Santus Pierachille, Flor Nicola, Saad Marina, Pini Stefano, Franceschi Elisa, Airoldi Andrea, Gaboardi Paolo, Ippolito Sonia, Rizzi Maurizio, Radovanovic Dejan
Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, 20157 Milano, Italy.
Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, 20157 Milano, Italy.
J Clin Med. 2021 Mar 2;10(5):1021. doi: 10.3390/jcm10051021.
Radiological and functional sequelae of Coronavirus Disease 2019 (COVID-19) pneumonia are still poorly understood. This was a prospective, observational, physiological, cohort study on consecutive adult patients with COVID-19 pneumonia admitted in April-May 2020 in the high dependency respiratory unit of L. Sacco University Hospital in Milan (Italy). During hospitalization, patients underwent chest computed tomography (CT), blood gas analysis, spirometry, and lung diffusion capacity for carbon monoxide (DLco), which were repeated 6 weeks post-discharge. Chest CTs were individually read by two expert radiologists, that calculated the total severity score (TSS). Twenty patients completed the study (mean age 58.2 years, 70% males). During the acute phase, mean DLco, alveolar volume (VA), and vital capacity (VC) were 56.0 (16.3), 64.8 (14.0), and 71.7 (16.9) % predicted, respectively, and were inversely associated with PaO/FiO ratio. Fifty percent of patients had a restrictive ventilatory pattern; mean TSS was 7.9 (4.0). At follow up, gas exchange parameters were normalized; consolidations persisted in 10% of cases, while DLco was <80% predicted in 65% of patients and was independently predicted by LogD-dimer at admission (β -18.675; 95%CI, -28.373--9.076; = 0.001). In conclusion, functional abnormalities in COVID-19 pneumonia survivors can persist during follow up and are associated with the severity of the disease.
2019冠状病毒病（COVID-19）肺炎的放射学和功能后遗症仍未得到充分了解。这是一项前瞻性、观察性、生理学队列研究，研究对象为2020年4月至5月在意大利米兰的L. Sacco大学医院高依赖性呼吸科收治的连续性成年COVID-19肺炎患者。住院期间，患者接受了胸部计算机断层扫描（CT）、血气分析、肺量计检查以及一氧化碳肺扩散容量（DLco）检测，并在出院后6周重复进行这些检查。胸部CT由两名专家放射科医生分别解读，计算总严重程度评分（TSS）。20名患者完成了研究（平均年龄58.2岁，70%为男性）。急性期时，平均DLco、肺泡容积（VA）和肺活量（VC）分别为预测值的56.0（16.3）%、64.8（14.0）%和71.7（16.9）%，且与PaO/FiO比值呈负相关。50%的患者存在限制性通气模式；平均TSS为7.9（4.0）。随访时，气体交换参数恢复正常；10%的病例中实变持续存在，而65%的患者DLco低于预测值的80%，且入院时LogD-二聚体可独立预测DLco（β -18.675；95%CI，-28.373--9.076；P = 0.001）。总之，COVID-19肺炎幸存者的功能异常在随访期间可能持续存在，并与疾病严重程度相关。
