不同呼吸道病毒感染中持续性淋巴细胞减少与院内静脉血栓栓塞之间的关联：一项回顾性队列研究。
The association between prolonged lymphopenia and in-hospital venous thromboembolism among different respiratory virus infections: a retrospective cohort study.
作者信息
Fan Guohui, Xu Feiya, Zhang Shuai, Si Chaozeng, Zhai Zhenguo, Wang Dingyi, Yang Weizhong
机构信息
School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College; State Key Laboratory of Respiratory Health and Multimorbidity; Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, P.R. China.
National Center for Respiratory Medicine; State Key Laboratory of Respiratory Health and Multimorbidity; National Clinical Research Center for Respiratory Diseases; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences; Department of Clinical Research and Data Management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, P.R. China.
出版信息
Res Pract Thromb Haemost. 2025 Apr 24;9(3):102868. doi: 10.1016/j.rpth.2025.102868. eCollection 2025 Mar.
BACKGROUND
Lymphopenia, a marker of prolonged clearance of virus, has unclear association with venous thromboembolism (VTE) in respiratory virus infection.
OBJECTIVES
This study aims to explore the correlation between prolonged lymphopenia and the risk of in-hospital VTE in patients with respiratory virus infection.
METHODS
Adult patients with laboratory-confirmed COVID-19 influenza and other respiratory virus infection from January 1, 2016, to December 31, 2023, were retrospectively recruited. The primary outcome was symptomatic VTE during hospitalization. Logistic regression and the Fine-Gray model for competing risks were performed to explore the association between lymphopenia and VTE. Correlations between lymphocyte counts and inflammation/coagulation factors were evaluated using the mixed-effects model.
RESULTS
Among 4172 patients (2640 with COVID-19, 844 with influenza, and 688 with other respiratory virus infection), in-hospital VTE incidences were 5.04%, 2.61%, and 3.63%, respectively. Lymphocyte counts were negatively correlated with D-dimer levels in the VTE group among COVID-19 patients (β, -0.012; 95% CI, 0.020 to -0.003; = .0061). Lymphopenia lasting for 4 to 7 days in COVID-19 (VTE incidence, 8.75%; adjusted odds ratio, 2.06; 95% CI, 1.07-3.96; = .0312) and for 1 to 3 days in other respiratory virus infection (VTE incidence, 7.53%; adjusted odds ratio, 3.81; 95% CI, 1.15-12.69; = .0291) significantly increased the VTE risk. Lymphocyte-related peripheral blood count ratios, including the monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio, were all significantly associated with VTE in COVID-19 patients (all < .0001).
CONCLUSION
VTE events were associated with prolonged lymphopenia in hospitalized patients infected with SARS-CoV-2 or other respiratory viruses. Lymphocyte-related blood count ratios were associated with VTE occurrence in patients infected with SARS-CoV-2. This finding provided additional evidence of the crosstalk between lymphocyte-related inflammation after respiratory virus infection and coagulation.
背景
淋巴细胞减少是病毒清除时间延长的一个指标，在呼吸道病毒感染中与静脉血栓栓塞症（VTE）的关联尚不清楚。
目的
本研究旨在探讨呼吸道病毒感染患者淋巴细胞持续减少与住院期间发生VTE风险之间的相关性。
方法
回顾性纳入2016年1月1日至2023年12月31日期间实验室确诊的新型冠状病毒肺炎、流感及其他呼吸道病毒感染的成年患者。主要结局是住院期间出现症状性VTE。采用逻辑回归和竞争风险的Fine-Gray模型探讨淋巴细胞减少与VTE之间的关联。使用混合效应模型评估淋巴细胞计数与炎症/凝血因子之间的相关性。
结果
在4172例患者中（新型冠状病毒肺炎患者2640例、流感患者844例、其他呼吸道病毒感染患者688例），住院期间VTE发生率分别为5.04%、2.61%和3.63%。在新型冠状病毒肺炎患者的VTE组中，淋巴细胞计数与D-二聚体水平呈负相关（β，-0.012；95%CI，-0.020至-0.003；P = 0.0061）。新型冠状病毒肺炎患者淋巴细胞减少持续4至7天（VTE发生率，8.75%；调整后的比值比，2.06；95%CI，1.07 - 3.96；P = 0.0312）以及其他呼吸道病毒感染患者淋巴细胞减少持续1至3天（VTE发生率，7.53%；调整后的比值比，3.81；95%CI，1.15 - 12.69；P = 0.0291）均显著增加VTE风险。淋巴细胞相关的外周血细胞比值，包括单核细胞与淋巴细胞比值、中性粒细胞与淋巴细胞比值以及血小板与淋巴细胞比值，在新型冠状病毒肺炎患者中均与VTE显著相关（均P < 0.0001）。
结论
VTE事件与感染严重急性呼吸综合征冠状病毒2或其他呼吸道病毒的住院患者淋巴细胞持续减少有关。淋巴细胞相关的血细胞比值与感染严重急性呼吸综合征冠状病毒2的患者发生VTE有关。这一发现为呼吸道病毒感染后淋巴细胞相关炎症与凝血之间的相互作用提供了更多证据。
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