Université de Paris, "Population-based Cohorts Unit," Institut National de la Santé et de la Recherche Médicale (INSERM), Paris Saclay University, Université de Versailles-Saint-Quentin-en-Yvelines, UMS 011, Paris, France.
Université Lille, Centre Hospitalier de Tourcoing, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France.
JAMA Intern Med. 2022 Jan 1;182(1):19-25. doi: 10.1001/jamainternmed.2021.6454.
After an infection by SARS-CoV-2, many patients present with persistent physical symptoms that may impair their quality of life. Beliefs regarding the causes of these symptoms may influence their perception and promote maladaptive health behaviors.
To examine the associations of self-reported COVID-19 infection and SARS-CoV-2 serology test results with persistent physical symptoms (eg, fatigue, breathlessness, or impaired attention) in the general population during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: Participants in this cross-sectional analysis were 26 823 individuals from the French population-based CONSTANCES cohort, included between 2012 and 2019, who took part in the nested SAPRIS and SAPRIS-SERO surveys. Between May and November 2020, an enzyme-linked immunosorbent assay was used to detect anti-SARS-CoV-2 antibodies. Between December 2020 and January 2021, the participants reported whether they believed they had experienced COVID-19 infection and had physical symptoms during the previous 4 weeks that had persisted for at least 8 weeks. Participants who reported having an initial COVID-19 infection only after completing the serology test were excluded.
Logistic regressions for each persistent symptom as the outcome were computed in models including both self-reported COVID-19 infection and serology test results and adjusting for age, sex, income, and educational level.
Of 35 852 volunteers invited to participate in the study, 26 823 (74.8%) with complete data were included in the present study (mean [SD] age, 49.4 [12.9] years; 13 731 women [51.2%]). Self-reported infection was positively associated with persistent physical symptoms, with odds ratios ranging from 1.39 (95% CI, 1.03-1.86) to 16.37 (95% CI, 10.21-26.24) except for hearing impairment (odds ratio, 1.45; 95% CI, 0.82-2.55) and sleep problems (odds ratio, 1.14; 95% CI, 0.89-1.46). A serology test result positive for SARS-COV-2 was positively associated only with persistent anosmia (odds ratio, 2.72; 95% CI, 1.66-4.46), even when restricting the analyses to participants who attributed their symptoms to COVID-19 infection. Further adjusting for self-rated health or depressive symptoms yielded similar results. There was no significant interaction between belief and serology test results.
The findings of this cross-sectional analysis of a large, population-based French cohort suggest that persistent physical symptoms after COVID-19 infection may be associated more with the belief in having been infected with SARS-CoV-2 than with having laboratory-confirmed COVID-19 infection. Further research in this area should consider underlying mechanisms that may not be specific to the SARS-CoV-2 virus. A medical evaluation of these patients may be needed to prevent symptoms due to another disease being erroneously attributed to "long COVID."
在感染 SARS-CoV-2 后，许多患者出现持续的身体症状，这可能会影响他们的生活质量。对这些症状原因的看法可能会影响他们的感知，并促进适应不良的健康行为。
在 COVID-19 大流行期间，调查自我报告的 COVID-19 感染和 SARS-CoV-2 血清学检测结果与一般人群中持续的身体症状（例如疲劳、呼吸困难或注意力受损）之间的关联。
设计、地点和参与者：本横断面分析的参与者为法国基于人群的 CONSTANCES 队列中的 26823 名个体，他们于 2012 年至 2019 年期间被纳入，参加了嵌套的 SAPRIS 和 SAPRIS-SERO 调查。2020 年 5 月至 11 月期间，使用酶联免疫吸附试验检测抗 SARS-CoV-2 抗体。2020 年 12 月至 2021 年 1 月期间，参与者报告他们是否认为自己经历了 COVID-19 感染，以及在过去 4 周内是否有持续至少 8 周的身体症状。仅在完成血清学检测后报告有初始 COVID-19 感染的参与者被排除在外。
在包括自我报告的 COVID-19 感染和血清学检测结果的模型中，对每个持续症状进行逻辑回归分析，并调整年龄、性别、收入和教育水平。
在被邀请参加研究的 35852 名志愿者中，有 26823 名（74.8%）完成了完整数据，纳入本研究（平均[标准差]年龄，49.4[12.9]岁；13731 名女性[51.2%]）。自我报告的感染与持续的身体症状呈正相关，比值比范围为 1.39（95%CI，1.03-1.86）至 16.37（95%CI，10.21-26.24），除听力障碍（比值比，1.45；95%CI，0.82-2.55）和睡眠问题（比值比，1.14；95%CI，0.89-1.46）外。血清学检测 SARS-COV-2 呈阳性仅与持续的嗅觉丧失呈正相关（比值比，2.72；95%CI，1.66-4.46），即使将分析仅限于将症状归因于 COVID-19 感染的参与者也是如此。进一步调整自我评估的健康状况或抑郁症状后，得出了类似的结果。在信念和血清学检测结果之间没有显著的相互作用。
这项对法国大型基于人群队列的横断面分析的研究结果表明，COVID-19 感染后的持续身体症状可能与相信自己感染了 SARS-CoV-2 更相关，而不是与实验室确诊的 COVID-19 感染更相关。该领域的进一步研究应考虑可能与 SARS-CoV-2 病毒无关的潜在机制。可能需要对这些患者进行医学评估，以防止将其他疾病引起的症状错误归因于“长 COVID”。
