新型冠状病毒肺炎合并糖尿病患者临床特点及死亡相关因素分析

Analysis of clinical characteristics and death-related factors of COVID-19 patients with diabetes mellitus

目的:探究新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)合并糖尿病患者的临床特点和导致死亡的危险因素。方法:收集2019年12月30日至2020年3月1日于武汉市中心医院住院确诊为COVID-19合并糖尿病的患者共68例,另选取同期住院的COVID-19不合并糖尿病患者126例纳入研究,收集患者一般资料及实验室指标。终点事件定义为:截至2020年3月20日,患者在住院期间发生死亡或治愈出院。结果:①对照组年龄、危重症比例、伴其余合并症的比例、治疗时间、心率、双肺受累比例、并发其他微生物感染比例小于糖尿病组,差异有统计学意义(P<0.05)。②对照组血糖、白细胞计数、血小板计数、D-二聚体、天冬氨酸氨基转移酶(aspartate transaminase,AST)低于糖尿病组,差异有统计学意义(P<0.05)。③是否行全身糖皮质激素治疗、是否行人γ-免疫球蛋白治疗、是否行胸腺肽治疗及疾病转归在对照组及糖尿病组间差异有统计学意义(P<0.05)。④年龄(OR=3.241,95%CI=2.056~6.342,P=0.017)、白蛋白(OR=11.991,95%CI=6.863~16.556,P=0.046)、糖化血红蛋白(OR=2.086,95%CI=1.106~27.233,P=0.007)是COVID-19合并糖尿病患者死亡的独立危险因素。结论:COVID-19合并糖尿病患者往往高龄、病情危重、治疗时间长、双肺受累严重,且高龄、低白蛋白、高糖化血红蛋白易导致COVID-19合并糖尿病患者发生死亡。

Objective:To explore the clinical characteristics and risk factors for death of COVID-19 patients with diabetes mellitus.Methods:The study included in 68 patients with COVID-19 and diabetes who were confirmed to be hospitalized in Wuhan Central Hospital on December 30,2019 to March 1,2020.In addition,126 COVID-19 patients without diabetes who were hospitalized at the same time were included in the study.General data and laboratory indicators were collected.End point events were defined as:by March 20,2020,the patient died during hospitalization or was cured and discharged from the hospital.Results:①In the control group,age,critical illness ratio,ratio of other complications,treatment time,heart rate,and proportion of double lung involvement and concurrent other microbial infections were less than those in the diabetes group,with statistically significant differences(P<0.05).②Blood glucose,white blood cell count,platelet count,d-dimer and aspartate aminotransferase(AST)in the control group were lower than those in the diabetes group,with statistically significant differences(P<0.05).③There were statistically significant differences between the control group and the diabetes group in the treatment of systemic glucocorticoid,the treatment of pedestrian immunoglobulin,the treatment of thymosin and the outcome of the disease(P<0.05).④Age(OR=3.241,95%CI=2.056-6.342,P=0.017),albumin(OR=11.991,95%CI=6.863-16.556,P=0.046),and glycosylated hemoglobin(OR=2.086,95%CI=1.106-27.233,P=0.007)were independent risk factors for death in COVID-19 patients with diabetes.Conclusion:COVID-19 patients with diabetes are often elderly,in a critical condition,with long treatment time and severe involvement in both lungs.In addition,the elderly with low albumin and high glycosylated hemoglobin are prone to death of COVID-19 patients with diabetes.