武汉雷神山医院部分病区320例COVID-19患者康复期随访研究

A follow-up study of 320 patients with COVID-19 during rehabilitation period after discharge from Wuhan Lei Shen Shan Hospital

摘要:

目的 了解新型冠状病毒肺炎(COVID-19)患者出院后呼吸系统功能及健康状况。 方法 选取2020年2—3月武汉雷神山医院收治的COVID-19患者，按照《新型冠状病毒肺炎诊疗方案(试行第七版)》分为普通型、重型两组。收集患者一般资料，以及吸烟史、既往史、运动情况等基线临床特征，改良医学研究会呼吸困难量表(mMRC)评分、6分钟步行试验(6MWT)结果，出院时胸部CT表现及评分。在出院后6、12、18、24个月进行随访，询问患者是否仍有COVID-19的临床症状。 结果 纳入320例COVID-19患者，普通型组179例(55.9%)，重型组141例(44.1%)；男性149例(46.6%)，女性171例(53.4%)。疲劳或乏力、睡眠障碍为患者出院后随访最常见的临床症状，与出院时相比，出院后12个月明显好转(P＜0.05)。与出院时相比，普通型组患者6分钟步行距离(6MWD)出院后6个月明显改善，重型组患者出院后12个月明显改善(均P＜0.05)。胸部CT最常见的异常表现为磨玻璃影及纤维化改变，截止出院后24个月有94.1%(174/185)的患者胸部CT病变完全吸收。经Cox回归分析，年龄较小(HR=0.975，95%CI：0.963~0.987，P < 0.001)，疾病严重程度较轻(普通型/重型组，HR=1.800，95%CI：1.255~2.581，P=0.001)，运动等级较高(中等活动量/波动量，HR=1.432，95%CI：1.046~1.961，P=0.025)，基线淋巴细胞绝对值较高(HR=1.126，95%CI：1.054~1.202，P < 0.001)，基线C反应蛋白水平较低(HR=0.991，95%CI：0.982~0.999，P=0.036)是COVID-19患者胸部CT异常表现完全吸收的独立保护因素。 结论 大多数普通型与重型COVID-19患者在24个月的随访中，呼吸系统功能恢复良好，普通型组比重型组恢复得更快。年龄较小、体育活动等级高、疾病严重程度较低、基线淋巴细胞水平较高、基线C反应蛋白水平较低均有利于患者胸部CT显示病变的完全吸收。

Abstract:

Objective To understand the respiratory system function and health status of patients with coronavirus disease 2019 (COVID-19) after discharge from hospital. Methods COVID-19 patients who admitted to Wuhan Lei Shen Shan Hospital from February to March 2020 were divided into two groups (common group and severe group) according to The diagnosis and treatment protocol for COVID-19 (trial version 7). The general data of patients, baseline clinical characteristics such as smoking history, past history and exercise status, scores of modified Medical Research Council (mMRC), results of 6-minute walking test (6MWT), as well as chest CT findings and scores at discharge were collected. Patients were followed up at 6, 12, 18 and 24 months after discharge, and were inquired whether they still had clinical symptoms of COVID-19. Results 320 patients with COVID-19 were included in the study, 179 (55.9%) in common group and 141 (44.1%) in severe group; 149 (46.6%) were males and 171 (53.4%) were females. Fatigue and sleep disturbance were the most common clinical symptoms at post-discharge follow-up visits, compared with discharge, these symptoms were significantly improved 12 months after discharge(P < 0.05). The 6-minute walking distance (6MWD) of patients in common group was significantly improved at 6 months after discharge, and patients in severe group was significantly improved at 12 months after discharge (both P < 0.05). The most common abnormal manifestations of chest CT were ground glass shadow and fibrosis, by the end of 24 months after discharge, 94.1% (178/185)of the patients had completely absorbed the chest CT lesions. Cox regression analysis showed that independent protective factors for complete absorption of abnormal chest CT findings in COVID-19 patients were as follows: younger age (HR=0.975, 95%CI: 0.963-0.987, P < 0.001), lower disease severity (common/severe group, HR=1.800, 95%CI: 1.255-2.581, P=0.001), higher level exercise (moderate activity/fluctuation, HR=1.432, 95%CI: 1.046-1.961, P=0.025), higher absolute value of baseline lymphocytes (HR=1.126, 95%CI: 1.054-1.202, P < 0.001), and low baseline C-reactive protein level (HR=0.991, 95%CI: 0.982-0.999, P=0.036). Conclusion Most common and severe types of COVID-19 patients recover well at 24-month follow-up, and the recovery of respiratory system function is faster in common group than severe group. Younger age, higher level of physical activity, lower disease severity, higher baseline lymphocyte level and lower baseline C-reactive protein level are all conducive to the complete absorption of lesions shown by chest CT.