腹膜透析患者新型冠状病毒感染的临床特征及危险因素

Clinical characteristics and risk factors of COVID⁃19 in peritoneal dialysis patients

目的:观察腹膜透析(PD)患者新型冠状病毒感染(COVID-19)的临床特征,并分析其感染的相关危险因素。方法:前瞻性观察2022-12-01至2023-01-31国家肾脏疾病临床医学研究中心随访的PD患者,分析COVID-19患者的临床资料及危险因素。结果:404例PD患者中发生COVID-19 112例(27.7%),疑似感染者10例,未感染者282例(69.8%)。COVID-19的PD患者中核酸阳性者22例(19.6%),抗原阳性者90例(80.4%)。常见的症状包括发热112例(100%)、咳嗽101例(90.2%)、咽痛98例(87.5%)、乏力97例(86.6%)、肌肉酸痛73例(65.2%)、头痛69例(61.6%)、纳差62例(55.4%)和焦虑60例(53.6%)。其中5例患者经过住院治疗后好转,无1例患者死亡。分析COVID-19前的最后1次随访指标,COVID-19组的体质量指数(BMI)、标准蛋白质分解率(nPCR)、血清白蛋白、血清前白蛋白、淋巴细胞计数、疫苗接种率、居家隔离比例更低(P<0.05),C反应蛋白(CRP)、超敏CRP及白细胞介素6(IL-6)水平更高(P<0.05)。Logistic回归分析发现,低BMI、nPCR、淋巴细胞计数、居家隔离比例和高超敏CRP是PD患者发生COVID-19的独立危险因素。结论:本组PD患者总体预后佳,低体重、营养不良、免疫功能差和微炎症状态是PD患者COVID-19的独立危险因素,居家隔离可预防感染。

Objective:To observe clinical characteristics of peritoneal dialysis(PD)patients infected COVID⁃19,and risk factors of infection.Methodology:A cohort of PD patients who were prospectively observed in our center from December,2022 to January,2023,and the clinical data and risk factors of COVID⁃19 were analyzed.Results:Of 404 patients performing PD in this cohort study,112 patients(27.7%)experienced COVID⁃19,10 patients were suspected of infection,282 patients(69.8%)had no infection.Among the infected patients,22 cases(19.6%)were positive for SARS⁃CoV⁃2 nucleic acid,90 cases(80.4%)were positive for SARS⁃CoV⁃2 antigen.The most common symptoms were fever(112 cases,100%),cough(101 cases,90.2%),sore throat(98 cases,87.5%),fatigue(97 cases,86.6%),myalgia(73 cases,65.2%),headache(69 cases,61.6%),anorexia(62 cases,55.4%)and anxiety(60 cases,53.6%).Five hospitalized patients with novel coronavirus pneumonia had a good recovery and were discharged after treatment,none of the patients died.The indexes of the last follow⁃up pre⁃COVID⁃19 were analyzed,the levels of body mass index(BMI),normalized protein catabolic rate(nPCR),serum albumin,serum pre⁃albumin,lymphocyte count,vaccination rate and home quarantine rate in the infected group were lower than those in the uninfected group(P<0.05).The levels of C⁃reactive protein(CRP),high sensitivity CRP and interleukin⁃6(IL⁃6)in the infected group were higher than those in the uninfected group(P<0.05).Logistic regression analysis showed that low BMI,nPCR,lymphocyte count and home quarantine rate,high sensitivity CRP were independent risk factors of COVID⁃19 in PD patients.Conclusion:The most common symptoms of PD patients infected COVID⁃19 were fever,cough,sore throat and fatigue,and the short⁃term prognosis was good.Low body weight,poor nutritional status,poor immune function and microinflammation were independent risk factors of COVID⁃19 in PD patients.Home quarantine could prevent COVID⁃19.