Dogu Zengin Didem, Ergun Dilek, Yormaz Burcu, Ergun Recai, Guven Halil, Korez Muslu Kazim, Ozer Halil, Unlu Ali, Tulek Baykal, Kanat Fikret
Department of Pulmonary Medicine, Konya City Hospital, Konya 42020, Turkey.
Department of Pulmonary Medicine, Selcuk University, Konya 42250, Turkey.
Viruses. 2025 Jul 6;17(7):954. doi: 10.3390/v17070954.
This study aims to identify predictive factors for pulmonary fibrosis development in COVID-19 patients by analyzing thorax CT (computed tomography) findings, serum prolidase activity, MMP-1, MMP-7, TGF-β values, laboratory findings, and demographic characteristics.
The investigation involved 68 patients, both male and female, aged 18 years and older, who were volunteers and had been diagnosed with confirmed COVID-19. The pulmonologist and the radiologist evaluated the thorax CT by consensus. Patients were evaluated in two categories, group 1 and group 2, based on the status of fibrotic changes, and 3-month fibrosis scores were calculated. Findings in both lungs were calculated and noted for the lobes, considering lobar spread. Correlations between quantitative parameters were assessed with Spearman's rho correlation coefficient. Comparisons between independent samples were evaluated using either the independent sample -test or the Mann-Whitney U test. We evaluated the relationship between categorical variables using the Pearson chi-square test and Fisher's exact test.
Serum prolidase activity, MMP-1, MMP-7, and TGF-β biomarkers were not statistically significant among groups. LDH was found to be significantly high in the group with fibrotic changes. Additionally, the group with fibrotic changes also had higher levels of fibrinogen. The percentage of neutrophils, the severity of the disease, muscle-joint pain and fatigue symptoms, and the length of hospitalization stay were correlated with the total scores of fibrosis at the third month. In the group with fibrotic changes, the duration of muscle-joint pain and fatigue symptoms and the length of hospitalization were longer than in the other group.
The group with fibrotic changes showed an increase in biomarkers. However, this increase did not reach a statistically significant level, suggesting that the third month may be an early period for these changes. The group with fibrotic changes showed high levels of LDH, one of the most important laboratory parameters of pulmonary fibrosis risk factors, along with fibrinogen, suggesting that these parameters are valuable in predicting pulmonary fibrosis. Patients with fibrotic changes can experience specific symptoms, commonly seen in COVID-19.
本研究旨在通过分析胸部CT（计算机断层扫描）结果、血清脯氨酰寡肽酶活性、基质金属蛋白酶-1（MMP-1）、基质金属蛋白酶-7（MMP-7）、转化生长因子-β（TGF-β）值、实验室检查结果和人口统计学特征，确定COVID-19患者发生肺纤维化的预测因素。
该调查纳入了68名年龄在18岁及以上的男性和女性志愿者，他们均被确诊为COVID-19。肺科医生和放射科医生通过协商一致对胸部CT进行评估。根据纤维化改变的情况，将患者分为1组和2组两类，并计算3个月时的纤维化评分。考虑到肺叶分布，计算并记录两肺各肺叶的情况。使用Spearman等级相关系数评估定量参数之间的相关性。使用独立样本t检验或Mann-Whitney U检验评估独立样本之间的差异。使用Pearson卡方检验和Fisher精确检验评估分类变量之间的关系。
血清脯氨酰寡肽酶活性、MMP-1、MMP-7和TGF-β生物标志物在各组之间无统计学意义。发现纤维化改变组的乳酸脱氢酶（LDH）显著升高。此外，纤维化改变组的纤维蛋白原水平也较高。中性粒细胞百分比、疾病严重程度、肌肉关节疼痛和疲劳症状以及住院时间与第三个月时的纤维化总分相关。在纤维化改变组中，肌肉关节疼痛和疲劳症状的持续时间以及住院时间比另一组更长。
纤维化改变组的生物标志物有所增加。然而，这种增加未达到统计学显著水平，这表明第三个月可能是这些变化的早期阶段。纤维化改变组的LDH水平较高，LDH是肺纤维化危险因素最重要的实验室参数之一，同时纤维蛋白原水平也较高，这表明这些参数在预测肺纤维化方面具有重要价值。发生纤维化改变的患者可能会出现COVID-19中常见的特定症状。
