慢性肾脏病患者合并新型冠状病毒感染的临床特征及预后

Clinical features and prognosis of COVID⁃19 in patients with chronic kidney disease

目的:回顾性分析慢性肾脏病(CKD)合并新型冠状病毒肺炎(NCP)患者的临床特征及预后。方法:纳入2022年12月至2023年6月国家肾脏疾病临床医学研究中心收治的CKD合并NCP患者,分析新型冠状病毒感染(COVID-19)前、后的临床特征及随访情况。结果:共纳入72例患者,男性39例(54.17%),COVID-19时中位年龄64(39,76)岁,CKD中位病程36(7,120)月。导致CKD的病因,主要为糖尿病肾病(22.22%)、狼疮性肾炎(12.50%)、膜性肾病(9.72%)和抗中性粒细胞胞质抗体相关肾炎(9.72%),新冠病毒疫苗接种率为18.06%。NCP中型占51.39%、重型20.83%、危重型27.78%。14例(19.44%)患者院内死亡,死亡组患者治疗期间炎症指标、真菌感染、心力衰竭、肝功能受损、气胸的比例高于存活组,淋巴细胞亚群均低于存活组(P<0.05)。多因素COX模型发现,年龄、乳酸脱氢酶、CD4+T细胞、C反应蛋白是CKD合并NCP患者死亡的独立危险因素。结论:CKD合并NCP患者,疫苗接种率低,伴发疾病多。高龄、缺氧、免疫功能低下、炎症反应强的患者预后差。治疗过程中易出现混合或重叠感染和多器官功能衰竭。

Objective:This retrospective study was to evaluate the clinical characteristics and prognosis of chronic kidney disease(CKD)patients complicated with novel coronavirus pneumonia(NCP).Methodology:We retrospectively analyzed the clinical and imaging features before and after coronavirus disease 2019(COVID⁃19)of CKD patients complicated with NCP who were admitted to the National Clinical Research Center of Kidney Diseases,Jinling Hospital from December 2022 to June 2023.Results:Among the 72 CKD patients with NCP,the median age at COVID⁃19 was 64(39,76)years old,and the median duration of CKD course was 36(7,120)months.The top four original diseases for CKD were diabetic nephropathy(22.22%),lupus nephritis(12.50%),membranous nephropathy(9.72%)and ANCA associated glomerulonephritis(9.72%),and the coverage rate of COVID⁃19 vaccine was 18.06%.51.39%of NCP were medium,20.83%were severe and 27.78%were critical.The in⁃hospital mortality rate was 19.44%.The inflammatory index,proportion of fungal infection,heart failure,hepatic injury,and pneumothorax in the death group were higher than those in the survival group,and the lymphocyte subsets were lower than those in the survival group(P<0.05).Multivariate COX model showed that age,lactic dehydrogenase,CD4+T lymphpocyte and C⁃reactive protein during COVID⁃19 were independent risk factors for death in CKD patients complicated with NCP.Conclusion:CKD patients with NCP have a high proportion of DN,a low vaccination rate and more concomitant diseases.Patients with advanced age,hypoxia,immunodeficiency and strong inflammatory response have a poor prognosis.Coinfections or superinfections of fungus and multiple organ failure are common during NCP treatment.