新冠病毒相关心肌损伤超声心动图表现与中医证候的相关性分析

董竞方; 魏伟; 王朝歆; 王琳; 王鑫毅; 王湘竹

doi:10.3969/j.issn.2095-6606.2023.05.005

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新冠病毒相关心肌损伤超声心动图表现与中医证候的相关性分析

临床研究 | 更新时间：2023-10-12

- 新冠病毒相关心肌损伤超声心动图表现与中医证候的相关性分析
- Influencing factor of COVID-19-related myocardial injury with echocardiographic identification and the correlation between TCM syndromes and echocardiography
- 现代中医临床 2023年30卷第5期页码：24-29
- 作者机构：
  
  1.北京中医药大学第三附属医院　北京　100029
  2.北京中医药大学东方医院
  3.北京中医药大学东直门医院
- 作者简介：
  
  董竞方，女，博士，主治医师
  # 王湘竹，女，硕士，副主任医师，E-mail：wxzhyzx@126.com
- 基金信息：
  
  北京中医药大学新教师启动基金项目(2023－JYB-XJSJJ061)
- DOI：10.3969/j.issn.2095-6606.2023.05.005
  中图分类号： R256.2
- 纸质出版日期：2023-09-30，
  
  收稿日期：2023-02-10，
- 稿件说明：
移动端阅览
董竞方, 魏伟, 王朝歆, 等. 新冠病毒相关心肌损伤超声心动图表现与中医证候的相关性分析[J]. 现代中医临床, 2023,30(5):24-29.

DONG Jingfang, WEI Wei, WANG Chaoxin, et al. Influencing factor of COVID-19-related myocardial injury with echocardiographic identification and the correlation between TCM syndromes and echocardiography[J]. Modern Chinese Clinical Medicine, 2023,30(5):24-29.
董竞方, 魏伟, 王朝歆, 等. 新冠病毒相关心肌损伤超声心动图表现与中医证候的相关性分析[J]. 现代中医临床, 2023,30(5):24-29. DOI： 10.3969/j.issn.2095-6606.2023.05.005.

DONG Jingfang, WEI Wei, WANG Chaoxin, et al. Influencing factor of COVID-19-related myocardial injury with echocardiographic identification and the correlation between TCM syndromes and echocardiography[J]. Modern Chinese Clinical Medicine, 2023,30(5):24-29. DOI： 10.3969/j.issn.2095-6606.2023.05.005.

摘要

目的

探讨新冠病毒相关心肌损伤超声心动图表现与中医证候的相关性。

方法

回顾性分析北京中医药大学3家附属医院自2022年12月10日—2023年1月20日感染新冠病毒，并出现心悸、胸闷、胸痛等心脏相关症状的患者894例，参照临床管理专家建议的新型冠状病毒肺炎相关心肌损伤的诊断标准，采用单因素和多因素回归分析，评价新冠病毒相关心肌损伤引起的超声心动图表现与中医证候之间的相关性。

结果

单因素分析显示，超声心动图所见如心包积液、室壁厚度、室壁运动情况、左室收缩功能、左室舒张功能、左室大小、右室大小均与心肌损伤有关(

0.05)；多因素 logistic 回归分析显示，年龄、心包积液、左室舒张功能3个变量与心肌损伤有关(

0.05)，比较回归系数

值发现对判定心肌损伤的影响从大到小依次为：心包积液

左室舒张功能

年龄。对345例出现心肌损伤的患者进行中医辨证分型，分别有热毒侵心94例，痰热瘀互结114例，气阴两虚137例。三种中医证型的超声心动图表现进行比较，心包积液和左室大小差异有统计学意义(

0.05)。

结论

心包积液、左室舒张功能以及年龄是判定新冠病毒相关心肌损伤的独立影响因素，其中心包积液影响程度最高，对判定心肌损伤贡献最大。在心肌损伤患者中，中医证候与超声心动图表现具有一定相关性，可为临床后续中医治疗提供一定参考依据。

Abstract

Objective

To explore the correlation between the echocardiographic result of COVID-19-related myocardial injury and Traditional Chinese Medicine (TCM) syndromes differentiation.

Methods

Retrospective analysis was performed of 894 patients with COVID-19 infection and cardiac-related symptoms

admitted to the three affiliated hospitals of Beijing University of Chinese Medicine from December 10

2022 to January 20

2023. According to the diagnostic criteria for myocardial injury associated with COVID-19 recommended by clinical management experts

the relationship between echocardiographic result and TCM syndrome was explored with both single-factor analysis and multiple-factor logistic regression analysis.

Results

Univariate analysis showed that central distribution of effusion

ventricular wall thickness

ventricular wall motion

left ventricular systolic function

left ventricular diastolic function

left ventricular size

and right ventricular size were all associated with myocardial injury (

0.05). Multifactorial logistic regression analysis showed that age

central pericardial effusion and left ventricular diastolic function

were related to myocardial injury (

0.05). Comparison of regression coefficients or odds ratios reveals that the impact on determining myocardial injury decreases in the following order: pericardial effusion

left ventricular diastolic function

age. 345 patients with myocardial injury were classified by TCM syndromes: 94 cases of heat toxin invading the heart

114 cases of binding of phlegm-heat and blood stasis

and 137 cases of both qi and yin deficiency. The echocardiographic result of the three TCM syndromes were compared

and the differences in the presence of pericardial effusion and left ventricular size were statistically significant (

0.05).

Conclusion

Pericardial effusion

left ventricular diastolic function

and age are independent influencing factors for determining COVID-19-related myocardial injury

among which pericardial effusion is the most influential and has the greatest contribution to determining myocardial injury. In patients who have myocardial injuries

there is a certain correlation between TCM syndrome and echocardiography

which can provide a certain reference basis for subsequent treatment.

关键词

新型冠状病毒肺炎心肌损伤超声心动中医证候影响因素

Keywords

COVID-19myocardial injuryechocardiographyTCM syndromesinfluencing factors

references

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, 323(11): 1061-1069.

CHEN L，LI X，CHEN M, et al. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV－2[J]. Cardiovasc Res, 2020, 116(6): 1097-1100.

魏之瑶，钱海燕.新型冠状病毒肺炎患者的心肌损伤表现[J].中华心血管病杂志, 2020, 48(6): 439-442.

WONG C K，LAM C W K, WU A K L，et al. Plasma inflammatory cytokines and chemokines in severe acute respiratory syndrome[J]. Clin Exp Immunol, 2010, 136(1): 95-103.

CHANNAPPANAVAR R，PERLMAN S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology[J].Semin Immunopathol, 2017, 39(5): 529-539.

MAHALLAW W H，KHABOUR O F，ZHANG Q, et al. MERS-CoV infection in humans is associated with a pro-inflammatory Th1 and Th17 cytokine profile[J].Cytokine, 2018, 104: 8-13.

吴小平，王培利，王承龙.新型冠状病毒肺炎的心脏损害及对策探析[J].中国中西医结合杂志, 2020, 40(3): 275-278.

杨帆.超声心动图检查对应激性心肌病的诊断价值分析[J].临床研究, 2019, 27(8): 149-151.

朱慧，左后娟，马飞，等.二维斑点追踪超声心动图评价非缺血性心肌病和缺血性心肌病的左心室功能[J].中国动脉硬化杂志, 2021, 29(7): 595-599.

张彦萍，卫颖.超声心动图指标联合心肌损伤标志物对应激性心肌病的诊断价值分析[J].影像研究与医学应用, 2023, 7(6): 60-62.

汪芳，杨杰孚，郭颖，等.新型冠状病毒肺炎相关心肌损伤的临床管理专家建议(第一版)[J].中国循环杂志, 2020, 35(4): 326-330.

张航.基于数据挖掘的病毒性心肌炎中医证型分布及处方用药规律研究[D].武汉：湖北中医药大学，2022.

LIU Y，YANG Y，ZHANG C, et al. Clinical and biochemical indexes from 2019－nCoV infected patients linked to viral loads and lung injury[J].Sci China Life Sci, 2020, 63(3): 364-374.

项莹，付林，赵卉，等.144 例新型冠状病毒感染的肺炎患者的临床特点及转归[J].临床肺科杂志, 2020, 25(12): 1836-1841.

LU R，ZHAO X，LI J，et al.Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding[J].Lancet, 2020, 395(10224): 565-574.

XIAOBO YANG，YUAN YU，JIQIAN XU, et al. Clinical course and outcomes of critically ill patients with SARS-CoV－2 pneumonia in Wuhan，China: a single-centered，retrospective, observational study [J]. Observational Study Lancet Respir Med, 2020, 8(5): 475-481.

CHEN L, LI X, CHEN M, et al. The ACE2 expression in human heart indicates new potential mechanism of heart injury among patients infected with SARS-CoV－2[J]. Cardiovasc Res, 2020, 116(6): 1097-1100.

NANSHAN CHEN，MIN ZHOU，XUAN DONG, 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): 30211-30217.

郭宁，黄素兰.新型冠状病毒肺炎急性心肌损伤分析及其危险因素研究[J].现代医药卫生, 2021, 2(37): 388-395.

郦琳，唐宇俊，王俏，等.新冠肺炎引起心肌损伤的机制及其治疗探讨[J].浙江中医药大学学报, 2021, 45(4): 319-324.

YU C M, WONG R S, WU E B, et al. Cardiovascular complications of severe acute respiratory syndrome[J]. Postgrad Med J, 2006, 82(964): 140144.

GAO Q, HU Y, DAI Z, et al. The epidemiological characteristics of 2019 novel coronavirus diseases (COVID－19)in Jingmen，Hubei, China [J]. Medicine, 2020, 99(23): e20605.

刘茜，王荣帅，屈国强，等.新型冠状病毒肺炎死亡尸体系统解剖大体观察报告[J].法医学杂志, 2020, 36(1): 19-21.

国家技术监督局. 中华人民共和国国家标准·中医临床诊疗术语疾病部分[M].北京：中国标准出版社, 1997: 8.

中医临床诊疗术语疾病部分[J].成都中医药大学学报, 1999, 22(1): 62-63.

GUO T，FAN Y，CHEN M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol, 2020, 5(7): 811-818.

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