Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Division of Transplantation, Immunology and Infectious Diseases, Università Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy.
Endocrine. 2022 Aug;77(2):392-400. doi: 10.1007/s12020-022-03096-7. Epub 2022 Jun 8.
Morphometric vertebral fractures (VFs) have been recently reported as an important component of the endocrine phenotype of COVID-19 and emerging data show negative respiratory sequelae at long-term follow-up in COVID-19 survivors. The aim of this study was to evaluate the impact of VFs on respiratory function in COVID-19 survivors.
We included patients referred to our Hospital Emergency Department and re-evaluated during follow-up. VFs were detected on lateral chest X-rays on admission using a qualitative and semiquantitative assessment and pulmonary function tests were obtained by Jaeger-MasterScreen-Analyzer Unit 6 months after discharge.
Fifty patients were included. Median age was 66 years and 66% were males. No respiratory function data were available at COVID-19 diagnosis. VFs were detected in 16 (32%) patients. No differences between fractured and non-fractured patients regarding age and sex were observed. Although no difference was observed between VF and non-VF patient groups in the severity of pneumonia as assessed by Radiological-Assessment-of-Lung-Edema score at admission, (5 vs. 6, p = 0.69), patients with VFs were characterized as compared to those without VFs by lower Forced Vital Capacity (FVC, 2.9 vs. 3.6 L, p = 0.006; 85% vs. 110% of predicted, respectively, p = 0.001), Forced Expiratory Volume 1st s (FEV1, 2.2 vs. 2.8 L, p = 0.005; 92% vs. 110% of predicted, respectively, p = 0.001) and Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO 5.83 vs. 6.98 mmol/min/kPa, p = 0.036, 59% vs. 86.3% of predicted, respectively, p = 0.043) at 6-month follow up.
VFs, expression of the endocrine phenotype of the disease, appear to influence medium-term impaired respiratory function of COVID-19 survivors which may significantly influence their recovery. Therefore, our findings suggest that a VFs assessment at baseline may help in identifying patients needing a more intensive respiratory follow-up and patients showing persistent respiratory impairment without evidence of pulmonary disease may benefit from VFs assessment to preventing the vicious circle of further fractures and respiratory deterioration.
形态计量学椎体骨折（VF）最近被报道为 COVID-19 内分泌表型的一个重要组成部分，并且有新的数据显示 COVID-19 幸存者在长期随访中存在负面的呼吸后遗症。本研究的目的是评估 VF 对 COVID-19 幸存者呼吸功能的影响。
我们纳入了在我院急诊科就诊并在随访期间再次评估的患者。VF 使用定性和半定量评估在入院时的侧位胸部 X 射线上检测，在出院后 6 个月使用 Jaeger-MasterScreen-Analyzer Unit 进行肺功能测试。
共纳入 50 例患者。中位年龄为 66 岁，66%为男性。在 COVID-19 诊断时没有呼吸功能数据。16 例（32%）患者存在 VF。在年龄和性别方面，骨折组和非骨折组之间无差异。尽管入院时通过放射学肺水肿评分（Radiological-Assessment-of-Lung-Edema score）评估肺炎严重程度无差异（5 分比 6 分，p=0.69），但与无 VF 患者相比，有 VF 的患者用力肺活量（FVC）较低（2.9 升比 3.6 升，p=0.006；分别为预测值的 85%比 110%，p=0.001），第 1 秒用力呼气量（FEV1）较低（2.2 升比 2.8 升，p=0.005；分别为预测值的 92%比 110%，p=0.001），一氧化碳弥散量（DLCO 5.83 比 6.98mmol/min/kPa，p=0.036；分别为预测值的 59%比 86.3%，p=0.043）。
VF 是疾病内分泌表型的表现，似乎会影响 COVID-19 幸存者的中期呼吸功能受损，这可能会显著影响他们的恢复。因此，我们的研究结果表明，在基线时进行 VF 评估可以帮助识别需要更强化呼吸随访的患者，并且没有肺部疾病证据但持续存在呼吸功能障碍的患者可能会受益于 VF 评估，以防止骨折和呼吸恶化的恶性循环。
