广州市新型冠状病毒肺炎患者消化系统损害及心理健康特征分析

Analysis of digestive system damage and mental health features of patients with Corona Virus Disease 2019 in Guangzhou

目的探讨新型冠状病毒肺炎(COVID-19)患者的消化系统损害和心理健康特征。方法收集2020年1月25日至2月20日广州市第八人民医院收治的123例COVID-19患者的临床资料,同期选择本院健康体检者85例,比较普通型组(n=87),重型、危重型组(n=36)患者消化系统症状差异及肝损伤特点,评估消化道损害的时效关系,对主要症状进行多因素分析,并对部分患者(85例)及健康对照组(85例)行汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、匹兹堡睡眠质量指数(PSQI)评分,比较两组差异。结果在患者一般症状中,以发热及咳嗽最为常见,分别为112例(91.06%)、94例(76.42%);在伴随的消化道症状中,以纳差最常见,为55例(44.72%),其次是腹泻23例(18.70%);以消化系统症状为首发表现者共2例(1.63%)。重型、危重型组患者中,合并有纳差、腹痛者[28(77.78%),5(13.89%)]多于普通型组[27(31.03%),2(2.30%)],均差异有统计学意义(均P<0.05);腹泻一般持续1~4 d,平均(2.69±0.87)d,纳差症状持续时间较长,可持续5~15 d,平均(9.67±2.54)d。重型、危重型组患者的谷丙转氨酶(ALT)[36.60(19.57,57.50)]、谷草转氨酶(AST)[39.70(22.40,61.75)]水平明显高于普通型组患者[20.50(12.70,27.88),18.80(13.40,22.90)],均差异有统计学意义(Z=-3.91,-5.36;均P<0.05),白蛋白(ALB)[33.35(30.02,35.30)]水平明显低于普通型组患者[38.10(34.90,39.90)],差异有统计学意义(Z=-5.61,P<0.05)。多因素Logistic回归分析发现,氧合指数(OR=0.99,95%CI:0.98~0.99)、焦虑或抑郁(OR=0.18,95%CI:0.03~0.97)对纳差产生显著的影响(均P<0.05)。COVID-19患者的焦虑、抑郁、睡眠障碍的发生率[28(32.94%),29(34.12%),40(47.06%)]明显高于健康对照组[9(10.59%),8(9.41%),10(11.76%)],均差异有统计学意义(χ^2=12.47,15.23,25.50;均P<0.05)。结论COVID-19患者消化道症状中以纳差最常见,部分COVID-19患者可伴焦虑、抑郁或睡眠障碍,氧合指数、焦虑或抑郁是纳差的重要影响因素。

Objectives To explore the digestive system damage and mental health features of patients with Corona Virus Disease 2019(COVID-19)in Guangzhou.MethodsThe clinical data of 123 patients with confirmed COVID-19 in Guangzhou Eighth People′s Hospital from January 25,2020 to February 20,2020 were collected,and 85 healthy controls were selected at the same time.The differences of digestive tract symptoms and the characteristics of liver injury among common(n=87)and severe and critical patients(n=36)were compared.The time-effect relationship of digestive tract damage was evaluated,and the main symptoms were analyzed by multivariate analysis.The Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and Pittsburgh Sleep Quality Index(PSQI)were evaluated and compared between some patients(85 cases)and healthy control group(85 cases).ResultsAmong the general symptoms,fever and cough were the most common symptoms[112 patients(91.06%)and 94 patients(76.42%),respectively].In terms of accompany digestive tract symptoms,anorexia was the most common symptom(55 patients,44.72%),followed by diarrhea(23 patients,18.70%).A total of 2 patients(1.63%)with the first clinical manifestation of digestive system symptoms.Among severe and critical patients,the numbers of patients with anorexia[28 patients(77.78%)]and abdominal pain[5 patients(13.89%)]were more than those in the common group[27 patients(31.03%),2 patients(2.30%)],the differences were statistically significant(all P<0.05).The symptoms of diarrhea were significantly relieved 1-4 days later,(2.69±0.87)days on average,while the anorexia lasted for 5-15 days,with an average of(9.67±2.54)days.Alanine aminotransferase(ALT)[36.60(19.57,57.50)]and aspartate aminotransferase(AST)[39.70(22.40,61.75)]levels of severe and critical patients were significantly higher than those of common group[20.50(12.70,27.88),18.80(13.40,22.90)](Z=-3.91,-5.36,all P<0.05),while albumin(ALB)level was significantly lower than that of common group[33.35(30.02,35.30),38.10(34.90,39.90)](Z=-5.61,P<0.05).Logistic regression analysis showed that oxygenation index(OR=0.99,95%CI:0.98-0.99),anxiety or depression(OR=0.18,95%CI:0.03-0.97)had significant influence on anorexia(all P<0.05).The incidences of anxiety[28(32.94%)],depression[29(34.12%)]and sleep disorder[40(47.06%)]in patients infected by COVID-19 were significantly higher than those in healthy control group[9(10.59%),8(9.41%),10(11.76%)],the differences were significant(χ^2=12.47,15.23,25.50,all P<0.05).ConclusionsAnorexia was the most common digestive tract symptom in COVID-19 patients.Some COVID-19 patients may be accompanied by anxiety,depression or sleep disorders,and oxygenation index,anxiety or depression are important influencing factors of anorexia.