COVID-19 住院患者的 6 个月结局和肺康复效果：一项回顾性队列研究。
Six-month outcomes and effect of pulmonary rehabilitation among patients hospitalized with COVID-19: a retrospective cohort study.
机构信息
Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China.
National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China.
出版信息
Ann Med. 2021 Dec;53(1):2099-2109. doi: 10.1080/07853890.2021.2001043.
BACKGROUND
Patients appear to maintain sequelae post-coronavirus disease 2019 (COVID-19) affecting daily life and physical health. We investigated the changes in and the effects of pulmonary rehabilitation (PR) on exercise capacity and immunology six months after COVID-19 hospitalization.
METHODS
This retrospective cohort reviewed 233 COVID-19 patients admitted from 17 January 2020 to 29 February 2020. Ninety-eight patients who completed 2-week and 6-month follow-ups and tests were included. Among 98 patients, 27 completed at least five sessions of PR at the First Hospital of Changsha, China, during the 6-month convalescence were allocated to the PR group; the reminder who had not performed any PR were assigned to the control group. The primary outcome was the change in six-minute walk distance (6-MWD) between the 2-week and 6-month follow-ups, which was assessed via analysis of covariance with a covariate of propensity score that adjusted for the potential confounders. Secondary outcomes were the changes in 6-MWD, SARS-CoV-2 immunoglobulins, T-lymphocytes and blood chemistry, which were evaluated via paired tests.
RESULTS
Participants' ages ranged from 19 to 84 years ( = 47, standard deviation (SD)=15) 45.9% identified as male. During the 6-month convalescence, 6-MWD increased 27.0%, with a mean [95% CI] of 113 [92-134] m ( .001). SARS-CoV-2 IgG and IgM decreased 33.3% ( = .002) and 43.8% ( = .009), CD4+ T cells increased 7.9% ( = .04), and the majority of blood chemistry significantly changed. The patients in the PR group acquired a greater increase in 6-MWD than those in control (unadjusted, 194 [167-221] m, < .001; adjusted, 123 [68-181] m, < .001), dose-responsiveness of PR on 6-MWD was observed ( .001). No differences in immunity variables and blood chemistry were observed between groups.
CONCLUSIONS
These findings suggest PR may be a strategy to promote the improvement of exercise capacity after COVID-19.
背景
新冠肺炎（COVID-19）患者在康复后似乎会遗留一些后遗症，从而影响其日常生活和身体健康。本研究旨在调查 COVID-19 住院 6 个月后，肺康复（PR）对运动能力和免疫的影响。
方法
这是一项回顾性队列研究，共纳入了 2020 年 1 月 17 日至 2 月 29 日期间因 COVID-19 住院的 233 例患者。其中，98 例患者完成了 2 周和 6 个月的随访和检查，被纳入研究。这 98 例患者中，有 27 例在长沙第一医院完成了至少 5 个疗程的 PR，将其分配到 PR 组；未进行任何 PR 的患者被分配到对照组。主要结局为 2 周和 6 个月随访时 6 分钟步行距离（6-MWD）的变化，采用协方差分析，协变量为倾向评分，可调整潜在混杂因素。次要结局为 6-MWD、SARS-CoV-2 免疫球蛋白、T 淋巴细胞和血液化学的变化，采用配对检验进行评估。
结果
参与者的年龄为 19-84 岁（均数 [SD] = 47 岁，15 岁），45.9%为男性。在 6 个月的康复期间，6-MWD 增加了 27.0%，平均（95% CI）为 113（92-134）m（.001）。SARS-CoV-2 IgG 和 IgM 分别下降了 33.3%（.002）和 43.8%（.009），CD4+T 细胞增加了 7.9%（.04），且大多数血液化学指标显著变化。与对照组相比，PR 组的 6-MWD 增加更明显（未校正，194[167-221]m， < .001；校正，123[68-181]m， < .001），且 PR 对 6-MWD 的剂量反应呈阳性（.001）。两组之间的免疫变量和血液化学无差异。
结论
这些发现表明，PR 可能是一种促进 COVID-19 后运动能力改善的策略。
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