COVID-19 感染出院后肺部的长期后果。
Pulmonary long-term consequences of COVID-19 infections after hospital discharge.
机构信息
Servicio de Enfermedades Infecciosas, Hospital Universitario San Pedro, Logroño, La Rioja, Spain; Centro de Investigación Biomédica de La Rioja, Logroño, La Rioja, Spain.
Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Spain; Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain.
出版信息
Clin Microbiol Infect. 2021 Jun;27(6):892-896. doi: 10.1016/j.cmi.2021.02.019. Epub 2021 Mar 2.
OBJECTIVES
Coronavirus disease 2019 (COVID-19) survivors are reporting residual abnormalities after discharge from hospital. Limited information is available about this stage of recovery or the lingering effects of the virus on pulmonary function and inflammation. This study aimed to describe lung function in patients recovering from COVID-19 hospitalization and to identify biomarkers in serum and induced sputum samples from these patients.
METHODS
Patients admitted to Spanish hospitals with laboratory-confirmed COVID-19 infection by a real-time PCR (RT-PCR) assay for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited for this study. Each hospital screened their lists of discharged patients at least 45 days after symptom onset. SARS-CoV-2-infected patients were divided into mild/moderate and severe disease groups according to the severity of their symptoms during hospitalization. Patients' epidemiological and medical histories, comorbidities, chronic treatments, and laboratory parameters were evaluated. Pulmonary function tests, the standardized 6-minute walk test (6MWT) and chest computed tomography (CT) were also performed. The levels of proteases, their inhibitors, and shed receptors were measured in serum and induced sputum samples.
RESULTS
A total of 100 patients with respiratory function tests were included in this study. The median number of days after the onset of symptoms was 104 (IQR 89.25, 126.75). COVID-19 was severe in 47% of patients (47/100). CT was normal in 48% of patients (48/100). Lung function was normal forced expiratory volume in one second (FEV1) ≥80%, forced vital capacity (FVC) ≥80%, FEV1/FVC ≥0.7, and diffusing capacity for carbon monoxide (DLCO) ≥80% in 92% (92/100), 94% (94/100), 100% (100/100) and 48% (48/100) of patients, respectively. Multivariate analysis showed that a DLCO <80% (OR 5.92; 95%CI 2.28-15.37; p < 0.0001) and a lower serum lactate dehydrogenase level (OR 0.98; 95%CI 0.97-0.99) were associated with the severe disease group of SARS-CoV-2 cases during hospital stay.
CONCLUSIONS
A diffusion deficit (DLCO <80%) was still present after hospital discharge and was associated with the most severe SARS-CoV-2 cases.
目的
新冠肺炎（COVID-19）患者出院后仍报告存在残留异常。目前有关这一康复阶段的信息有限，也不清楚病毒对肺功能和炎症的持续影响。本研究旨在描述 COVID-19 住院患者的肺功能，并确定这些患者血清和诱导痰样本中的生物标志物。
方法
本研究招募了因严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）实时 PCR（RT-PCR）检测而在西班牙医院住院的 COVID-19 感染患者。每家医院至少在症状出现后 45 天筛查出院患者名单。根据住院期间症状的严重程度，将 SARS-CoV-2 感染患者分为轻症/中度和重症疾病组。评估患者的流行病学和医疗史、合并症、慢性治疗和实验室参数。还进行了肺功能检查、标准化 6 分钟步行试验（6MWT）和胸部计算机断层扫描（CT）。测量了血清和诱导痰样本中的蛋白酶、其抑制剂和脱落受体的水平。
结果
本研究共纳入 100 例进行呼吸功能检查的患者。症状发作后中位天数为 104 天（IQR 89.25，126.75）。47%（47/100）的患者病情严重。48%（48/100）的患者 CT 正常。92%（92/100）、94%（94/100）、100%（100/100）和 48%（48/100）的患者用力呼气量一秒率（FEV1）≥80%、用力肺活量（FVC）≥80%、FEV1/FVC≥0.7 和一氧化碳弥散量（DLCO）≥80%。多变量分析显示，DLCO＜80%（OR 5.92；95%CI 2.28-15.37；p＜0.0001）和血清乳酸脱氢酶水平较低（OR 0.98；95%CI 0.97-0.99）与住院期间 SARS-CoV-2 病例的重症疾病组相关。
结论
出院后仍存在弥散缺陷（DLCO＜80%），与最严重的 SARS-CoV-2 病例相关。
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