新型冠状病毒感染相关心肌损伤、心肌炎和感染后状态管理专家共识（第二版）

doi:10.12114/j.issn.1007-9572.2023.0083

摘要/Abstract

摘要： 新型冠状病毒感染（COVID-19）已被证实可累及全身多个系统，其中心血管系统受累很常见。为帮助临床医师合理诊治COVID-19相关心血管问题，共识组建议：（1）对于因COVID-19住院或伴有心脏相关症状的患者，应常规检测心肌肌钙蛋白，以评估心肌损伤，判断有无心脏并发症；非心脏原因所致心肌损伤的患者预后较差；（2）COVID-19相关急性心肌炎较为罕见，对怀疑心肌炎的患者应根据危险分层进行诊治；（3）COVID-19可增加心血管事件风险，所有感染者应更加严格遵循健康生活方式，接受规范的心血管疾病一级或二级预防；（4）COVID-19后3个月时有持续心脏相关症状或新发相关症状，且至少持续2个月，但心血管相关检查未见异常，可考虑为"COVID-19后状态"，此类患者应以康复治疗为主。

关键词: 新型冠状病毒感染, 心肌疾病, 心肌损伤, 心肌炎, 新型冠状病毒感染后状态, 专家共识, 指南

Abstract:

Evidence shows that coronavirus disease 2019 (COVID-19) can impact multiple bodily systems, with the cardiovascular system being commonly affected. In order to guide healthcare providers in diagnosing and managing cardiovascular issues related to COVID-19, the consensus group recommends: (1) Routine cardiac troponin testing is necessary for patients who are hospitalized or exhibit symptoms related to heart conditions after COVID-19 infection to evaluate potential myocardial injury and help detect any cardiac complications. Patients with myocardial injury not related to heart issues tend to have a poorer outcome. (2) Relatively few cases of acute myocarditis linked to COVID-19 have been reported, and individuals suspected of having myocarditis should be evaluated and managed based on risk stratification. (３) COVID-19 infection should be considered a risk factor for increasing the incidence of cardiovascular disease. All individuals who have been infected should adhere to a healthy lifestyle more strictly and implement appropriate primary or secondary preventive measures for cardiovascular disease. (4) For individuals who experience the persistence or emergence of new symptoms 3 months after the initial COVID-19 infection and have been experiencing these symptoms for at least 2 months, with no clear diagnosis of a cardiovascular disease through standard diagnostic tests, it is advisable to consider the possibility of "post COVID-19 condition". Rehabilitation should be given top priority for these patients.

Key words: COVID-19, Cardiomyopathies, Myocardial injury, Myocarditis, Post COVID-19 condition, Expert consensus, Guidebook

国家老年医学中心,中国老年医学学会心电与心功能分会,北京医学会心血管病学分会影像学组,等. 新型冠状病毒感染相关心肌损伤、心肌炎和感染后状态管理专家共识（第二版）[J]. 中国全科医学, 2023, 26(14): 1692-1702. DOI: 10.12114/j.issn.1007-9572.2023.0083.
National Center of Gerontology,Electrocardiology and Cardiac Function Branch of Chinese Geriatric Society,Imaging Group of Cardiovascular Department, Beijing Medical Association, et al. Expert Consensus for Management of Myocardial Injury, Myocarditis, and Post-infection Condition with Coronavirus Disease 2019 (Second Edition)[J]. Chinese General Practice, 2023, 26(14): 1692-1702. DOI: 10.12114/j.issn.1007-9572.2023.0083.

图/表 2

表1 COVID-19患者发生急性心血管事件和心肌损伤的常见原因[9]

Table 1 Causes of acute cardiac events and myocardial injury in COVID-19 patients

项目

具体原因

心脏原因

（1）1型心肌梗死（包括STEMI和NSTEMI）；（2）2型心肌梗死（冠状动脉痉挛、冠状动脉栓塞、自发性冠状动脉夹层）；（3）急性心肌损伤〔多数情况下心肌肌钙蛋白稳定或不变、COVID-19直接损伤（罕见）、其他疾病所致的间接损伤〕；（4）冠状动脉正常或接近正常的急性冠脉综合征；（5）心肌炎；（6）冠状动脉炎；（7）急性心力衰竭；（8）急性心律失常

非心脏原因

（1）肺栓塞；（2）危重疾病；（3）低氧血症；（4）败血症；（5）休克；（6）贫血；（7）肾脏疾病

图1 疑似心肌炎或心脏受累患者的评估和处理流程注：a提示心脏受累的症状包括胸痛、呼吸困难、心悸和晕厥；b说明ECG若出现广泛导联ST-T改变、QRS波显著延长、窦性停搏和高度房室阻滞，提示心肌损伤严重；c表示常呈非冠状动脉分布，也可能包括异常心室应变；d包括低血压、心原性休克、持续性室性心律失常和/或高度房室传导阻滞；e表示这是一个不完整的潜在病因列表；f提示如果可能的话，应在冷冻心脏组织上进行病毒基因组检测，以排除心肌炎的其他原因；g表示假设胸痛为唯一症状，左心室收缩功能保留，无室性心律失常；h包括ECG、超声心动图、动态心律监测和CMR。COVID-19=新型冠状病毒感染，ECG=心电图，cTn=心肌肌钙蛋白，CTA=计算机断层扫描血管造影，PCT=降钙素原，LVEF=左心室射血分数，CMR=心脏磁共振成像

Figure 1 Evaluation and management of patients with suspected myocarditis or myocardial involvement

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