免疫缺陷人群新型冠状病毒感染诊治策略中国专家共识(2023.V2版)

Chinese expert consensus on diagnosis and treatment strategies for SARS-CoV-2 infection in immunocompromised populations(2023 edition-2)

自2019年年底以来,新型冠状病毒(以下简称新冠病毒)感染席卷全球,给人类社会带来极大危害,卫生经济负担显著增加。奥密克戎变异株由于传染性更强、传播力更快、再感染率更高,现已取代德尔塔变异株成为我国境外输入和本土疫情的主要流行株。我国《新型冠状病毒感染诊疗方案(试行第十版)》中强调“强化重点人群保护”,其中就包括数量越来越多的免疫缺陷人群。此类人群罹患新冠病毒感染后重症发生率高、病死率高,属于重型/危重型高危人群;而且由于基础疾病的存在,此类人群长期服用免疫抑制剂等相关药物,抗新冠病毒的治疗药物与原有药物之间复杂的相互作用,给新冠病毒感染后的治疗带来极大挑战。目前,尚缺乏可供参考的针对免疫缺陷人群新冠病毒感染诊疗的相关指南或共识。因此,广州呼吸健康研究院、国家呼吸医学中心组织国内多学科(呼吸与危重症医学科、器官移植科、风湿免疫科、血液科、感染科、重症医学科等)专家,基于循证医学证据,经过多次讨论,总结出13条建议供同行参考,以期为该类特殊人群的诊治策略提供理论和实践参考。

Since the end of 2019,severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection has swept the world,bringing great harm to human society and significantly increasing the health burden.Due to stronger infectivity,faster transmission,and higher reinfection rate of the Omicron variant,it has now replaced the Delta variant as the main epidemic strain for both imported and local outbreaks in China.Chinese Diagnosis and treatment protocol for SARS-CoV-2 infection(10th trial version)emphasizes“strengthening the protection of key populations,”which includes the increasing number of immunocompromised population.These people have a high incidence of severe diseases and a high fatality rate after infected with SARS-CoV-2,and belong to the high-risk populations of severe or critical diseases.Moreover,due to underlying diseases,these people take immunosuppressants and other related drugs chronically.The interactions between anti-SARS-CoV-2 infection treatment drugs and original drugs are complicated,thus bring significant challenges to the treatment after the SARS-CoV-2 infection.Currently,there is a lack of guidelines or consensus on the diagnosis and treatment of SARS-CoV-2 infection among immunocompromised population.Therefore,the Guangzhou Institute of Respiratory Health and National Center for Respiratory Medicine organized experts from multiple disciplines(respiratory and critical care medicine,organ transplantation,rheumatology and immunology,hematology,infection,critical care medicine,etc.)in China.After multiple rounds of discussions,13 items of recommendations are made as the reference for peers based on evidence-based medical evidence,so as to provide a theoretical and practical reference for the diagnosis and treatment strategies of this population.