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中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (01): 33 -37. doi: 10.3877/cma.j.issn.1674-6902.2022.01.008

论著 上一篇    

老年糖尿病患者并发新型冠状病毒肺炎预后及其相关因素分析
钱丹 1, 何佳霖 2, 林昊 3, 黄其密 2, 刘唯佳 2, 赵国策 2, 刘玺 2, 高梦圆 2 , ( ), 潘鑫涛 4 , ( ), 任成山 2   
  1. 1. 400037 重庆,陆军(第三)军医大学第二附属医院检验科
    2. 400037 重庆,陆军(第三)军医大学第二附属医院消化内科
    3. 610000 成都,四川大学华西临床医学院2019级临床医学八年制(2019181620268)
    4. 200065 上海,上海同济大学附属同济医院发展部
  • 收稿日期:2021-08-25 出版日期:2022-02-25
  • 通信作者: 高梦圆, 潘鑫涛
  • 基金资助:
    重庆市科卫联合资助项目(2020FYYX123)

Prognosis and related factors in elderly patients with diabetes mellitus complicated with COVID-19

Dan Qian 1, Jialin He 2, Hao Lin 3, Qimi Huang 2, Weijia Liu 2, Guoche Zhao 2, Xi Liu 2, Mengyuan Gao 2 , ( ), Xintao Pan 4( ), Chengshan Ren 2   

  1. 1. Department of Laboratory, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, 400037, China
    2. Department of Gastroenterology, The Second Affiliated Hospital, the Third Military Medical University, Chongqing, 400037, China
    3. Eight-year-program for Clinical Medicine(2019181620268), West China School of Medicine, Sichuan University, Chengdu 610041, China
    4. Development Department of Tongji Hospital,Tongji University, Shanghai 200065, China
  • Received:2021-08-25 Published:2022-02-25
  • Corresponding author: Mengyuan Gao, Xintao Pan
目的

分析老年糖尿病患者并发新型冠状病毒肺炎(COVID-19)的临床特征及其预后相关因素,为早期防治提供参考依据。

方法

以2020年2月4日至2020年4月16日确诊的COVID-19 3 733例中伴有糖尿病的老年患者227例作为分析对象,采集患者一般资料、基础疾病、临床特征、实验室结果等信息,采用SPSS 23.0进行数据描述和分析。

结果

227例老年糖尿病患者并发COVID-19被纳入分析,住院期间死亡16例,病死率为7.0%(16/227);单因素和多因素Logistic回归分析结果提示:肺部疾病、血糖、白细胞、中性粒细胞、肌酐、CKMB和呼吸困难是老年糖尿病并发COVID-19预后危险因素;采用这些因素预测老年糖尿病并发COVID-19死亡的ROC曲线下面积(AUC)为96.0%(95CI:91.0%~100.0%)。

结论

老年人群中,糖尿病患者并发COVID-19的患者其预后风险较高,采用血糖和白细胞等因素预测COVID-19的预后具有临床意义。

Objective

To invistigate the clinical characteristics and related mortality factors of elderly patients with diabetes mellitus complicated with COVID-19, and to provide reference for the early prevention and treatment of such patients.

Methods

A total of 3733 COVID-19 patients confirmed in Hospital, and 227 elderly patients with diabetes were included as the analysis subjects. From medical records extracted general information, basic diseases, clinical characteristics, laboratory results and death of patients and then descripte and analysis through SPSS 23.0.

Results

227 elderly patients with diabetes mellitus complicated with COVID-19. Sixteen elderly patients with COVID-19 complicated with diabetes died during hospitalization, with a fatality rate of 7.0% (16/227). Univariate and multivariate logistic regression analysis showed that pulmonary disease, leukocyte, blood sugar, Neutrophils, creatinin, CKMB and dyspnea were correlation factors of prognosis in elderly patients with diabetes complicated with COVID-19; The area under ROC curve for predicting death in elderly patients with diabetes combined with COVID-19 by these factors was 96.0%(95CI: 91.0%-100.0%).

Conclusion

Among the elderly patients, the risk of prognosis with diabetes complicated with COVID-19 is higher, and it possesses higher degree of accuracy to predict the risk of prognosis within these patients by using related factors such as blood sugar and leukocyte.

表1 老年糖尿病患者并发COVID-19的临床特征及预后的单因素分析[n(%)]
临床资料 合计(n=227) 存活(n=211) 死亡(n=16) χ2/t P
男/女 126/101 114/97 12/4 - 0.123
年龄[median(P25~P75)] 69(65~75) 69(65~74) 77.5(68~82.5) 2.166 0.030
体温(Mean±SD) 37. 66±1.03 37.63±1.02 38.14±1.10 1.804 0.089
发热 155(68.28) 143(67.77) 12(75.00) 0.359 0.549
呼吸频率(次/min) 20(19~22) 20(19~22) 22(20~24) 2.907 0.004
脉搏(次/min) 85(78~95) 85(78~94) 93.5(81~111.75) 2.105 0.035
首发症状持续时间(h) 20(12~30) 20(13~30) 13(10~28.25) 1.365 0.172
临床症状          
  咳嗽 158(69.6) 144(68.25) 14(87.5) 2.606 0.106
  咳痰 30(13.22) 28(13.27) 2(12.5) - 1.000
  呼吸困难 74(32.6) 62(29.38) 12(75) 14.085 0.000
  胸闷 47(20.7) 43(20.38) 4(25) - 0.748
  腹泻 9(3.96) 9(4.27) 0 - -
  食欲减退 73(32.16) 67(31.75) 6(37.5) 0.225 0.635
既往疾病史          
  高血压史 136(59.91) 128(60.66) 8(50.00) 0.704 0.401
  冠心病史 29(12.78) 24(11.37) 5(31.25) 5.272 0.022
  肺部疾病史 11(4.85) 8(3.79) 3(18.75) - 0.034
  空腹血糖(mmol/L) 10.59±3.98 9.89±4.12 13.26±3.89 3.165 0.002
WBC(>10×109/L) 19(8.37) 12(5.69) 7(43.75) 28.094 0.000
中性粒细胞(>75%) 47(20.7) 37(17.54) 10(62.5) 18.315 0.000
胆红素(>26 μmol/L) 8(3.52) 4(1.90) 4(25.00) - 0.001
ALT(>50 IU/L) 27(11.89) 22(10.43) 5(31.25) 6.154 0.013
AST(>40 IU/L) 7(3.08) 4(1.90) 3(18.75) 14.136 0.000
白蛋白(<35 g/L) 39(17.18) 36(17.06) 3(18.75) - 0.742
CRP(>4.0 mg/L) 131(57.71) 118(55.92) 13(81.25) - 0.065
肌酐(>111 μmol/L) 18(7.93) 13(6.16) 5(31.25) 12.822 0.000
CKMB(>24 IU/L) 29(12.78) 21(9.95) 8(50) 21.405 0.000
重症患者 86(37.89) 73(34.6) 13(81.25) 13.755 0.000
表2 老年糖尿病患者并发COVID-19死亡相关因素的Logistic回归分析(n=227)
图1 老年糖尿病患者并发COVID-19病死预测的ROC曲线
表3 老年糖尿病并发COVID-19预后因素及预测曲线下面积(AUC)
1

URL    
2
Calabrese F, Pezzuto F, Fortarezza F, et al. Pulmonary pathology and COVID-19: lessons from autopsy. the experience of european pulmonary pathologists[J]. Virchows Arch, 2020, 477(3): 359-372.
3
任成山,林 辉,杨仕明,等. 冠状病毒及新型冠状病毒肺炎防控策略[J/CD]. 中华肺部疾病杂志(电子版), 2020, 13(1): 1-5.
4
Duarte-Neto AN, Monteiro RAA, da Silva LFF, et al. Pulmonary and systemic involvement in COVID-19 patients assessed with ultrasound-guided minimally invasive autopsy[J]. Histopathology, 2020, 77(2): 186-197.
5
刘 茜,王荣帅,屈国强,等. 新型冠状病毒肺炎死亡尸体系统解剖大体观察报告[J]. 法医学杂志2020, 36(1): 21-23.
6
中国疾病预防控制中心新型冠状病毒肺炎应急响应机制流行病学组. 新型冠状病毒肺炎流行病学特征分析[J]. 中华流行病学杂志2020, 41(2): 145-151.
7
Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China[J]. N Engl J Med, 2020, 382(18): 1708-1720.
8
CDC COVID-19 Response Team. Severe outcomes among patients with coronavirus disease 2019 (COVID-19)-United States, February 12-March 16, 2020[J]. MMWR Morb Mortal Wkly Rep, 2020, 69(12): 343-346.
9
林连君,朱 蕾,时国朝,等. 老年新型冠状病毒肺炎诊治与防控专家共识[J]. 中华内科杂志2020, 59(8): 588-597.
10
Singh AK, Gupta R, Misra A. Comorbidities in COVID-19: Outcomes in hypertensive cohort and controversies with renin an-giotensin system blockers[J]. Diabetes Metab Syndr, 2020, 14(4): 283-287.
11
Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis[J]. IJID, 2020, 94: 91-95.
12
Nicoli F, Paudel D, Solis-Soto MT. Old and new coronaviruses in the elderly[J]. Aging (Albany NY), 2021, 13(9): 12295-12296.
13
国家卫生健康委员会. 新型冠状病毒肺炎诊疗方案(试行第七版)[BE/OL]. 2020-03-03.)

URL    
14
International diabetes federation guideline development group. global guideline for type2 diabetes[J]. Diabetes Res Clin Pract, 2014, 104: 1-52.
15
Ramachandran A, Snehalatha C, Shetty AS, et al. Trends in prevalence of diabetes in Asian countries[J]. World J Diabetes, 2012, 3(6): 110-117.
16
Whiting DR, Guariguata L, Weil C, et al. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030[J]. Diabetes Res Clin Pract, 2011, 94(3): 311-321.
17
中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志2018, 10(1): 4-67.
18
Yan RH, Zhang YY, Li YN, et al. Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2[J]. Science, 2020, 367(6485): 1444-1448.
19
Beyerstedt S, Casaro EB, Rangel ÉB. COVID-19: angiotensin-converting enzyme 2 (ACE2) expressions and tissue susceptibility to SARS-CoV-2 infection [J]. Eur J Clin Microbiol Infect Dis, 2021, 40(5): 905-919.
20
Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID-19[J]. JAMA, 2020, 323(14): 1406-1407.
21
Chenn S, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China:a descriptive study[J]. Lancet, 2020, 395(10223): 507-513.
22
Hu L, Chen S, Fu Y, et al. Risk factors associated with clinical outcomes in 323 coronavirus disease 2019 (COVID-19) hospitalized patients in Wuhan, China[J]. Clin Infect Dis, 2020, 71(16): 2089-2098.
23
Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study[J]. Lancet Infect Dis, 2020, 20(4): 425-434.
24
Wrapp D, Wang N, Corbett KS, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation[J]. Science, 2020, 367(6483): 1260-1263.
25
Yang JK, Lin SS, Ji XJ, Guo LM. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes[J]. Acta Diabetol, 2010, 47(3): 193-199.
26
Fu Y, Cheng Y, Wu Y. Understanding SARS-CoV-2-mediated inflammatory responses: From mechanisms to potential therapeutic tools [J]. Virol Sin, 2020, 35(3): 266-271.
27
Chakraborty S, Bhattacharyya R, Banerjee D. Infections: A possible risk factor for type 2 diabetes[J]. Adv Clin Chem, 2017, 80: 227-251.
28
王阳春,仝瑞祥,刘 飞,等. 糖尿病患者易感新型冠状病毒的免疫因素分析[J]. 中国糖尿病杂志2020, 28(3): 176-179.
29
刘 瑶,申虎威. 从微观到宏观探讨COVID-19与糖尿病的发生发展[J]. 世界最新医学信息文摘2020, 20(4A): 160-161, 163.
30
中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华内分泌代谢杂志2021, 37(4): 311-398.
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