, 1238.4) pg/ml, creatine kinase(CK)level was 122.7(105.8, 135.1) mmol/L, creatine kinase isoenzyme(CK-MB) level was 54.3(50.2, 80.1) mmol/L and the proportion of estimated glomerular filtration rate(GFR) < 60 ml/min was 14.3%, which were significantly higher than(4.76(3.66, 6.37)×10~9/L, 3.88(2.65, 5.37)×10~9/L, 2.08(1.25, 3.25), 31.5(12.2, 71.2) mg/L,343.7(279.7, 408.3) pg/ml, 25.6(11.1, 37.7) mmol/L, 16.3(9.7, 21.4) mmol/L, 1.7% in non-myocardial injury group; the hemoglobin level of myocardial injury group was(116.1±2.5) g/L, which was significantly lower than(120.4±2.7) g/L of non-myocardial injury group; the differences were statistically significant(P<0.05). There was no statistically significant difference between the two groups in the comparison of gender, proportions of diabetes mellitus, hypertension, hyperlipidemia, smoking, previous cerebrovascular disease(CVD), type Ⅰ respiratory failure and type Ⅱ respiratory failure(P>0.05). There was no statistically significant difference between the two groups in the comparison of creatinine, lymphocyte count, platelet count, triglyceride(TC), total cholesterol(TG),low density lipoprotein cholesterol(LDL-C) and high density lipoprotein cholesterol(HDL-C) levels(P>0.05).There was no statistically significant difference between the two groups in the proportions of angiotensin Ⅱreceptor blockers(ARBs), dihydropyridine calcium channel blockers(CCBS), β-blockers, statins, diuretics,aspirin and antiviral drugs(P>0.05). The proportion of severe pneumonia and mortality in myocardial injury group was higher than that in non-myocardial injury group, but the difference was not statistically significant(P>0.05).The correlation between NLR and myocardial injury was assessed by multivariate Logistic regression model,which showed that age, NLR, CRP and BNP were independent predictors of myocardial injury in patients with COVID-19 infection. It was further shown by ROC curves that NLR had good predictive efficacy for myocardial injury in patients with COVID-19 infection [area under the curve(AUC) of 0.756, 95%CI=(1.238, 14.345)].Conclusion Myocardial injury is common in COVID-19 infection patients, suggesting a poor prognosis. NLR might act as a simple and facile predictor for assessing myocardial injury in COVID-19 patients.更多还原