Calabrese Cecilia, Annunziata Anna, Flora Martina, Mariniello Domenica Francesca, Allocca Valentino, Palma Maria Ilaria, Coppola Antonietta, Meoli Ilernando, Pafundi Pia Clara, Fiorentino Giuseppe
Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
Department of Intensive Care, A.O.R.N dei Colli, Naples, Italy.
Front Mol Biosci. 2022 Feb 3;8:809186. doi: 10.3389/fmolb.2021.809186. eCollection 2021.
Previous studies have demonstrated persistent dyspnoea and impairment of respiratory function in the follow-up of patients who have recovered from COVID-19 pneumonia. However, no studies have evaluated the clinical and functional consequences of COVID-19 pneumonia complicated by pulmonary embolism. The aim of our study was to assess the pulmonary function and exercise capacity in COVID-19 patients 3 months after recovery from pneumonia, either complicated or not by pulmonary embolism. This was a retrospective, single-centre, observational study involving 68 adult COVID-19 patients with a positive/negative clinical history of pulmonary embolism (PE) as a complication of COVID-19 pneumonia. Three months after recovery all patients underwent spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), and 6 minute walk test (6MWT). In addition, high-resolution computed tomography (HRCT) of the lung was carried out and CT-pulmonary angiography was conducted only in the PE+ subgroup. Patients with a previous diagnosis of PE or chronic lung diseases were excluded from the study. Of the 68 patients included in the study, 24 had previous PE (PE+) and 44 did not (PE-). In comparison with the PE- subgroup, PE+ patients displayed a FVC% predicted significantly lower (87.71 ± 15.40 vs 98.7 ± 16.7, = 0.009) and a significantly lower DLCO% predicted ( = 0.023). In addition, a higher percentage of patients were dyspnoeic on exercise, as documented by a mMRC score ≥1 (75% vs 54.3%, < 0.001) and displayed a SpO <90% during 6MWT (37.5% vs 0%, < 0.001). HRCT features suggestive of COVID-19 pneumonia resolution phase were present in both PE+ and PE- subjects without any significant difference ( = 0.24) and abnormalities at CT pulmonary angiography were detected in 57% of the PE+ subgroup. At the 3 month follow-up, the patients who recovered from COVID-19 pneumonia complicated by PE showed more dyspnoea and higher impairment of pulmonary function tests compared with those without PE.
既往研究表明，新冠肺炎肺炎康复患者在随访中存在持续的呼吸困难和呼吸功能损害。然而，尚无研究评估新冠肺炎肺炎合并肺栓塞的临床和功能后果。我们研究的目的是评估新冠肺炎患者肺炎康复3个月后的肺功能和运动能力，无论是否合并肺栓塞。这是一项回顾性、单中心观察性研究，纳入了68例有/无肺栓塞（PE）临床病史的成年新冠肺炎患者，PE为新冠肺炎肺炎的并发症。康复3个月后，所有患者均接受了肺活量测定、肺一氧化碳弥散量（DLCO）和6分钟步行试验（6MWT）。此外，对肺部进行了高分辨率计算机断层扫描（HRCT），仅在PE+亚组中进行了CT肺动脉造影。既往诊断为PE或慢性肺部疾病的患者被排除在研究之外。在纳入研究的68例患者中，24例既往有PE（PE+），44例无PE（PE-）。与PE-亚组相比，PE+患者的预测FVC%显著更低（87.71±15.40对98.7±16.7，P=0.009），预测DLCO%显著更低（P=0.023）。此外，如mMRC评分≥1所示，更高比例的患者运动时出现呼吸困难（75%对54.3%，P<0.001），并且在6MWT期间SpO₂<90%（37.5%对0%，P<0.001）。PE+和PE-受试者均出现提示新冠肺炎肺炎吸收期的HRCT特征，无显著差异（P=0.24），57%的PE+亚组在CT肺动脉造影中检测到异常。在3个月随访时，与未合并PE的患者相比，新冠肺炎肺炎合并PE康复的患者出现更多呼吸困难和肺功能测试损害。
