Lancet Diabetes Endocrinol:2型糠尿病老年患者面临更高的COVID-19死亡风险

2020-04-27 竹子 转化医学网

导言:《柳叶刀肿瘤》上前有研究表明,COVID-19患者中,同时患有癌症的人死亡风险更高。武汉大学中南医院的研究团队发现与年龄相关的基础疾病,如高血压和糖尿病等,会明显减缓COVID-19患者体内病毒

导言:《柳叶刀肿瘤》上前有研究表明,COVID-19患者中,同时患有癌症的人死亡风险更高。武汉大学中南医院的研究团队发现与年龄相关的基础疾病,如高血压和糖尿病等,会明显减缓COVID-19患者体内病毒清除速度。但鲜有研究表明糖尿病,尤其是2型糖尿病的特定人群患上COVID-19后死亡风险更高。

近日,莫纳什大学参与的一项研究发现,患有COVID-19的老年糖尿病患者死于该疾病的风险更高——该病毒实际上可能触发正常健康人群的糖尿病发作。该研究发表在《柳叶刀糖尿病与内分泌学》上,发现在全球范围内,大流行期间被诊断出COVID-19的患者中有20%至50%患有糖尿病。它还指出,在糖尿病患者中,特别是老年2型糖尿病患者,死于COVID-19的风险高出50%。

在澳大利亚,截至4月12日,死于COVID-19的46人中有三分之一患有糖尿病,而752例因病毒感染住院的人中有20%患有糖尿病。

这项研究是由糖尿病领域的国际专家小组完成的。他们汇聚一堂,为发达国家和发展中国家的临床医生提供了有关糖尿病管理的指导和实用建议。

合著者莫纳什大学糖尿病系教授保罗·齐默特(Paul Zimmet AO),还是国际糖尿病联合会的名誉主席,一直为联邦卫生部长就政府的《国家糖尿病战略》提供意见。

齐默特教授说,数据突显了COVID-19对糖尿病患者的真正威胁性,因为他们更容易患上严重的肺炎和脓毒症。这项研究很重要,因为它汇集了当前世界上有关COVID-19对糖尿病患者的影响,而且鉴于这种流行病是最近发生的,他们面临的风险增加了。

在受COVID-19严重影响的地区进行的流行病学观察,以及疾病控制中心(CDC)和其他国家卫生中心和医院的报告表明,在COVID-19患者中,糖尿病患者致命风险比没有糖尿病的患者高出50%以上。

这项研究的大部分重点都集中在2型糖尿病患者上。到目前为止,大多数信息都集中在相关的老年群体上,患有1型糖尿病的年轻人中COVID-19的风险似乎要低得多。只要他们能够保证足够的医疗保健,并良好地控制自己的糖尿病。在此问题上,儿童和青少年的父母算是吃下一颗“定心丸”了。

该研究指出,对胰腺β细胞(制造胰岛素的细胞)的损害可能会导致胰腺功能的直接损害。尽管这尚未在人类中得到证实,但研究人员认为糖尿病不仅可能是严重COVID-19疾病的危险因素,而且感染可能导致新发糖尿病。

由新冠病毒导致的胰岛素缺乏引起的潜在胰岛β细胞损伤,也有证据支持这一发现。其他共同作者曾报道住院期间经常发生严重的糖尿病酮症酸中毒(DKA)。

齐默特教授说,这项研究建议对患有COVID-19感染的人实施糖尿病检测,以鉴定以前健康的人是否由于感染病毒而患上了糖尿病。因为这显然会影响他们的医疗管理和健康结果。

根据这项研究,糖尿病患者发生严重并发症的风险增加,包括成人呼吸窘迫综合征和包括肺、心脏和肾脏在内的多器官衰竭。

齐默特教授说,还应该向从事COVID-19患者护理的糖尿病保健专业人员发出警告,以确保他们获得防止感染病毒所需的保护。

某些糖尿病患者亚组可能也需要特别关注,包括:
· 对糖尿病的新陈代谢(血糖)控制不良的人
· 患有糖尿病并发症的人(总体而言,重症COVID-19感染者有肾衰竭的高风险)
· 肥胖的2型糖尿病患者(这可能会引起管理问题)
· 因肥胖而进行减肥手术的糖尿病患者(需要特别注意)
· 曾经接受过胰腺和肾脏移植的人,或者接受定期透析的人
· 接受其他疾病免疫抑制治疗或可的松治疗的患者
· 那些服用某些糖尿病药物的人(如果病得很重,可能会影响病情进展)
· 患有高血压和高血脂(脂肪)的2 型糖尿病患者(继续采用适当的降压和降脂方案至关重要)

原始出处:

Stefan R Bornstein, Francesco Rubino, Kamlesh Khunti, et.al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol April 23, 2020

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    2020-06-22 howi
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    2020-04-27 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

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