抗心肌抗体对新型冠状病毒急性感染患者预后评估价值

余刘玉; 苏恺; 余淼; 梁力元; 付茗婕; 余浩瑗; 张佩月; 王秋涵; 程翔

doi:10.13201/j.issn.1001-1439.2025.04.004

抗心肌抗体对新型冠状病毒急性感染患者预后评估价值

- 1.
  华中科技大学同济医学院附属协和医院心内科(武汉，430022)
- 2.
  生物靶向治疗研究湖北省重点实验室
- 3.
  心血管疾病免疫诊疗湖北省工程研究中心
- 4.
  生物靶向治疗教育部重点实验室(华中科技大学)
基金项目:
国家重点研发计划(No：2024YFC3044500)

详细信息

通讯作者: 程翔：E-mail：nathancx@hust.edu.cn

中图分类号: R542.2

收稿日期: 2025-03-07

刊出日期: 2025-04-13

The value of anti-heart antibodies in the prognosis evaluation of hospitalized patients with COVID-19

- 1.
  Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- 2.
  Hubei Key Laboratory of Biological Targeted Therapy
- 3.
  Hubei Provincial Engineering Research Center of Immunological Diagnosis and Therapy for Cardiovascular Diseases
- 4.
  Key Laboratory of Biological Targeted Therapy[Huazhong University of Science and Technology], Ministry of Education

More Information

Corresponding author: CHENG Xiang, E-mail: nathancx@hust.edu.cn

Received Date: 07 March 2025

Publish Date: 13 April 2025

摘要

摘要: 目的评估抗心肌抗体(anti-heart antibodies，AHA)对新型冠状病毒急性感染患者的预后价值。方法回顾性分析华中科技大学同济医学院附属协和医院2020年1月1日—2024年8月30日新型冠状病毒感染住院患者62例，纳入标准为按国家卫健委发布的《新型冠状病毒感染诊疗方案(试行第十版)》确诊为新型冠状病毒感染的年龄大于18岁的住院患者，并完成超敏肌钙蛋白I(hs-cTnI)及AHA检测。收集所有患者的临床资料，根据住院期间预后结局分为预后良好组和预后不良组，比较两组间临床资料的差异性，并进行统计分析。结果住院期间，共22例(35.5%)患者出现了至少一项不良结局，定义为预后不良组。预后不良组合并至少一种基础疾病(81.8% vs 55.0%，P=0.035)、重症及危重症(63.6% vs 20.0%，P < 0.001)患者比例明显高于预后良好组。预后不良组的D-二聚体水平[1.1(0.5, 2.0) mg/L vs 0.5(0.3, 1.0) mg/L，P=0.008]、肌酸激酶同工酶[2.7(1.0, 6.0) ng/mL vs 0.9(0.4, 2.0) ng/mL，P=0.003]、乳酸脱氢酶[239.0(200.8, 392.5) U/L vs 200.5(160.0, 282.0) U/L，P=0.019]和hs-cTnI[381.5(53.5, 2 502.5) ng/L vs 20.9(3.1, 114.2) ng/L，P < 0.001]明显高于预后良好组，且差异有统计学意义。AHA检查中，预后不良组出现抗钙通道抗体阳性患者比例均高于预后良好组(50.0% vs 15.0%，P=0.003)，且两组间差异存在统计学意义。多因素logistic回归分析结果提示抗钙通道抗体阳性(OR=13.0，95%CI 2.5~67.3)、合并症(OR=10.3, 95%CI 1.6~68.5)和肌酸激酶同工酶升高(OR=2.1，95%CI 1.3~3.4)为新型冠状病毒感染预后不良的独立危险因素。结论在新型冠状病毒急性感染的患者中，预后不良组出现抗钙通道抗体阳性明显高于预后良好组，抗钙通道抗体阳性是新型冠状病毒急性感染患者预后不良的独立预测因子。
- 新型冠状病毒感染 /
- 抗心肌抗体 /
- 心肌损伤 /
- 预后
Abstract: Objective To evaluate the prognostic value of anti-heart antibodies(AHA) in patients with COVID-19.Methods A retrospective analysis was conducted on 62 hospitalized patients with COVID-19 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 1, 2020, to August 30, 2024. The inclusion criteria were patients aged over 18 years old who were hospitalized and diagnosed with COVID-19 according to the "Diagnosis and Treatment Protocol for Novel Coronavirus Infection(Trial Version 10)" issued by the National Health Commission. All included patients had completed tests for high-sensitivity cardiac troponin I(hs-cTnI) and AHA. Clinical data of all patients were collected. Patients were divided into two groups based on their prognosis during hospitalization: the good-prognosis group and the poor-prognosis group. Differences in clinical data between the two groups were compared and statistical analyses were performed.Results During the hospitalization period, a total of 22 patients(35.5%) experienced at least one adverse outcome, which was defined as the poor-prognosis group. The poor-prognosis group had a significantly higher proportion of patients with at least one comorbidity(81.8% vs 55.0%, P=0.035) and severe or critical illness(63.6% vs 20.0%, P < 0.001) compared to the good-prognosis group. The levels of D-dimer(1.1[IQR 0.5-2.0]mg/L vs 0.5[IQR 0.2-1.0]mg/L, P=0.008), creatine kinase isoenzyme(2.7[IQR 1.0-6.0]ng/mL vs 0.9[IQR 0.4-2.0]ng/mL, P=0.003), lactate dehydrogenase(239.0[IQR 200.8-392.5]U/L vs 200.5[IQR 160.0-282.0]U/L, P=0.019), and hs-cTnI(381.5[IQR 53.5-2502.5]ng/L vs 20.9[IQR 3.1-114.2]ng/L, P < 0.001) were significantly higher in the poor-prognosis group than in the good-prognosis group, with statistically significant differences. In the AHA testing, the poor-prognosis group had a higher proportion of patients positive for anti-calcium channel antibodies(50% vs 15%, P=0.003) compared to the good-prognosis group, with a statistically significant difference between the two groups. Multivariate logistic regression analysis indicated that positivity for anti-calcium channel antibodies(OR 13.0, 95%CI 2.5-67.3), presence of comorbidity(OR 10.3, 95%CI 1.6-68.5), and elevated creatine kinase isoenzyme(OR 2.1, 95%CI 1.3-3.4) were independent risk factors for poor prognosis in patients with COVID-19.Conclusion In patients with COVID-19, the poor-prognosis group had a significantly higher rate of positivity for anti-calcium channel antibodies. The positivity for anti-calcium channel antibodies is an independent predictor of poor prognosis in patients with acute novel coronavirus infection.
- COVID-19 /
- anti-heart antibodies /
- myocardial injury /
- prognosis

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表 1 急性新冠病毒感染预后良好组和预后不良组临床资料比较

Table 1. Clinical data between the good prognosis group and poor prognosis group in acute COVID-19 infection 例(%), M(P₂₅, P₇₅)

项目	预后良好组(40例)	预后不良组(22例)	P
男性	14(35.0)	15(68.2)	0.012
年龄/岁	60.0(47.8，79.0)	67.5(51.8，84.0)	0.462
合并症	22(55.0)	18(81.8)	0.035
临床分型(重症)	8(20.0)	14(63.6)	< 0.001
抗心肌抗体
抗β1受体抗体	4(10.0)	7(31.8)	0.071
抗钙通道抗体	6(15.0)	11(50.0)	0.003
抗肌球蛋白重链抗体	5(12.5)	6(27.3)	0.267
抗ADP/ATP载体抗体	5(12.5)	6(27.3)	0.267
白细胞计数/(×10⁹/L)	5.8(4.4，8.2)	6.5(4.8，7.7)	0.775
中性粒细胞计数/(×10⁹/L)	3.7(2.5，6.5)	4.5(3.0，6.3)	0.466
淋巴细胞计数/(×10⁹/L)	1.3(0.9，1.7)	1.0(0.7，1.5)	0.071
血小板计数/(×10⁹/L)	206.5(132.8，225.8)	176.0(115.3，234.5)	0.440
谷丙转氨酶/(U/L)	18.5(14.0，26.8)	25.0(17.8，30.3)	0.074
谷草转氨酶/(U/L)	24.0(21.0，33.0)	34.5(26.8，41.5)	0.070
肌酐/(μmol/L)	75.0(62.2，93.5)	94.2(60.1，118.5)	0.156
D-二聚体/(mg/L)	0.5(0.3，1.0)	1.1(0.5，2.0)	0.008
PT/s	13.2(12.7，13.8)	13.9(13.0，14.2)	0.109
FIB/(g/L)	3.7(3.0，4.8)	4.4(3.3，5.9)	0.178
CRP/(mg/L)	15.5(3.2，40.5)	29.3(6.0，84.1)	0.259
肌酸激酶/(U/L)	81.0(47.0，129.0)	198.5(53.0，268.0)	0.094
肌酸激酶同工酶/(ng/mL)	0.9(0.4，2.0)	2.7(1.0，6.0)	0.003
乳酸脱氢酶/(U/L)	200.5(160.0，282.0)	239.0(200.8，392.5)	0.019
hs-cTnI /(ng/L)	20.9(3.1，114.2)	381.5(53.5，2 502.5)	< 0.001

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表 2 单因素及多因素logistic回归分析急性新冠病毒感染患者不良预后的危险因素

Table 2. Univariate and multivariate logistic regression analysis

影响因素	单因素分析		多因素分析
影响因素	Wald	OR(95%CI)	Wald	OR(95%CI)
男性	6.0	4.0(1.3~12.0)
合并症	4.2	3.7(1.1~12.8)	5.9	10.3(1.6~68.5)
临床分型(重症)	10.7	7.0(2.2~22.4)
抗钙通道抗体阳性	8.0	5.7(1.7~18.9)	9.4	13.0(2.5~67.3)
D-二聚体	6.1	1.7(1.1~2.5)
肌酸激酶同工酶	6.9	1.6(1.1~2.2)	9.1	2.1(1.3~3.4)
乳酸脱氢酶	5.5	3.1(1.2~8.2)
hs-cTnI	12.1	1.4(1.2~1.7)

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