COVID-19引发肺纤维化的案例报道汇总分析

Summary analysis of case reports of pulmonary fibrosis caused by COVID-19

目的:探索影响COVID-19患者肺纤维化发生时间和死亡的相关因素。方法:通过检索PubMed、Embase、CNKI、万方、维普、中国生物医学、百度学术数据库,汇总分析2021年12月31日之前发表的有关COVID-19引发肺纤维化的个案报道。结果:共纳入55篇文献,包含73个病例,患者出现症状至发生肺纤维化时间(time from symptom onset to pulmonary fibrosis,TSPF)中位数为34 d(3,180)。单因素分析显示,在TSPF>34 d的患者中,使用瑞德西韦的患者相较于使用其他或未使用抗病毒药所占的比例更高(χ^(2)=12.377,P<0.01)。多因素Logistic回归分析显示,TSPF≤34 d(OR=3.81,95%CI:1.14~12.76,P=0.030)以及合并心血管疾病(OR=3.44,95%CI:1.10~10.78,P=0.034)是影响患者死亡的独立危险因素。生存分析Log-rank检验显示,使用瑞德西韦的患者8周内生存率有明显改善(P=0.045)。结论:瑞德西韦可能延缓COVID-19患者发生肺纤维化的时间,并延长患者的生存时间。COVID-19后较早出现肺纤维化(≤34 d)以及合并心血管疾病都可能增加死亡风险。

OBJECTIVE To explore the factors associated with the time to onset of pulmonary fibrosis and death in patients with COVID-19.METHODS By searching PubMed,Embase,CNKI,WanFang,VIP,China biomedical sciences and Baidu academic databases,the case reports on pulmonary fibrosis caused by COVID-19 published before December 31,2021 were analyzed.RESULTS A total of 55 studies including 73 cases were included.The median time from symptom onset to pulmonary fibrosis(TSPF)was 34 days(3,180).Univariate analysis showed that patients using remdesivir were a higher proportion of those with TSPF>34 days than those using other or not using antivirals(χ^(2)=12.377,P<0.01).Multivariate logistic regression analysis showed that TSPF≤34 days(OR=3.81,95%CI:1.14-12.76,P=0.030)and combined cardiovascular disease(OR=3.44,95%CI:1.10-10.78,P=0.034)were independent risk factors for death in patients.Log-rank test in survival analysis showed that patients using remdesivir had an advantage in survival at 8 weeks(P=0.045).CONCLUSION Remdesivir may delay the onset of pulmonary fibrosis in patients with COVID-19 and prolong patient survival.Earlier onset of pulmonary fibrosis after COVID-19(≤34 days)and comorbid cardiovascular disease may increase the risk of death in patients with COVID-19.