二甲双胍对新型冠状病毒肺炎合并冠心病糖尿病患者心肌损伤的保护作用

目的探讨冠状动脉粥样硬化性心脏病(冠心病)合并糖尿病人群在感染新型冠状病毒肺炎(COVID-19)后,服用的二甲双胍是否对心肌损伤有保护作用。方法选取同济医院2020年1月18日至4月25日入院治疗的COVID-19合并冠心病及糖尿病的患者。根据其是否服用二甲双胍分为二甲双胍组和无二甲双胍(对照组)。回顾性分析两组患者的人口学特征、临床症状、实验室检查、治疗方法和临床结局。结果按照制定的纳入和排标准,最终纳入96例患者,其中男50例、女46例,年龄(69.16±11.04)岁。二甲双胍组患者29例,心肌损伤3例(12.0%,3/25),死亡1例(3.4%):死因为急性呼吸衰竭并发感染性休克;无二甲双胍组67例,心肌损伤24例(37.5%,24/64),死亡15例(22.4%):1例为感染性休克并发弥漫性血管内凝血死亡、1例为呼吸衰竭合并脑出血可能死亡、2例为急性呼吸衰竭死亡、1例爆发性心肌炎死亡、3例急性心肌梗死死亡、7例突发心跳骤停死亡。二甲双胍组心肌损伤发生率(12.0%vs.37.5%,P=0.019)、院内死亡率(3.4%vs.22.4%,P=0.034)、心血管事件死亡率(0.0%vs.16.4%,P=0.049)均显著低于无二甲双胍组。在多元logistic回归分析中,胰岛素(OR=11.235,P=0.003)是院内死亡的独立影响因素,二甲双胍(OR=0.154,P=0.013)是心肌损伤的独立影响因素。结论在冠心病合并糖尿病的患者感染COVID-19时,二甲双胍的使用可有效减少心肌损伤,对降低院内死亡率有一定作用。结合临床考虑,我们认为其值得推广使用。

Protective effects of metformin on myocardial injury in patients with COVID-19 combined with coronary heart diseases and diabetes

Objective To investigate whether metformin has protective effect on myocardial injury in patients with coronavirus disease 2019(COVID-19)combined with coronary heart diseases and diabetes.Methods COVID-19 patients with coronary heart disease and diabetes who were admitted to Tongji Hospital from January 18 to April 25 in 2020 were enrolled.They were divided into a metformin group and a none-metformin group according to whether the metformin was used.The demographic characteristics,clinical symptoms,laboratory parameters,treatment and clinical outcomes of the two groups were analyzed retrospectively.Results There were 29 patients in the metformin group,3 patients(12.0%,3/25)suffered myocardial injury and 1(3.4%)died of acute respiratory failure complicated by septic shock;67 patients were in the non-metformin group and 24(37.5%,24/64)had myocardial injury but 15 died in hospital among whom 1 died of septic shock complicated by disseminated intravascular coagulation,1 acute respiratory failure complicated by possible cerebral hemorrhage,2 acute respiratory failure,1 fulminant myocarditis,3 acute myocardial infarction and 7 cardiac arrest.The incidence of myocardial injury(12.0%vs.37.5%,P=0.019),hospital mortality(3.4%vs.22.4%,P=0.034)and mortality of cardiovascular events(0.0%vs.16.4%,P=0.049)in the metformin group were significantly lower than those in the non-metformin group.Multivariate analysis showed that the use of insulins(OR=11.235,P=0.003)was an influencing factor for in-hospital mortality of patients.The use of metformin(OR=0.154,P=0.013)was positively correlated with the myocardial injury.Conclusion When patients with coronary heart disease and diabetes are infected with COVID-19,metformin can effectively reduce myocardial damage and has a certain effect on reducing hospital mortality.Combined with clinical considerations,it is worthy of popularization.