Email Alert | RSS

北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (3): 420-424. doi: 10.19723/j.issn.1671-167X.2020.03.004

• 论著 • 上一篇    下一篇

合并高血压、冠心病、糖尿病的新型冠状病毒肺炎患者发生病死的危险因素分析

杨航1,杨林承2,张瑞涛2,凌云鹏1,△(),葛庆岗3,△()   

  1. 1. 北京大学第三医院 心脏外科,北京 100191
    2. 北京大学第三医院 心血管内科,北京 100191
    3. 北京大学第三医院 危重医学科,北京 100191
  • 收稿日期:2020-04-13 出版日期:2020-06-18 发布日期:2020-06-30
  • 通讯作者: 凌云鹏,葛庆岗 E-mail:micsling@163.com;qingganggelin@126.com

Risks factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes

Hang YANG1,Lin-cheng YANG2,Rui-tao ZHANG2,Yun-peng LING1,△(),Qing-gang GE3,△()   

  1. 1. Department of Cardiac Surgery
    2. Department of Cardiology
    3. Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-04-13 Online:2020-06-18 Published:2020-06-30
  • Contact: Yun-peng LING,Qing-gang GE E-mail:micsling@163.com;qingganggelin@126.com

RICH HTML

   

PDF (PC)

摘要：

目的 新型冠状病毒肺炎(corona virus disease 2019,COVID-19)相关心肌损伤的发病机制尚不清楚,对结局的影响证据尚不充分,本研究旨在探讨合并高血压、冠心病、糖尿病的COVID-19患者发生病死的可能危险因素。方法 本研究为单中心回顾性研究,分析了北京大学援鄂国家医疗队于2020年1月29日至2020年3月10日在武汉华中科技大学同济医学院附属同济医院中法新城院区收治的COVID-19患者。鼻咽拭子标本检测COVID-19病毒核酸阳性以及合并高血压和/或糖尿病和/或冠心病为纳入标准,收集符合条件的患者的临床资料和实验室检查结果,评估COVID-19患者发生病死的相关因素。结果 共有94例患者纳入本研究中,其中存活患者81例,病死患者13例,平均年龄 66.7 岁。入院生命体征:与存活组患者相比,病死组患者基础心率较快(103.2次/min vs. 88.4次/min, P=0.004), 呼吸急促(29.0次/min vs. 20.0次/min, P<0.001)。血常规提示:病死组患者中性粒细胞计数较高(9.2×109/L vs. 3.8×109/L, P<0.001), 淋巴细胞计数较低(0.5×109/L vs. 1.1×109/L, P<0.001)。心肌损伤标记物提示:病死组患者肌酸激酶同工酶MB(creatine kinase MB,CK-MB;3.2 μg/L vs. 0.8 μg/L, P<0.001)、高敏肌钙蛋白Ⅰ (high sensitivity cardiac troponinⅠ,hs-cTNⅠ; 217.2 ng/L vs. 4.9 ng/L, P<0.001)、N末端B型利钠肽原(N-terminal pro brain natriuretic peptide,NT-proBNP; 945.0 μg/L vs. 154.0 μg/L, P <0.001)较高。炎症因子提示:病死组患者铁蛋白(770.2 μg/L vs. 622.8 μg/L, P =0.050)、白细胞介素-2受体(interleukin-2 recepter,IL-2R;1 586.0 U/mL vs. 694.0 U/mL, P <0.001)、白细胞介素-6(interleukin-6,IL-6; 82.3 ng/L vs. 13.0 ng/L, P <0.001)、白细胞介素-10(interleukin-10,IL-10; 9.8 ng/L vs. 5.0 ng/L, P <0.001)较高。单因素Logistic回归分析发现:高龄、不吸氧血氧饱和度低、淋巴细胞计数低、发生心肌损伤、IL-2R、IL-6、IL-10指标异常升高是COVID-19患者合并高血压、冠心病、糖尿病病死的相关因素。多因素Logistic回归分析发现:高龄(OR=1.11, 95%CI =1.03~1.19, P =0.026)、不吸氧血氧饱和度低(OR=0.85, 95% CI =0.72~0.99, P =0.041)、IL-10异常(>9.1 ng/L;OR=101.93, 95%CI =4.74~2190.71, P =0.003)是COVID-19患者合并高血压、冠心病、糖尿病病死的独立危险因素。结论 高龄、不吸氧血氧饱和度低、淋巴细胞计数低、发生心肌损伤、IL-2R、IL-6、IL-10指标异常升高是COVID-19患者合并高血压、冠心病、糖尿病病死的相关因素;高龄、不吸氧血氧饱和度低、IL-10异常(>9.1 ng/L)是COVID-19患者合并高血压、冠心病、糖尿病病死的独立危险因素。

关键词: 新型冠状病毒肺炎, 高血压, 糖尿病, 冠心病, 危险因素

Abstract:

Objective: The pathogenesis of myocardial injury upon corona virus disease 2019 (COVID-19) infection remain unknown,evidence of impact on outcome is insufficient, therefore, we aim to investigate the risk factors for death among COVID-19 patients combined with hypertension, coronary heart disease or diabetes in this study.Methods: This was a single-centered, retrospective, observational study. Patients of Sino-French Eco-City section of Tongji Hospital, Wuhan, China attended by Peking University Supporting Medical Team and admitted from Jan. 29, 2020 to Mar. 20, 2020 were included. The positive nucleic acid of COVID-19 virus and combination with hypertension, coronary heart disease or diabetes were in the standard. We collected the clinical data and laboratory examination results of the eligible patients to evaluate the related factors of death.Results: In the study, 94 COVID-19 patients enrolled were divided into the group of death (13 cases) and the group of survivors (81 cases), the average age was 66.7 years. Compared with the survival group, the death group had faster basal heart rate(103.2 beats/min vs. 88.4 beats /min, P=0.004), shortness of breath(29.0 beats /min vs. 20.0 beats /min, P<0.001), higher neutrophil count(9.2×109/L vs. 3.8×109/L, P<0.001), lower lymphocyte count(0.5×109/L vs. 1.1×109/L, P<0.001), creatine kinase MB(CK-MB, 3.2 μg/L vs. 0.8 μg/L, P<0.001), high sensitivity cardiac troponin Ⅰ(hs-cTnⅠ, 217.2 ng/L vs. 4.9 ng/L, P<0.001), N-terminal pro brain natriuretic peptide(NT-proBNP; 945.0 μg/L vs. 154.0 μg/L, P<0.001), inflammatory factor ferritin(770.2 μg/L vs. 622.8 μg/L , P=0.050), interleukin-2 recepter(IL-2R, 1 586.0 U/mL vs. 694.0 U/mL, P<0.001), interleukin-6(IL-6, 82.3 ng/L vs. 13.0 ng/L, P<0.001), interleukin-10(IL-10, 9.8 ng/L vs. 5.0 ng/L, P<0.001)were higher than those in the survival group. Univariate logistic regression analysis showed that the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, abnormal increase of IL 2R, IL-6, and IL-10. Multivariate regression showed that old age (OR=1.11, 95%CI=1.03-1.19, P=0.026), low non oxygen saturation(OR=0.85, 95%CI=0.72-0.99, P=0.041), and abnormal increase of IL-10(>9.1 ng/L, OR=101.93, 95%CI=4.74-2190.71, P=0.003)were independent risk factors for COVID-19 patients combined with hypertension, coronary heart disease or diabetes.Conclusion: In COVID-19 patients combined with hypertension, coronary heart disease or diabetes, the risk factors for death were old age, low non oxygen saturation, low lymphocyte count, myocardial injury, and abnormal increase of IL-2R, IL-6, and IL-10. Old age, low non oxygen saturation and abnormal increase of IL-10 were independent risk factors.

Key words: COVID-19, Hypertension, Coronary heart disease, Diabetes, Risk factors

中图分类号: 

  • R563.1

表1

COVID-19患者合并症情况"

Items Death group
(n=13)		 Survival group
(n=81)
Hypertension 7 47
Diabetes 2 3
CHD 0 6
Hypertension & diabetes 1 13
Hypertension & CHD 1 4
Diabetes & CHD 1 1
Hypertension & diabetes & CHD 1 7

表2

人口统计学信息和基本资料"

Items Death group(n=13) Survival group(n=81) t/Z/χ2 P
General information
Age/years, M(IQR) 77.0 (67.5, 83.0) 66.0 (59.0, 72.5) -2.894 0.731
Male, n(%) 8 (61.5) 37 (45.7) 1.129 0.288
Vital signs on admission
Heart rate/(beats/min), x?±s 103.2±15.8 88.4±16.7 2.997 0.004
Systolic pressure/mmHg, M(IQR) 135.0 (109.0, 161.5) 140.0 (125.0, 149.5) -0.526 0.599
Diastolic pressure (mmHg), x?±s 84.6±15.7 84.0±13.1 0.156 0.876
Respiratory rate/(beats/min), M(IQR) 29.0 (24.0, 30.0) 20.0 (20.0, 24.0) -3.689 <0.001
SpO2/%, M(IQR) 89.0 (78.5, 94.5) 96.0 (94.0, 98.0) -3.232 1.000
Complete blood count
WBC (×109/L), M(IQR) 10.2 (6.3, 14.7) 5.6 (4.5, 7.8) -3.242 1.000
Neutrophil (×109/L), M(IQR) 9.2 (5.5, 13.9) 3.8 (2.7, 5.9) -3.510 <0.001
Lymphocyte (×109/L), M(IQR) 0.5 (0.3, 0.7) 1.1 (0.7, 1.5) -3.719 <0.001
Creatinine/(μmol/L), M(IQR) 86.0 (73.5, 112.5) 74.0 (57.0, 92.0) -1.807 0.073
Biomarkers of myocardial injury
CK-MB/(μg/L), M(IQR) 3.2 (2.3, 6.9) 0.8 (0.5, 1.0) -4.196 <0.001
hs-cTNⅠ/(ng/L), M(IQR) 217.2 (34.4, 4037.4) 4.9 (2.5, 13.9) -4.513 <0.001
NT-proBNP/(μg/L), M(IQR) 945.0 (518.5, 3 464.0) 154.0 (75.0, 415.3) -4.111 <0.001
Myocardial injury, n(%) 10 (76.9) 13 (16.0) 22.461 <0.001
Cytokines
Ferritin/(μg/L), M(IQR) 770.2 (598.0, 2 172.0) 622.8 (385.3, 1 162.7) -2.180 0.050
IL-2R/(U/mL), M(IQR) 1 586.0 (1 253.0, 2 364.0) 694.0 (425.0, 1 054.5) -3.740 <0.001
IL-6/(ng/L), M(IQR) 82.3 (37.8, 164.8) 13.0 (4.0, 39.4) -3.960 <0.001
IL-8/(ng/L), M(IQR) 29.1 (16.2, 52.4) 12.4 (7.0, 21.3) -2.551 0.160
IL-10/(ng/L), M(IQR) 9.8 (6.8, 17.9) 5.0 (5.0, 5.5) -4.376 <0.001
TNF-α/(ng/L), M(IQR) 13.3 (7.2, 17.4) 8.8 (5.7, 12.3) -2.202 0.051

表3

病死因素的Logistic回归分析"

Items Univariate analysis Multivariate analysis
OR(95%CI) P OR(95%CI) P
Age/years 1.11 (1.03, 1.19) 0.004 1.18 (1.02, 1.36) 0.026
Male 1.90 (0.57, 6.32) 0.293 0.16 (0.02, 1.55) 0.113
Hypertension (No vs. Yes) 0.47 (0.11, 2.00) 0.307
Diabetes (No vs. Yes) 1.48 (0.44, 5.00) 0.524
CHD (No vs. Yes) 1.05 (0.26, 4.23) 0.945
SpO2/% 0.89 (0.83, 0.96) 0.001 0.85 (0.72, 0.99) 0.041
Neutrophil (×109/L) 1.05 (0.98, 1.11) 0.155
Lymphocyte (×109/L) 0.03 (0.00, 0.30) 0.003
Creatinine/(μmol/L) 1.00 (0.99, 1.01) 0.897
Myocardial injury 17.44 (4.21, 72.1) <0.001 11.77 (0.93, 148.87) 0.057
Ferritin>400 μg/L 5.36 (0.66, 43.48) 0.116
IL-2R>710 U/mL 5.64 (1.18, 27.05) 0.031
IL-6>35 ng/L 8.40 (2.12, 33.33) 0.002
IL-8>62 ng/L 4.73 (0.71, 31.52) 0.109
IL-10>9.1 ng/L 14.60 (3.84, 55.46) <0.001 101.93 (4.74, 2 190.71) 0.003
TNF-α>8.1 ng/L 1.71 (0.49, 6.02) 0.402
[1] Xu X, Chen P, Wang J, et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission[J]. Sci China Life Sci, 2020,63(3):457-460.
pmid: 32009228
[2] Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020,395(10223):497-506.
doi: 10.1016/S0140-6736(20)30183-5 pmid: 31986264
[3] Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study[J]. Lancet, 2020,395(10229):1054-1062.
pmid: 32171076
[4] Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China[J]. JAMA, 2020, 2(2020-02-07)[2020-04-06]. https://jamanetwork.com/journals/jama/fullarticle/2761044.
[5] Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018)[J]. J Am Coll Cardiol, 2018,72(18):2231-2264.
[6] Chan JWM, Ng CK, Chan YH, et al. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS)[J]. Thorax, 2003,58(8):686-689.
pmid: 12885985
[7] Booth CM, Matukas LM, Tomlinson GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area[J]. JAMA, 2003,289(21):2801-2809.
pmid: 12734147
[8] Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis[J]. Int J Infect Dis, 2016,49:129-133.
[9] Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor[J]. Cell, 2020,181(2):271-280.
doi: 10.1016/j.cell.2020.02.052 pmid: 32142651
[10] Hamming I, Timens W, Bulthuis M, et al. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis[J]. J Pathol, 2004,203(2):631-637.
[11] Keidar S, Kaplan M, Gamliellazarovich A, et al. ACE2 of the heart: From angiotensin Ⅰ to angiotensin (1-7)[J]. Cardiovasc Res, 2007,73(3):463-469
pmid: 17049503
[12] Clerkin KJ, Fried JA, Raikhelkar J, et al. Corona virus disease 2019 (COVID-19) and cardiovascular disease[J]. Circulation, 2020, 3(2020-03-21)[2020-04-07]. https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.120.046941.
[13] Guan W, Ni Z, Hu Y, et al. Clinical characteristics of corona virus disease 2019 in China[J]. N Engl J Med, 2020,382(18):1708-1720.
[14] Hu H, Ma F, Wei X, et al. Coronavirus fulminant myocarditis saved with glucocorticoid and human immunoglobulin[J]. Eur Heart J, 2020, (2020-03-16)[2020-04-08]. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184348.
pmid: 32562486
[15] Sala S, Peretto G, Gramegna M, et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection[J] Eur Heart J, 2020, 4(2020-04-08)[2020-04-10]. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa286/5817735.
[16] Chen Z, Hu Y, Xiong T, et al. IL-10 promotes development of acute respiratory distress syndrome via inhibiting differentiation of bone marrow stem cells to alveolar type 2 epithelial cells[J]. Eur Rev Med Pharmacol Sci, 2018,22:6085-6092.
[17] Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology[J]. Semin Immunopathol, 2017,39(5):529-539.
[18] Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J]. Lancet, 2020,395(10223):507-513.
doi: 10.1016/S0140-6736(20)30211-7 pmid: 32007143
[19] Watts ER, Walmsley SR. Inflammation and Hypoxia: HIF and PHD Isoform Selectivity[J]. Trends Mol Med, 2019,25(1):33-46.
[20] Campbell EL, Bruyninckx WJ, Kelly CJ, et al. Transmigrating neutrophils shape the mucosal microenvironment through localized oxygen depletion to influence resolution of inflammation[J]. Immunity, 2014,40(1):66-77.
[1] 魏慧, 张警丰, 姚中强, 赵金霞. 类风湿关节炎合并慢性病贫血患者的临床特征及相关因素[J]. 北京大学学报（医学版）, 2026, 58(2): 307-312.
[2] 赵杰, 付春, 赵秀娟, 薛海岩, 李纾, 王振洲, 朱凤雪. 胸部创伤患者在重症监护病房内发生呼吸机相关性肺炎的危险因素[J]. 北京大学学报（医学版）, 2026, 58(2): 351-358.
[3] 郭芷均, 俎明, 马超, 张贺军, 张静, 丁士刚. 同时性多发早期胃癌漏诊病灶的临床病理特征[J]. 北京大学学报（医学版）, 2026, 58(2): 410-415.
[4] 闵鹤葳, 吴一波, 史宇晖, 李明子, 孙昕霙. 基于健康行动过程取向模型分析2型糖尿病患者膳食模式及血糖控制的影响因素[J]. 北京大学学报（医学版）, 2025, 57(6): 1145-1152.
[5] 顾静妍, 李欣艺, 赵金霞, 穆荣. 误诊为类风湿关节炎、痛风的糖尿病致Charcot关节病1例[J]. 北京大学学报（医学版）, 2025, 57(6): 1193-1197.
[6] 曹沛, 栾庆先. 牙周炎与全身系统性疾病的思考与探索[J]. 北京大学学报（医学版）, 2025, 57(5): 852-858.
[7] 李博闻, 张强, 孙益鑫. 儿童及青年漏斗胸患者Nuss术后发生脊柱侧弯的风险预测模型建立及验证[J]. 北京大学学报（医学版）, 2025, 57(5): 941-946.
[8] 杨小勇, 张帆, 马潞林, 刘承. 前列腺导管腺癌临床特征及腺外侵犯的影响因素[J]. 北京大学学报（医学版）, 2025, 57(5): 956-960.
[9] 刘伟, 郭稳, 过哲, 李春艳, 李云龙, 刘思奇, 张亮, 宋慧. 痛风患者放射学阴性骨侵蚀的相关危险因素[J]. 北京大学学报（医学版）, 2025, 57(4): 735-739.
[10] 陆梦溪, 刘秋萍, 周恬静, 刘晓非, 孙烨祥, 沈鹏, 林鸿波, 唐迅, 高培. 基于社区人群队列的甘油三酯-葡萄糖指数与心血管病发病和死亡的关联[J]. 北京大学学报（医学版）, 2025, 57(3): 430-435.
[11] 陈子砚, 张晓悦, 顾亦梧, 常春. 2型糖尿病患者使用E-health管理疾病意愿与影响机制[J]. 北京大学学报（医学版）, 2025, 57(3): 522-528.
[12] 杨龙傲, 金旭, 黄文初, 何丽华, 陈娟. 视屏作业人员视疲劳及干眼的流行病学调查[J]. 北京大学学报（医学版）, 2025, 57(3): 554-561.
[13] 郭华秋, 王哲, 杨雪, 白洁. 口腔急诊出血患者的临床特征与危险因素[J]. 北京大学学报（医学版）, 2025, 57(1): 142-147.
[14] 邓敏婷, 王楠, 夏斌, 赵玉鸣, 朱俊霞. 儿童及青少年挫入恒前牙自行再萌出的相关影响因素[J]. 北京大学学报（医学版）, 2025, 57(1): 148-153.
[15] 李钰锴, 王红彦, 罗靓, 李云, 李春. 抗磷脂抗体在白塞病合并血栓中的临床意义[J]. 北京大学学报（医学版）, 2024, 56(6): 1036-1040.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部