长新冠患者的临床症状及凝血和炎症标志物检测的初步分析

Preliminary analysis of clinical conditions,coagulation and inflammatory markers in patients with long COVID-19

目的 分析长新冠(long COVID,LC)患者临床症状的分布特点及体内凝血和炎症状态的变化特征,初步探讨LC发病的危险因素及病理机制。方法 回顾性分析门诊就诊的轻、中型新型冠状病毒感染后30 d仍有症状持续的44例患者病例特征,对就诊症状进行描述性分析,统计各症状发生的比例。评估患者的凝血功能及炎症指标,统计各指标的测量值,观察其正常和异常的发生率。结果 44例LC患者中男14例(31.82%),女30例(68.18%),女性患者明显多于男性,发病年龄集中在41~60岁;合并糖尿病患者的比例为15.90%。LC患者的主要症状为胸闷(36.36%)、失眠(22.73%)和心悸(18.18%),其次为咳嗽(13.64%)、胸痛(9.09%)和疲劳(9.09%)。仅有5%~10%LC患者的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)时间缩短、纤维蛋白原(FIB)升高,血小板计数(PLT)升高,20%患者的D-二聚体(D-D)升高;90%以上患者的炎症指标正常。结论 中年、女性、合并糖尿病是LC的危险因素,LC患者持续存在的临床症状主要来自循环、呼吸和神经系统。新型冠状病毒感染发生时的炎症风暴、内皮损伤、全身广泛的微血栓在LC时期已基本趋于正常,可能不再作为LC的主要致病机制,关于LC症状持续的原因有待进一步研究。

Objective To analyze the distribution characteristics of clinical conditions and the changes in biomarkers of coagulation and inflammation in patients with Long COVID-19(LC)and preliminarily explore the risk factors and possible mechanism of LC.Methods A total of 44 patients with persistent symptoms 30 days after infection with light or moderate COVID-19 were collected.The clinical symptoms of the included patients were descriptively analyzed,and the occurrence rate of the symptoms was counted.The biological markers of coagulation and inflammation in LC patients were evaluated,and the mean and standard deviation of each index were calculated to observe the normal and abnormal incidence.Results Of the 44 LC patients,there were 14 males(31.82%)and 30 females(68.18%),showing that the female patients were significantly more than the male patients.The age of onset was concentrated in 41-60 years old.15.90%of the included patients had diabetes.The main symptoms of LC patients were chest tightness(36.36%),insomnia(22.73%),palpitations(18.18%),cough(13.64%),chest pain(9.09%),and fatigue(9.09%).Prothrombin time(PT)and activated partial thromboplastin time(APTT)were shortened,fibrinogen(FIB)and platelet(PLT)were increased in only 5%-10%of patients with LC,and D-Dimer was increased in 20%of patients with LC.More than 90%of patients with LC had normal inflammatory indicators.Conclusion Middle-aged,female and diabetic patients may be the risk factors for LC patients.The clinical symptoms that persist in patients with LC are mainly from the circulatory,respiratory and nervous systems.Cytokine storm,endothelial damage,and widespread microthrombus during COVID-19 return to normal during LC,making them no longer the main pathogenic mechanism of LC.The causes of the persistence of LC symptoms requires further study.