2型糖尿病患者罹患重型COVID-19的临床特征及危险因素

Clinical Features and Risk Factors of Type 2 Diabetes Patients with Severe Corona Virus Disease 2019

目的观察2型糖尿病合并重型新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者的临床特征,并探索可能的危险因素。方法回顾性分析2020-01-01~3-20日在中部战区总医院住院的60例2型糖尿病合并COVID-19患者的临床资料,根据COVID-19病情分为重型组和普通型组,各30例。分别收集患者病史、临床症状、实验室检查和治疗方案,观察其预后,并进行比较。结果与普通型组比较,重型组年龄偏大(P<0.05),男性居多(P<0.05),糖尿病病程长(P<0.05),既往多合并高血压、脑血管疾病、慢性肾病(P<0.05)。空腹血糖、糖化血红蛋白、C-反应蛋白、白介素6、降钙素原和中性粒细胞计数水平增高,全血淋巴细胞计数、总T淋巴细胞绝对数、抑制/细胞毒性T淋巴细胞绝对数、辅助性T细胞比例绝对数和总B淋巴细胞绝对数水平低下为2型糖尿病罹患重型COVID-19患者的危险因素(P<0.05)。结论高龄、男性、糖尿病病程长以及既往合并症多的2型糖尿病患者易罹患重型COVID-19;入院时糖代谢水平差、高炎症因子水平及低淋巴细胞水平是2型糖尿病合并COVID-19预后不佳的危险因素。

Objective To observe the clinical characteristics of type 2 diabetes patients with severe corona virus disease 2019(COVID-19)and to explore the possible risk factors.Methods A total of 60 patients with type 2 diabetes complicated with COVID-19 who were admitted to author’s hospital from January to March 2020 were retrospectively analyzed.They were divided into severe group(n=30)and common group(n=30)according to the condition of COVID-19.The patient’s medical history,clinical symptoms,laboratory examination results and treatment plan were collected.The prognosis was observed and compared.Results Compared with the common group,the severe group was older(P<0.05),mostly male(P<0.05),longer course of diabetes(P<0.05),and more complicated with hypertension,cerebrovascular disease and chronic nephropathy(P<0.05).The increase of fasting blood glucose,glycosylated hemoglobin,C-reactive protein,interleukin-6,procalcitonin and neutrophil count,and the decrease of whole blood lymphocyte count,total T lymphocyte absolute count,inhibitory/cytotoxic T lymphocyte absolute number,helper T cell proportion absolute number and total B lymphocyte absolute number were the risk factors of severe COVID-19 patients with type 2 diabetes(P<0.05).Conclusion The elderly,male,type 2 diabetes patients with long course and previous complications are likely to suffer from severe COVID-19;with poor glucose metabolism,high inflammatory cytokines and low lymphocyte levels are the risk factors for poor prognosis of type 2 diabetes complicated with COVID-19.