危重型新型冠状病毒肺炎患者心肌肌钙蛋白及D-二聚体水平与病死率的Meta分析

doi:10.3969/j.issn.1004-583X.2022.04.001

摘要/Abstract

摘要：

目的评价危重型新型冠状病毒肺炎(COVID-19)患者心肌肌钙蛋白(cTn)及D-二聚体(D-D)水平与病死率的相关性。方法检索PubMed、万方期刊数据库、中国知网、维普中文科技期刊数据库等,搜集以COVID-19与cTn为主题的相关研究。检索时限均为2020年1月1日-2021年12月31日。由2名评价员独立筛选文献、提取资料,采用RevMan 5.3软件进行Meta分析,结果用RR及其95%CI表示。结果纳入分析的文献为15篇,纽卡斯尔-渥太华质量评估量表(NOS)评分均≥6分,涉及患者7 290例,均为确诊的危重型COVID-19住院患者,死亡组1 820例,存活组5 470例。Meta分析结果显示,cTn水平升高的COVID-19患者病死率更高(RR=3.13,95%CI=2.13-4.62,Z=5.76,P<0.01),D-D水平升高的COVID-19患者病死率也较高,差异有统计学意义(RR=1.69,95%CI=1.27-2.26,Z=3.60,P=0.0003)。性别亚组分析的结果显示COVID-19死亡患者中男性居多,表明COVID-19男性患者的病死率更高(P<0.01)。结论 cTn及D-D水平升高的危重型COVID-19患者更易死亡,cTn及D-D与危重型COVID-19患者的病死率具有相关性。

关键词: 新型冠状病毒肺炎, 心肌肌钙蛋白, D-二聚体, 病死率, Meta分析

Abstract:

Objective To evaluate the correlation between cardiac troponin (cTn) and D-dimer (D-D) levels and mortality in coronavirus disease 2019 (COVID-19) critical illness patients. Methods We searched related researches using COVID-19 and cTn as keyword in PubMed, Wanfang Journal Database, CNKI, VIP Chinese Scientific and Technological Periodical Database (VIP), etc., the period is from January 1, 2020 to December 31, 2021. Two reviewers independently conducted this work. We performed Meta-analysis using RevMan5.3 software, and the results were expressed as relative risk (RR) and its 95% confidence interval (CI). Results There were eligible15 literatures in the analysis, the Newcastle-Ottawa Quality Assessment Scale(NOS) scores were ≥6, and involving 7290 inpatients with COVID-19 critical illness, of which 1820 as the death group and 5470 as the survival group. Meta-analysis results showed that both elevated cTn level (RR=3.13, 95%CI=2.13-4.62, Z=5.76, P<0.01) and up-regulated D-D level (RR=1.69, 95%CI=1.27-2.26, Z=3.60, P=0.0003) of COVID-19 patients had obviously higher mortality. The results of gender subgroup analysis indicated that the mortality of COVID-19 male patients was more prevalent (P<0.01). Conclusion For COVID-19 critical illness patients, both elevated cTn level and up-regulation D-D level are more likely to rise mortality.

Key words: COVID-19, cardiac troponin, D-dimer, mortality, meta analysis

中图分类号:

R563.12

郭茹, 刘芮宏, 蔺雪峰, 韩轩茂, 张柱, 陈瑞英. 危重型新型冠状病毒肺炎患者心肌肌钙蛋白及D-二聚体水平与病死率的Meta分析[J]. 临床荟萃, 2022, 37(4): 293-298.

Guo Ru, Liu Ruihong, Lin Xuefeng, Han Xuanmao, Zhang Zhu, Chen Ruiying. Correlation between cardiac troponin and D-dimer levels and mortality in COVID-19 critical illness patients: A meta analysis[J]. Clinical Focus, 2022, 37(4): 293-298.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.04.001

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I4/293

图/表 7

参考文献 36

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纳入研究	发表年份	国家	研究总人数	cTn截止值	样本量(例)		cTn升高人数(例)
纳入研究	发表年份	国家	研究总人数	cTn截止值	死亡组	幸存组	死亡组	幸存组
Si et al^[15]	2020	中国	1 159	>26.2 pg/ml	186	973	121/186	49/973
Pan et al^[16]	2020	中国	124	>19.3 μg/ml	89	35	41/89	15/35
Shi et al^[17]	2020	中国	671	>0.04 ng/ml	62	609	47/62	59/609
Mikami et al^[18]	2020	纽约	2 820	>0.03 ng/ml	806	2 014	504/718	410/1 108
Du et al^[19]	2020	中国	179	≥0.05 ng/ml	21	158	13/21	28/158
Chen et al^[20]	2020	中国	274	15.6 pg/ml	113	161	68/94	15/109
王朗等^[21]	2020	中国	202	>0.04 μg/L	33	169	17/33	10/169
贺行巍等^[22]	2020	中国	54	>34.3 ng/L	26	28	18/26	6/28
章晋辉等^[23]	2021	中国	30	>0.014 ng/ml	18	12	14/18	2/12
李伶芝等^[24]	2021	中国	113	>0.04 μg/L	50	63	43/50	30/63
Maino et al^[25]	2021	意大利	60	/	32	28	17/32	10/28
Mohamed Ali et al^[26]	2021	迪拜	745	≥52 ng/L	130	615	34/130	42/615
Singh et al^[27]	2021	美国	144	/	38	106	31/38	79/106
Chen et al^[28]	2021	中国	174	>28 pg/ml	127	47	46/108	9/39
Alkindi et al^[29]	2021	阿曼	541	>14 ng/L	89	452	68/89	103/452

纳入研究	发表年份	国家	研究总人数	cTn截止值	样本量(例)		cTn升高人数(例)
纳入研究	发表年份	国家	研究总人数	cTn截止值	死亡组	幸存组	死亡组	幸存组
Si et al^[15]	2020	中国	1 159	>26.2 pg/ml	186	973	121/186	49/973
Pan et al^[16]	2020	中国	124	>19.3 μg/ml	89	35	41/89	15/35
Shi et al^[17]	2020	中国	671	>0.04 ng/ml	62	609	47/62	59/609
Mikami et al^[18]	2020	纽约	2 820	>0.03 ng/ml	806	2 014	504/718	410/1 108
Du et al^[19]	2020	中国	179	≥0.05 ng/ml	21	158	13/21	28/158
Chen et al^[20]	2020	中国	274	15.6 pg/ml	113	161	68/94	15/109
王朗等^[21]	2020	中国	202	>0.04 μg/L	33	169	17/33	10/169
贺行巍等^[22]	2020	中国	54	>34.3 ng/L	26	28	18/26	6/28
章晋辉等^[23]	2021	中国	30	>0.014 ng/ml	18	12	14/18	2/12
李伶芝等^[24]	2021	中国	113	>0.04 μg/L	50	63	43/50	30/63
Maino et al^[25]	2021	意大利	60	/	32	28	17/32	10/28
Mohamed Ali et al^[26]	2021	迪拜	745	≥52 ng/L	130	615	34/130	42/615
Singh et al^[27]	2021	美国	144	/	38	106	31/38	79/106
Chen et al^[28]	2021	中国	174	>28 pg/ml	127	47	46/108	9/39
Alkindi et al^[29]	2021	阿曼	541	>14 ng/L	89	452	68/89	103/452

纳入研究	发表年份	①	②	③	④	⑤	⑥	总分
Si et al^[15]	2020	1	1	1	1	1	1	6
Pan et al^[16]	2020	1	1	1	1	1	1	6
Shi et al^[17]	2020	1	1	1	1	2	1	7
Mikami et al^[18]	2020	1	1	1	1	2	1	7
Du et al^[19]	2020	1	1	1	1	2	1	7
Chen et al^[20]	2020	1	1	1	1	1	1	6
王朗等^[21]	2020	1	1	1	1	2	1	7
贺行巍等^[22]	2020	1	1	1	1	1	1	6
章晋辉等^[23]	2021	1	1	1	1	2	1	7
李伶芝等^[24]	2021	1	1	1	1	2	1	7
Maino et al^[25]	2021	1	1	1	1	1	1	6
Mohamed Ali et al^[26]	2021	1	1	1	1	2	1	7
Singh et al^[27]	2021	1	1	1	1	2	1	7
Chen et al^[28]	2021	1	1	1	1	2	1	7
Alkindi et al^[29]	2021	1	1	1	1	2	1	7

纳入研究	发表年份	①	②	③	④	⑤	⑥	总分
Si et al^[15]	2020	1	1	1	1	1	1	6
Pan et al^[16]	2020	1	1	1	1	1	1	6
Shi et al^[17]	2020	1	1	1	1	2	1	7
Mikami et al^[18]	2020	1	1	1	1	2	1	7
Du et al^[19]	2020	1	1	1	1	2	1	7
Chen et al^[20]	2020	1	1	1	1	1	1	6
王朗等^[21]	2020	1	1	1	1	2	1	7
贺行巍等^[22]	2020	1	1	1	1	1	1	6
章晋辉等^[23]	2021	1	1	1	1	2	1	7
李伶芝等^[24]	2021	1	1	1	1	2	1	7
Maino et al^[25]	2021	1	1	1	1	1	1	6
Mohamed Ali et al^[26]	2021	1	1	1	1	2	1	7
Singh et al^[27]	2021	1	1	1	1	2	1	7
Chen et al^[28]	2021	1	1	1	1	2	1	7
Alkindi et al^[29]	2021	1	1	1	1	2	1	7