糖尿病对COVID-19疾病进展及预后的影响

Impact of diabetes mellitus on disease progression and prognosis of COVID-19

摘要:

目的 分析合并糖尿病的新型冠状病毒肺炎（COVID-19）患者的临床及流行病学特征，从而确定糖尿病是否是COVID-19疾病进展及不良预后的危险因素。 方法 收集浙江省2020年1月17日—2月7日确诊为COVID-19的856例住院病例，其中64例合并糖尿病，对合并糖尿病及未合并糖尿病患者的临床特征、流行病学、治疗及预后进行比较分析。 结果 所收集的64例糖尿病患者年龄（58.1±11.2）岁，高于非糖尿病患者（P < 0.001），起病时最常见的症状包括发热（89.1%）、咳嗽（71.9%）、咳痰（39.1%）及乏力（25.0%），其中合并糖尿病的患者更容易出现肌肉酸痛（P=0.047）。与未合并糖尿病的患者相比，糖尿病患者血清中与炎症相关的生物标志物（如中性粒细胞、C反应蛋白）升高（P < 0.05），重症病例的比例也更高，且更容易出现急性呼吸窘迫综合征（P < 0.01）。在调整了吸烟和性别因素后，合并糖尿病的患者到达复合终点（包括因病情进展进入ICU、休克、机械通气及死亡）风险高于未合并糖尿病组，危险比（HR）为3.50，95%置信区间（CI）为1.51~8.11。 结论 合并糖尿病的COVID-19患者年龄大，重症病例比例高且更容易导致严重不良结局，应该将糖尿病视为COVID-19疾病进展和不良预后的危险因素。

Abstract:

Objective To analyze the clinical and epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients who were complicated with diabetes mellitus (DM), so as to determine whether DM is a risk factor for disease progression and poor prognosis of COVID-19. Methods A total of 856 hospitalized patients who were confirmed with COVID-19 in Zhejiang Province from January 17 to February 7, 2020 were collected, including 64 patients with DM. Clinical characteristics, epidemiology, treatment and prognosis of patients with and without DM were compared and analyzed. Results Age of 64 patients with DM were (58.1±11.2) years, which was higher than that of patients without DM (P < 0.001), the most common symptoms at onset included fever (89.1%), cough (71.9%), expectoration (39.1%) and fatigue (25.0%), patients with DM were more likely to develop muscle soreness (P=0.047). Compared with patients without DM, serum inflammatory-related markers (such as neutrophils and C-reactive protein) in patients with DM increased (P < 0.05), proportion of severe cases was higher, and acute respiratory distress syndrome was more prone to occur (P < 0.01). After adjusting smoking and gender factors, the risk of reaching the composite endpoint (including admission in ICU due to disease progression, shock, mechanical ventilation and death) in DM patients was higher than that in non-diabetic group, and the hazard ratio (HR) was 3.50 (95%CI: 1.51-8.11). Conclusion COVID-19 patients with DM have a higher age and higher proportion of severe cases and are more likely to cause serious adverse outcomes, DM should be regarded as a risk factor for disease progression and poor prognosis of COVID-19.