接种疫苗和关注变异株对长新冠临床表型的影响。
Impact of vaccination and variants of concern on long COVID clinical phenotypes.
机构信息
Centre for Experimental Pathogen Host Research, University College Dublin, Belfield Dublin 4, Ireland.
St Vincent's University Hospital, Dublin, Ireland.
出版信息
BMC Infect Dis. 2023 Nov 16;23(1):804. doi: 10.1186/s12879-023-08783-y.
BACKGROUND
Defining patterns of symptoms in long COVID is necessary to advance therapies for this heterogeneous condition. Here we aimed to describe clusters of symptoms in individuals with long COVID and explore the impact of the emergence of variants of concern (VOCs) and vaccination on these clusters.
METHODS
In a prospective, multi centre cohort study, individuals with symptoms persisting > 4 weeks from acute COVID-19 were divided into two groups based on timing of acute infection; pre-Alpha VOC, denoted wild type (WT) group and post-Alpha VOC (incorporating alpha and delta dominant periods) denoted VOC group. We used multiple correspondence analysis (MCA) and hierarchical clustering in the WT and VOC groups to identify symptom clusters. We then used logistic regression to explore factors associated with individual symptoms.
RESULTS
A total of 417 individuals were included in the analysis, 268 in WT and 149 in VOC groups respectively. In both groups MCA identified three similar clusters; a musculoskeletal (MSK) cluster characterised by joint pain and myalgia, a cardiorespiratory cluster and a less symptomatic cluster. Differences in characteristic symptoms were only seen in the cardiorespiratory cluster where a decrease in the frequency of palpitations (10% vs 34% p = 0.008) and an increase in cough (63% vs 17% p < 0.001) in the VOC compared to WT groups was observed. Analysis of the frequency of individual symptoms showed significantly lower frequency of both chest pain (25% vs 39% p = 0.004) and palpitations (12% vs 32% p < 0.001) in the VOC group compared to the WT group. In adjusted analysis being in the VOC group was significantly associated with a lower odds of both chest pain and palpitations, but vaccination was not associated with these symptoms.
CONCLUSION
This study suggests changes in long COVID phenotype in individuals infected later in the pandemic, with less palpitations and chest pain reported. Adjusted analyses suggest that these effects are mediated through introduction of variants rather than an effect from vaccination.
背景
明确长新冠症状模式对于推进针对这种异质性疾病的治疗方法至关重要。在这里，我们旨在描述长新冠患者的症状聚类，并探讨关注变异株（VOC）的出现和接种疫苗对这些聚类的影响。
方法
在一项前瞻性、多中心队列研究中，根据急性 COVID-19 感染的时间，将症状持续存在超过 4 周的个体分为两组；阿尔法变异株（Alpha VOC）前组，记为野生型（WT）组，阿尔法变异株后组（包含 alpha 和 delta 主导期），记为 VOC 组。我们使用多元对应分析（MCA）和层次聚类在 WT 和 VOC 组中识别症状聚类。然后，我们使用逻辑回归来探讨与个体症状相关的因素。
结果
共纳入 417 名患者进行分析，WT 组 268 例，VOC 组 149 例。在两组中，MCA 均识别出三个相似的聚类；一个肌肉骨骼（MSK）聚类，特征为关节疼痛和肌痛；一个心肺聚类；以及一个症状较少的聚类。只有心肺聚类的特征症状存在差异，在 VOC 组中，心悸的频率降低（10%对 34%，p=0.008），咳嗽的频率增加（63%对 17%，p<0.001）。对个体症状频率的分析表明，VOC 组胸痛（25%对 39%，p=0.004）和心悸（12%对 32%，p<0.001）的频率明显低于 WT 组。在调整分析中，VOC 组胸痛和心悸的可能性均显著降低，但接种疫苗与这些症状无关。
结论
这项研究表明，在大流行后期感染的个体中，长新冠表型发生了变化，报告的心悸和胸痛较少。调整分析表明，这些影响是通过变异株的引入而不是疫苗接种的影响介导的。
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