柳叶刀：近20万人数据显示，新冠感染一年内，这种疾病的风险增加40%！

2022-04-13 乐一 MedSci原创

梅斯头条

企业/

柳叶刀子刊：这项针对近20万人的大规模研究显示，与未感染者相比，新冠病毒感染者1年内罹患糖尿病的风险显著提高了40%！

"如果你感染了COVID-19，糖尿病就是致命的。"

2020年3月一篇发表于《柳叶刀》的研究，纳入191名武汉COVID-19确诊者，发现48%的患者存在基础疾病，其中合并糖尿病的患者占19%，而在死亡病例（54人）中，有高达三分之一的患者合并糖尿病。

Diabetes Care也曾刊文，对武汉两家医院感染COVID-19的糖尿病患者的临床特征和危险因素进行分析。发现相比无基础病的新冠患者，本身就具有糖尿病的患者ICU住院率更高，死亡人数也更多。

（图片来源：Diabetes Care）

这项研究共选取1 561例COVID-19患者，其中包括糖尿病患者153例（中南医院42例，人民医院111例），糖尿病患病率为9.8％。调查发现，新冠合并糖尿患者的胆固醇水平、PaO₂水平和CD8⁺细胞计数水平通常偏低，而血糖和降钙素原水平则偏高。更重要的是，糖尿病患者罹患急性呼吸窘迫综合征（ARDS）、急性心脏损伤、继发感染、休克的可能性更高。

总的来说，与普通新冠患者相比，新冠合并糖尿患者表现出了更严重的临床征兆，进入ICU的比例也大大提升。

参与调查患者的治疗结果。（图片来源：Diabetes Care）

同样，该研究也发现，糖尿病患者在感染COVID-19后表现出了较高的死亡率。死亡的新冠合并糖尿患者的肺部CT结果与普通新冠患者相比，其肺部的受累率>75％的比例更高，受累率<25％的比例更少，死亡患者的呼吸频率和心率也更高。

“最终归宿”为死亡的新冠合并糖尿患者在治疗期间被送入ICU的可能性更大，且接受的治疗时间明显缩短。其中，年龄≥70岁和高血压是新冠合并糖尿患者发生院内死亡的重要危险因素。

COVID-19合并糖尿病患者和非糖尿病患者的生存曲线。（图片来源：Diabetes Care）

由此可见，糖尿病患者在感染新冠之后会承受比常人更高的“伤害值”，对于本身就有糖尿病等基础病的患者，在面对新冠病毒时应当更加小心，时时防范。

你以为新冠与糖尿病的“渊源”仅限于此吗？并不，近年来随着对病毒更为深入的研究，科学家发现新冠病毒也会导致糖尿病的发生。

近日，《柳叶刀》子刊发表了题为：Risks and burdens of incident diabetes in long COVID: a cohort study 的研究论文。这项针对近20万人的大规模研究显示，与未感染者相比，新冠病毒感染者1年内罹患糖尿病的风险显著提高了40%！

（图片来源：Lancet Diabetes Endocrinol）

该分析纳入了2020年3月至2021年9月30日期间，来自美国退伍军人医疗数据库中确诊为COVID-19的约18万名新冠受试者，同时纳入了同年约410万名健康人受试者作为“当代对照组”，以及2017年约420万名健康人作为“历史对照组”。平均随访时间为一年。

有趣的是，一年后对照组诊断出糖尿病的比例为35人/1000人，而感染新冠的人诊断出糖尿病的比例为48人/1000人，并且几乎均为2型糖尿病。相比之下，新冠患者一年后患糖尿病的风险比健康人高出了近40%。

与对照组相比，确诊患者感染糖尿病风险。（图片来源：Lancet Diabetes Endocrinol）

同时，将新冠严重程度分为未住院、住院或重症监护三个级别，罹患糖尿病的风险也会随着症状的严重程度而增加。与对照组相比，住院或重症的新冠感染者的糖尿病风险大约是其3倍。即使是轻症、未住院的新冠感染者，患糖尿病的风险也会增加。

与对照组相比，按感染严重程度划分的急性COVID-19患糖尿病风险。

（图片来源：Lancet Diabetes Endocrinol）

并且，65岁以上新冠患者有着更高的糖尿病风险；之前患有超重/肥胖、心血管疾病、高血压、高脂血症或糖尿病前期的患者在感染COVID-19后也更有可能发生糖尿病。另一方面，与BMI 18·5 kg/m² ~25 kg/m²的患者相比，BMI为25 kg/m²~30 kg/m²的患者和BMI为30 kg/m²以上的新冠患者的患糖尿病风险均有不同程度的增加。

COVID-19患者糖尿病风险。（图片来源：Lancet Diabetes Endocrinol）

这么一看，新冠病毒与糖尿病竟像是“相辅相成”了：糖尿病增加了新冠肺炎的严重程度和死亡率，新冠肺炎患者中也表现出了较高的糖尿病患病风险。

纪立农教授等全球20位顶级糖尿病及内分泌领域专家对此进行了精彩的阐述，相关结论发表在Lancet Diabetes Endocrinol上。他们认为，新冠病毒与糖尿病二者“双向奔赴”：一方面，糖尿病被认为是导致新冠肺炎加重的重要危险因素。另一方面，新冠肺炎极有可能是导致新发糖尿病的关键因素，且加重糖尿病患者的疾病状态。

（图片来源：Lancet Diabetes Endocrinol）

对于在新冠肺炎中合并糖尿病或高血糖的患者，纪立农表示：“要在不增加低血糖风险的前提下严格控制血糖，改善患者的预后。胰岛素具有无胃肠道副作用、降糖效果明显、有利于组织修复、剂量可及时调整且不受肝肾功能禁忌等优点，应作为首选治疗药物。”

参考文献

[1] Shi Q, Zhang X, Jiang F, Zhang X, Hu N, Bimu C, Feng J, Yan S, Guan Y, Xu D, He G, Chen C, Xiong X, Liu L, Li H, Tao J, Peng Z, Wang W. Clinical Characteristics and Risk Factors for Mortality of COVID-19 Patients With Diabetes in Wuhan, China: A Two-Center, Retrospective Study. Diabetes Care. 2020 Jul;43(7):1382-1391. doi: 10.2337/dc20-0598.

[2] Xie Y, Al-Aly Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol. 2022 Mar 21:S2213-8587(22)00044-4. doi: 10.1016/S2213-8587(22)00044-4.

[3] Bornstein SR, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020;8(6):546-550. doi:10.1016/S2213-8587(20)30152-2.

[4] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L, Wei Y, Li H, Wu X, Xu J, Tu S, Zhang Y, Chen H & Cao B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020.

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2022-04-13 ms5000000462690030

有理有据

54 0
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2022-04-13 尾鱼

🤔

51 0
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2022-04-13 121bd5e0m05暂无昵称

有道理

46 0
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2022-04-13 HH757

写的挺好

54 0
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2022-04-13 1211c54em14(暂无昵称)

新冠和糖尿病相辅相成

48 0

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