新型冠状病毒2感染出院后对多个重要器官、运动能力、认知、生活质量和心理健康的中期影响。
Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge.
作者信息
Raman Betty, Cassar Mark Philip, Tunnicliffe Elizabeth M, Filippini Nicola, Griffanti Ludovica, Alfaro-Almagro Fidel, Okell Thomas, Sheerin Fintan, Xie Cheng, Mahmod Masliza, Mózes Ferenc E, Lewandowski Adam J, Ohuma Eric O, Holdsworth David, Lamlum Hanan, Woodman Myles J, Krasopoulos Catherine, Mills Rebecca, McConnell Flora A Kennedy, Wang Chaoyue, Arthofer Christoph, Lange Frederik J, Andersson Jesper, Jenkinson Mark, Antoniades Charalambos, Channon Keith M, Shanmuganathan Mayooran, Ferreira Vanessa M, Piechnik Stefan K, Klenerman Paul, Brightling Christopher, Talbot Nick P, Petousi Nayia, Rahman Najib M, Ho Ling-Pei, Saunders Kate, Geddes John R, Harrison Paul J, Pattinson Kyle, Rowland Matthew J, Angus Brian J, Gleeson Fergus, Pavlides Michael, Koychev Ivan, Miller Karla L, Mackay Clare, Jezzard Peter, Smith Stephen M, Neubauer Stefan
机构信息
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom.
Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom.
出版信息
EClinicalMedicine. 2021 Jan 7;31:100683. doi: 10.1016/j.eclinm.2020.100683. eCollection 2021 Jan.
BACKGROUND
The medium-term effects of Coronavirus disease (COVID-19) on organ health, exercise capacity, cognition, quality of life and mental health are poorly understood.
METHODS
Fifty-eight COVID-19 patients post-hospital discharge and 30 age, sex, body mass index comorbidity-matched controls were enrolled for multiorgan (brain, lungs, heart, liver and kidneys) magnetic resonance imaging (MRI), spirometry, six-minute walk test, cardiopulmonary exercise test (CPET), quality of life, cognitive and mental health assessments.
FINDINGS
At 2-3 months from disease-onset, 64% of patients experienced breathlessness and 55% reported fatigue. On MRI, abnormalities were seen in lungs (60%), heart (26%), liver (10%) and kidneys (29%). Patients exhibited changes in the thalamus, posterior thalamic radiations and sagittal stratum on brain MRI and demonstrated impaired cognitive performance, specifically in the executive and visuospatial domains. Exercise tolerance (maximal oxygen consumption and ventilatory efficiency on CPET) and six-minute walk distance were significantly reduced. The extent of extra-pulmonary MRI abnormalities and exercise intolerance correlated with serum markers of inflammation and acute illness severity. Patients had a higher burden of self-reported symptoms of depression and experienced significant impairment in all domains of quality of life compared to controls (<0.0001 to 0.044).
INTERPRETATION
A significant proportion of patients discharged from hospital reported symptoms of breathlessness, fatigue, depression and had limited exercise capacity. Persistent lung and extra-pulmonary organ MRI findings are common in patients and linked to inflammation and severity of acute illness.
FUNDING
NIHR Oxford and Oxford Health Biomedical Research Centres, British Heart Foundation Centre for Research Excellence, UKRI, Wellcome Trust, British Heart Foundation.
背景
冠状病毒病（COVID-19）对器官健康、运动能力、认知、生活质量和心理健康的中期影响尚不清楚。
方法
招募了58名出院后的COVID-19患者以及30名年龄、性别、体重指数和合并症相匹配的对照者，进行多器官（脑、肺、心脏、肝脏和肾脏）磁共振成像（MRI）、肺功能测定、六分钟步行试验、心肺运动试验（CPET）、生活质量、认知和心理健康评估。
研究结果
在发病后2至3个月，64%的患者出现呼吸急促，55%的患者报告有疲劳感。MRI检查发现，肺部（60%）、心脏（26%）、肝脏（10%）和肾脏（29%）存在异常。患者脑MRI显示丘脑、丘脑后辐射和矢状层有变化，并表现出认知功能受损，特别是在执行和视觉空间领域。运动耐力（CPET上的最大耗氧量和通气效率）和六分钟步行距离显著降低。肺外MRI异常程度和运动不耐受与炎症血清标志物及急性疾病严重程度相关。与对照组相比，患者自我报告的抑郁症状负担更高，生活质量的所有领域均有显著受损（<0.0001至0.044）。
解读
相当一部分出院患者报告有呼吸急促、疲劳、抑郁症状，且运动能力有限。患者中持续存在肺部和肺外器官MRI异常表现很常见，且与炎症及急性疾病严重程度有关。
资助
英国国家卫生研究院牛津和牛津健康生物医学研究中心、英国心脏基金会卓越研究中心、英国研究与创新署、惠康基金会、英国心脏基金会。
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