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新冠肺炎出院患者 3 个月随访研究。

Three-month Follow-up Study of Survivors of Coronavirus Disease 2019 after Discharge.

机构信息

Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

J Korean Med Sci. 2020 Dec 7;35(47):e418. doi: 10.3346/jkms.2020.35.e418.

Abstract

BACKGROUND

Most patients including health care workers (HCWs) survived the coronavirus disease 2019 (COVID-19), however, knowledge about the sequelae of COVID-19 after discharge remains limited.

METHODS

A prospectively observational 3-month follow-up study evaluated symptoms, dynamic changes of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG and IgM, lung function, and high resolution computed tomography (HRCT) of survivors of COVID-19 after discharge at Wuhan Union Hospital, China.

RESULTS

Seventy-six survivors (55 females) with a mean age of 41.3 ± 13.8 years were enrolled, and 65 (86%) were HCWs. A total of 69 (91%) patients had returned to their original work at 3-months after discharge. Most of the survivors had symptoms including fever, sputum production, fatigue, diarrhea, dyspnea, cough, chest tightness on exertion and palpitations in the three months after discharge. The serum troponin-I levels during the acute illness showed high correlation with the symptom of fatigue after hospital discharge ( = 0.782; = 0.008) and lymphopenia was correlated with the symptoms of chest tightness and palpitations on exertion of patients after hospital discharge ( = -.285, = 0.027; = -.363, = 0.004, respectively). The mean values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity and diffusion capacity were all normal (> 80% predicted) and lung HRCTs returned to normal in most of the patients (82%), however, 42% of survivors had mild pulmonary function abnormalities at 3-months after discharge. SARS-CoV-2 IgG turned negative in 11% (6 of 57 patients), 8% (4 of 52 patients) and 13% (7 of 55 patients), and SARS-CoV-2 IgM turned negative in 72% (41 of 57 patients), 85% (44 of 52 patients) and 87% (48 of 55 patients) at 1-month, 2-months and 3-months after discharge, respectively.

CONCLUSION

Infection by SARS-CoV-2 caused some mild impairments of survivors within the first three months of their discharge and the duration of SARS-CoV-2 antibody was limited, which indicates the necessity of long-term follow-up of survivors of COVID-19.

摘要

背景

大多数患者(包括医护人员)在感染 2019 年冠状病毒病(COVID-19)后存活下来,但对出院后 COVID-19 的后遗症仍知之甚少。

方法

一项前瞻性观察性的 3 个月随访研究评估了出院后 COVID-19 幸存者的症状、严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)IgG 和 IgM 的动态变化、肺功能和高分辨率计算机断层扫描(HRCT)。

结果

共纳入 76 名(55 名女性)平均年龄 41.3 ± 13.8 岁的幸存者,其中 65 名(86%)为医护人员。出院后 3 个月时,共有 69 名(91%)患者恢复了原来的工作。大多数幸存者在出院后 3 个月内出现发热、咳痰、乏力、腹泻、呼吸困难、咳嗽、活动后胸闷和心悸等症状。急性疾病期间的肌钙蛋白 I 水平与出院后乏力症状高度相关( = 0.782; = 0.008),淋巴细胞减少与出院后胸闷和心悸症状相关( = -0.285, = 0.027; = -0.363, = 0.004)。用力呼气量 1 秒(FEV1)、用力肺活量(FVC)、FEV1/FVC、肺总量和弥散量的平均值均正常(>80%预测值),大多数患者的肺部 HRCT 在出院后 3 个月内恢复正常(82%),但出院后 3 个月时仍有 42%的幸存者存在轻度肺功能异常。出院后 1 个月、2 个月和 3 个月时,SARS-CoV-2 IgG 分别转为阴性 11%(57 例中的 6 例)、8%(52 例中的 4 例)和 13%(55 例中的 7 例),SARS-CoV-2 IgM 分别转为阴性 72%(57 例中的 41 例)、85%(52 例中的 44 例)和 87%(55 例中的 48 例)。

结论

SARS-CoV-2 感染导致部分出院后 3 个月内的幸存者出现轻度受损,且 SARS-CoV-2 抗体持续时间有限,这表明有必要对 COVID-19 幸存者进行长期随访。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c82a/7721559/c64d498c7414/jkms-35-e418-g001.jpg

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