Lee Minkyeong, Park Byoung Kwon, Shin Dong Hoon, Oh Hong Sang, Jeong Chae-Hong, Lee So-Young, Kim Jungyeon, Park Sang-Won
Department of Internal Medicine, Seoul National University College of Medicine & Boramae Medical Center, Seoul, Republic of Korea.
Center for Emerging Virus Research, Korea National Institute of Health, Korea Disease Control and Prevention Agency, Cheongju, Republic of Korea.
PLoS One. 2025 Jun 5;20(6):e0325379. doi: 10.1371/journal.pone.0325379. eCollection 2025.
During the COVID-19 endemic phase, pulmonary sequelae substantially contributed to disease burden. Immunologic responses may be critical in both acute COVID-19 and in long-term sequelae. We aimed to evaluate associations between convalescent neutralizing antibodies and long-term pulmonary sequelae in patients hospitalized with mild to moderate COVID-19.
Among patients who recovered from hospitalization due to COVID-19, those who consented to participate in the study provided convalescent serum between June 2021 and April 2022. These baseline patients were invited for a second follow-up visit between September and November 2023. A serum sample was collected at the second visit, and low-dose chest computed tomography (CT) was performed. Pulmonary sequelae were defined as findings of fibrotic, fibrotic-like, and ground-glass opacities (GGOs). Antibody and cytokine levels were assessed in serum samples from the baseline convalescent phase, and antibody levels were also measured in the serum sample at the second visit.
A total of 107 patients were enrolled at baseline, and 37 consented to the second follow-up visit. Most second-visit patients (97.3%, 36/37) did not require an oxygen supply beyond that provided via masks or nasal prongs. Twenty-two patients (59.5%) exhibited pulmonary sequelae on chest CT at a median follow-up period of 27 months (interquartile range 25-28, range 22-30) after hospitalization for COVID-19. Fifteen patients (40.5%) had fibrotic or fibrotic-like pulmonary changes, and twelve (32.4%) had GGOs. Pulmonary sequelae were associated with older age (adjusted odds ratio 1.130, 95% confidence interval 1.028-1.243; P = 0.011). There were no significant differences in convalescent cytokines or neutralizing antibodies between patients with pulmonary sequelae and those without.
Pulmonary sequelae were quite common on chest CT after two years of mild to moderate COVID-19 and were associated with older age. The immunological or inflammatory status in the immediate post-acute infection period did not predict long-term complications.
在新冠疫情流行阶段，肺部后遗症对疾病负担有很大影响。免疫反应在急性新冠感染期和长期后遗症中可能都至关重要。我们旨在评估轻度至中度新冠感染住院患者康复期中和抗体与长期肺部后遗症之间的关联。
在因新冠感染住院康复的患者中，那些同意参与研究的患者在2021年6月至2022年4月期间提供了康复期血清。这些基线患者在2023年9月至11月期间被邀请进行第二次随访。在第二次随访时采集血清样本，并进行低剂量胸部计算机断层扫描（CT）。肺部后遗症定义为纤维化、类纤维化及磨玻璃影（GGO）的表现。在基线康复期的血清样本中评估抗体和细胞因子水平，在第二次随访时的血清样本中也测量抗体水平。
共有107例患者在基线时入组，37例同意进行第二次随访。大多数第二次随访患者（97.3%，36/37）除通过口罩或鼻导管提供的氧气外，不需要额外吸氧。22例患者（59.5%）在新冠感染住院后的中位随访期27个月（四分位间距25 - 28，范围22 - 30）时胸部CT显示有肺部后遗症。15例患者（40.5%）有纤维化或类纤维化肺部改变，12例（32.4%）有磨玻璃影。肺部后遗症与年龄较大相关（调整优势比1.130，95%置信区间1.028 - 1.243；P = 0.011）。有肺部后遗症的患者与无肺部后遗症的患者在康复期细胞因子或中和抗体方面无显著差异。
轻度至中度新冠感染两年后，胸部CT显示肺部后遗症相当常见，且与年龄较大相关。急性感染后即刻的免疫或炎症状态不能预测长期并发症。
