Université de Paris, Neurodiderot, Inserm, F-75018, Paris, France; Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, F-75018, Paris, France.
Université de Paris, Inserm U 1152, F-75018, Paris, France; Service de Radiologie, Hôpital Bichat Claude Bernard, F-75018, Paris, France.
Respir Med. 2021 Aug;184:106435. doi: 10.1016/j.rmed.2021.106435. Epub 2021 May 15.
Lung function in survivors of SARS-Co-V2 pneumonia is poorly known, but concern over the possibility of sequelae exists.
Retrospective study on survivors with confirmed infection and pneumonia on chest-CT. Correlations between PFT and residual radiologic anomalies at three months taking into account initial clinical and radiological severity and steroid use during acute phase.
137 patients (69 men, median age 59 (Q1 50; Q3 68), BMI 27.5 kg/m (25.1; 31.7)) were assessed. Only 32.9% had normal PFT, 75 had altered DLCO. Median (Q1; Q3) values were: VC 79 (66; 92) % pred, FEV1 81 (68; 89), TLC 78 (67; 85), DLCO 60 (44; 72), and KCO 89 (77; 105). Ground glass opacities (GGO) were present in 103 patients (75%), reticulations in 42 (30%), and fibrosis in 18 (13%). There were significantly lower FEV1 (p = 0.0089), FVC (p = 0.0010), TLC (p < 0.0001) and DLCO (p < 0.0001) for patients with GGO, lower TLC (p = 0.0913) and DLCO (p = 0.0181) between patients with reticulations and lower FVC (p = 0.0618), TLC (p = 0.0742) DLCO (p = 0.002) and KCO (p = 0.0114) between patients with fibrosis. Patients with initial ≥50% lung involvement had significantly lower FEV1 (p = 0.0019), FVC (p = 0.0033), TLC (p = 0.0028) and DLCO (p = 0.0003) compared to patients with ≤10%. There was no difference in PFT and residual CT lesions between patients who received steroids and those who did not.
The majority of patients have altered PFT at three months, even in patients with mild initial disease, with significantly lower function in patients with residual CT lesions. Steroids do not seem to modify functional and radiological recovery. Long-term follow-up is needed.
SARS-CoV-2 肺炎幸存者的肺功能知之甚少，但人们担心会出现后遗症。
对胸部 CT 证实感染和肺炎的幸存者进行回顾性研究。考虑到初始临床和影像学严重程度以及急性期使用类固醇，将 PFTS 与三个月时残留影像学异常之间的相关性进行了评估。
评估了 137 例患者（69 名男性，中位年龄 59 岁（Q1 为 50 岁；Q3 为 68 岁），BMI 为 27.5kg/m2（25.1；31.7））。只有 32.9%的患者 PFTS 正常，75 例患者存在弥散功能降低。中位数（Q1；Q3）值为：VC 79（66；92）%预测值，FEV1 81（68；89），TLC 78（67；85），DLCO 60（44；72），KCO 89（77；105）。103 例患者（75%）存在磨玻璃影（GGO），42 例（30%）存在网状影，18 例（13%）存在纤维化。GGO 患者的 FEV1（p=0.0089）、FVC（p=0.0010）、TLC（p<0.0001）和 DLCO（p<0.0001）明显较低，网状影患者的 TLC（p=0.0913）和 DLCO（p=0.0181）较低，纤维化患者的 FVC（p=0.0618）、TLC（p=0.0742）、DLCO（p=0.002）和 KCO（p=0.0114）较低。初始肺受累≥50%的患者的 FEV1（p=0.0019）、FVC（p=0.0033）、TLC（p=0.0028）和 DLCO（p=0.0003）明显低于肺受累≤10%的患者。使用和不使用类固醇的患者之间的 PFTS 和残留 CT 病变无差异。
即使在初始疾病较轻的患者中，三个月时大多数患者的 PFTS 也会发生改变，且残留 CT 病变患者的功能明显降低。类固醇似乎不会改变功能和影像学的恢复。需要长期随访。
