Huang Xiao-Yan, Yang Li-Juan, Hu Xiang, Zhang Xing-Xing, Gu Xiao, Du Lin-Jia, He Zhi-Ying, Gu Xue-Jiang
Department of Endocrine and Metabolic Disease, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
Department of Endocrine and Metabolic Disease, Yueqing People's Hospital, Affiliated Hospital of Wenzhou Medical University, Wenzhou 325600, Zhejiang Province, China.
World J Diabetes. 2022 Jul 15;13(7):543-552. doi: 10.4239/wjd.v13.i7.543.
The association between blood levels of fructosamine (FMN) and recurrent coronavirus disease 2019 (COVID-19) is currently unclear.
To investigate a prospective relationship between blood levels of FMN and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection.
A total of 146 Chinese hospitalized patients infected with SARS-CoV-2 were consecutively collectively recruited and followed from January 2020 to May 2021. Diagnosis of COVID-19 and SARS-CoV-2 reinfection was based on the diagnostic criteria and treatment protocol in China. The levels of FMN were determined in blood and divided into tertiles based on their distribution in the cohort of COVID-19 patients. Multivariate-adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for SARS-CoV-2 reinfection across the tertiles of FMN levels. A Cox regression model was used to generate the HR for SARS-CoV-2 reinfection in the participants in the top tertile of FMN levels compared with those at the bottom. Disease-free survival was used as the time variable, and relapse was used as the state variable, adjusted for age, gender, influencing factors such as diabetes mellitus, hypertension, and corticosteroid therapy, and clinical indexes such as acute liver failure, acute kidney failure, white blood cell (WBC) count, C-reactive protein, prognostic nutritional index (PNI), and blood lipids. Kaplan-Meier analysis with log-rank tests was used to compare the survival rate between patients with elevated FMN levels (FMN > 1.93 mmol/L, the top tertile) and those with nonelevated levels.
Clinical data for the 146 patients with confirmed COVID-19 [age 49 (39-55) years; 49% males] were analyzed. Eleven patients had SARS-CoV-2 reinfection. The SARS-CoV-2 reinfection rate in patients with elevated FMN levels was significantly higher than that in patients with nonelevated FMN (17% 3%; = 0.008) at the end of the 12-mo follow-up. After adjustments for gender, age, diabetes mellitus, hypertension, corticosteroid therapy, WBC count, PNI, indexes of liver and renal function, and blood lipids, patients with nonelevated FMN levels had a lower risk of SARS-CoV-2 reinfection than those with elevated FMN levels (HR = 6.249, 95%CI: 1.377-28.351; = 0.018). Kaplan-Meier analysis showed that the cumulative survival rate of patients infected with SARS-CoV-2 was higher in patients with nonelevated FMN levels than in those with elevated FMN levels (97% 83%; log rank = 0.002).
Elevated levels of FMN are independently associated with SARS-CoV-2 reinfection, which highlights that patients with elevated FMN should be cautiously monitored after hospital discharge.
目前尚不清楚果糖胺（FMN）血水平与2019冠状病毒病（COVID-19）复发之间的关联。
探讨FMN血水平与严重急性呼吸综合征冠状病毒2（SARS-CoV-2）再次感染之间的前瞻性关系。
2020年1月至2021年5月，连续招募并随访了146例在中国住院的SARS-CoV-2感染患者。COVID-19和SARS-CoV-2再次感染的诊断依据中国的诊断标准和治疗方案。测定血液中FMN水平，并根据其在COVID-19患者队列中的分布分为三分位数。估计FMN水平三分位数的SARS-CoV-2再次感染的多变量调整风险比（HR）及95%置信区间（CI）。采用Cox回归模型生成FMN水平最高三分位数参与者与最低三分位数参与者相比的SARS-CoV-2再次感染HR。将无病生存期用作时间变量，复发用作状态变量，并对年龄、性别、糖尿病、高血压和皮质类固醇治疗等影响因素以及急性肝衰竭、急性肾衰竭、白细胞（WBC）计数、C反应蛋白、预后营养指数（PNI）和血脂等临床指标进行调整。采用Kaplan-Meier分析和对数秩检验比较FMN水平升高（FMN>1.93 mmol/L，最高三分位数）患者与未升高患者之间的生存率。
分析了146例确诊COVID-19患者的临床数据[年龄49（39 - 55）岁；49%为男性]。11例患者发生SARS-CoV-2再次感染。在12个月随访结束时，FMN水平升高患者的SARS-CoV-2再次感染率显著高于FMN水平未升高患者（17%对3%；P = 0.008）。在对性别、年龄、糖尿病、高血压、皮质类固醇治疗、WBC计数、PNI、肝肾功能指标和血脂进行调整后，FMN水平未升高患者的SARS-CoV-2再次感染风险低于FMN水平升高患者（HR = 6.249，95%CI：1. 377 - 28.351；P = 0.018）。Kaplan-Meier分析显示，FMN水平未升高的SARS-CoV-2感染患者的累积生存率高于FMN水平升高的患者（97%对83%；对数秩P = 0.002）。
FMN水平升高与SARS-CoV-2再次感染独立相关，这突出表明FMN水平升高的患者出院后应谨慎监测。
