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柳叶刀：武汉大规模数据！近半数新冠患者1年后还有后遗症

2021-09-09 梅斯医学 MedSci原创

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近期，由武汉金银潭医院、北京中日友好医院呼吸科研究所等团队在柳叶刀上联合发表了一项迄今为止规模最大的新冠康复者队列研究，该研究具体分析了新冠康复者出院1年以后的健康状况。

近期，由武汉金银潭医院、北京中日友好医院呼吸科研究所等团队在柳叶刀上联合发表了一项迄今为止规模最大的新冠康复者队列研究，该研究具体分析了新冠康复者出院1年以后的健康状况。
研究发现，将近有一半的新冠康复者在出院1年以后，仍然伴有新冠后遗症。新冠后遗症（又称长期 Covid）指的是疲劳、健忘、身体疼痛、睡眠困难、脱发、嗅觉和味觉障碍等症状持续很长时间，其中最常见的症状是疲劳或肌肉无力 。
 
也就是说，对于某些新冠患者来说，1年后完全康复是不可能的，他们需要更长的时间才能达到感染新冠以前的基线健康状态。
在该研究中，研究员对2020 年 1 月 7 日至 5 月 29 日期间从武汉金银潭医院出院的2218名新冠康复者进行了随访，最长随访时间为1年。
 
 在 6 个月和 12 个月的随访中，康复者接受了关于症状和健康相关生活质量 (HRQoL) 的问卷采访，并接受了体检、6 分钟步行测试和其他指标测试。最终有1276 名 COVID-19 幸存者完成了两次访问。研究员还招募了未感染新冠的参与者，当作对照组，对照组接受了采访并完成了问卷，以评估普遍症状和 HRQoL。
 
研究员分析数据时，将参与者根据住院期间的严重程度分为三组，分别是3级，（不需要补充氧气）；4级（需要补充氧气）和5-6级（需要高流量鼻插管、无创机械通气或有创机械通气）。

该研究的主要结果是新冠症状、患者呼吸困难评价量表评分（mMRC score）、生活质量评分和 6 分钟步行距离 (6MWD)。

 
研究结果发现，在患者出院6个月后，有68%的人还至少有一种后遗症（831/1227），到患者出院12个月时，还有49%的人存在一种或一种以上后遗症。其中疲劳或肌肉无力是两次就诊时最常报告的症状。
 
在总队列和所有三个亚组中，疲劳或肌肉无力、睡眠困难、脱发、嗅觉障碍和味觉障碍这些症状随着时间的推移而明显缓解。但是，以mMRC评分为1分或以上为特征的呼吸困难患者（呼吸困难）的比例反而随着时间的推移而增加，在6个月时，呼吸困难患者的比例为26%（313/1185），而到12个月时，这一比例增加到了30%（380/1271）。
 
此外，焦虑和抑郁症也随着时间的推移而增加，在6个月时，焦虑和抑郁症的比例是23%，到了第12个月，这一比例为26%。其中以轻度焦虑或抑郁症为主。
 
接下来，研究人员根据新冠症状严重程度来进一步分析了康复者的健康状况。
 
经多变量调整后，严重程度为5-6级的参与者在12个月时出现肺部弥散障碍的风险高于3级的参与者。12个月时，严重程度3级组有23%（13/56）的患者出现肺弥散障碍，而5-6级组出现肺弥散障碍的比例为54%（38/70）。
 
弥散功能障碍是指O2、CO2等气体通过肺泡膜进行交换的物理弥散过程发生障碍。临床上当肺部病变产生弥散功能障碍时，其后果均导致缺氧。肺部弥散障碍可归因于肺上皮损伤，或肺间质或肺血管异常。
 
这说明，新冠重症越严重，对肺造成的损伤就越大，导致后期肺部健康恢复的也慢。
 
同时，研究人员发现，与男性相比，女性更容易感觉到焦虑、疲劳或肌无力。女性的疲劳或肌无力的OR值为1.43，焦虑或抑郁的OR值为2.00。此外，急性期的皮质类固醇治疗也会增加疲劳或肌肉无力的风险（OR 1.51）。
 
年龄也是影响新冠康复者长期症状的一个重要因素。研究结果表明年龄与焦虑、抑郁和弥散障碍呈正相关。年龄每增加10年，焦虑或抑郁的风险便增加18%（OR 1.18），弥散障碍的风险增加30%（1.30，）。 
 
该研究表明了，至少有一半新冠康复患者在一年后还没有完全康复，存在一种或一种以上的后遗症，而且年龄越大，焦虑或抑郁症的风险越高。此外，女性更容易比男性发焦虑或抑郁症和疲劳或肌肉无力。
长期后遗症会在生活中的各个方面影响患者的生活质量，甚至有的人因不能忍受新冠后遗症而自杀。之前有报道，美国一CEO因为无法忍受长期后遗症而自杀。
 
 
 
目前在国内，大部分人都接种了新冠疫苗。疫苗除了可以防重症，还可以降低出现长期症状的风险。9月1号，发表在最新的《《柳叶刀·传染病》的一项研究发现，与未接种疫苗的对照组相比，所有参与者在接种两次疫苗后，出现长期（≥28 天）症状的几率较低（OR 0·51 )。
 
感染新冠出现重症和新冠后遗症对于患者来说都是致命性的打击，而接种疫苗不仅可以防重症，还能保护人们免受新冠后遗症的侵害。
 

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    2022-07-25 tidiq

    #新冠患者#

    0

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    2022-05-09 ylz8403

    #大规模#

    0

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    2021-09-11 huirong

    #后遗症#

    0

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    2021-09-09 公卫新人

    新冠肺炎，疫情何时才能消失

    0

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    2021-09-09 公卫新人

    新冠肺炎，疫情何时才能消失

    0

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    2021-09-09 ms5000001133975157

    做好防护，避免传染

    0