单中心维持性血液透析患者新型冠状病毒感染的回顾性分析

A single-center retrospective analysis of severe acute respiratory syndrome coronavirus 2 infection in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者感染新型冠状病毒(新冠)后的临床表现特点和疫苗接种情况。方法该研究为横断面调查研究,通过微信问卷星调查方式回顾性收集上海交通大学医学院附属瑞金医院血液透析中心MHD患者在新冠感染实施乙类乙管后首轮流行期间(2022年12月8日至2023年1月12日)的新冠感染情况、感染后的临床表现及流行前的疫苗接种情况。按照患者研究期间是否感染新冠、感染新冠后是否合并肺炎分组。采用Logistic回归模型法分析新冠感染合并肺炎、新冠抗原/核酸转阴后出现持续性症状的影响因素。结果共发放问卷241份,回收有效问卷223份(92.5%),其中175例MHD患者在研究期间感染新冠,感染率为78.5%(175/223)。患者感染新冠至抗原/核酸转阴时间为10(7,14)d。无症状感染者占10.3%(18/175),有症状感染者占89.7%(157/175),其中出现频次最高的前5种症状分别是咳嗽(70.1%,110/157)、发热(64.3%,101/157)、咽痛(35.0%,55/157)、肌肉疼痛(28.7%,45/157)和鼻塞(21.0%,33/157),有54.3%(95/175)的感染者合并肺炎。48.6%(85/175)的感染者在新冠抗原/核酸转阴后仍有持续性症状。新冠感染者与未感染者在年龄、性别分布、合并糖尿病比例、合并肿瘤比例等项目上的差异均无统计学意义(均P>0.05)。与无肺炎组比较,肺炎组患者有呼吸困难比例(12.6%比1.3%,χ^(2)=8.181,P=0.004)和胸闷比例(23.2%比10.0%,χ^(2)=5.293,P=0.021)均较高。肺炎组与无肺炎组患者在年龄、性别分布、合并糖尿病比例、合并肿瘤比例、新冠转阴时间、症状数量及新冠疫苗接种率项目上的差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,腹泻为感染新冠的MHD患者发生肺炎的独立影响因素[OR(95%CI)=6.323(1.061~37.682),P=0.043],发病时的症状数目[OR(95%CI)=1.571(1.318~1.873),P<0.001]和合并肿瘤病史[OR(95%CI)=0.206(0.054~0.777),P=0.020]是MHD患者新冠抗原/核酸转阴性后出现持续性症状的独立影响因素。MHD患者新冠疫苗接种率为7.2%(16/223),安全性担忧(81.2%,164/202)是患者接种疫苗犹豫的主要原因。结论MHD患者是新冠易感人群,感染新冠后临床症状表现多样、异质性大、合并肺炎比例高。腹泻为感染新冠的MHD患者发生肺炎的独立影响因素。新冠转阴后有近半数患者会出现持续性症状。MHD患者新冠疫苗接种率较低,需加强对新冠疫苗安全性和有效性的宣传。

Objective To investigate the clinical characteristics and vaccination of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in maintenance hemodialysis(MHD)patients.Methods It was a cross-sectional survey.Through wechat questionnaire star mode,the status of SARS-CoV-2 infection,clinical manifestation after infection and vaccination of MHD patients in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine between December 8,2022 and January 12,2023 were retrospectively collected during the period that SARS-CoV-2 infection was managed with measures against class B infectious diseases.The patients were grouped according to whether they were infected with SARS-CoV-2 and whether they were complicated with pneumonia after infection during the study period.Logistic regression analysis was used to analyze the risk factors of SARS-CoV-2 infection combined with pneumonia or persistent symptoms after SARS-CoV-2 turning negative.Results A total of 241 questionnaires were issued,and 223 valid questionnaires were returned,of which 175 patients(78.5%)were infected with SARS-CoV-2 during the study period.The time of negative conversion of antigen or nucleic acid after SARS-CoV-2 infection was 10(7,14)days.Asymptomatic infections accounted for 10.3%(18/175).Symptomatic infections accounted for 89.7%(157/175),and the top five most frequent symptoms were cough(70.1%,110/157),fever(64.3%,101/157),pharyngeal pain(35.0%,55/157),muscle pain(28.7%,45/157),and nasal obstruction(21.0%,33/157).Pneumonia was reported in 54.3%(95/175)of infected patients.There were no statistically significant differences in age,gender distribution,proportion of diabetes mellitus,and proportion of history of tumors between SARS-CoV-2-infected and uninfected patients(all P>0.05).Compared with the non-pneumonia group,the proportions of dyspnea(12.6%vs.1.3%,χ^(2)=8.181,P=0.004)and chest tightness(23.2%vs.10.0%,χ^(2)=5.293,P=0.021)in the pneumonia group were both higher.There were no significant differences in age,gender distribution,time of negative SARS-CoV-2 transition,number of symptoms and SARS-CoV-2 vaccination rate,and proportions of diabetes mellitus and tumors between the pneumonia group and the non-pneumonia group(all P>0.05).There were 48.6%(85/175)infected patients having long-lasting clinical symptoms after SARS-CoV-2 turning negative.Logistic regression analysis results showed that diarrhea was an independent influencing factor of pneumonia in MHD patients infected with SARS-CoV-2[OR(95%CI)=6.323(1.061-37.682),P=0.043].The number of symptoms at onset[OR(95%CI)=1.571(1.318-1.873),P<0.001]and history of tumors[OR(95%CI)=0.206(0.054-0.777),P=0.020]were independent influencing factors of long-lasting clinical symptoms.The SARS-CoV-2 vaccination rate was 7.2%(16/223)in MHD patients due to safety concerns(81.2%,164/202).Conclusions MHD patients are SARS-CoV-2-susceptible population.The clinical symptoms after infection are diverse,heterogeneous,and the proportion of complicated pneumonia is high.Diarrhea is an independent influencing factor of pneumonia in SARS-CoV-2-infected MHD patients.Nearly half of patients experience long-lasting clinical symptoms after SARS-CoV-2 turning negative.The low rate of vaccination in the MHD population necessitates increased awareness about the safety and efficacy of SARS-CoV-2 vaccine.