肺间质异常患者并发新型冠状病毒肺炎的临床分析

Clinical analysis of COVID-19 in patients with preexisting interstitial lung abnormalities

目的总结肺间质异常(interstitial lung abnormalities,ILA)患者在新型冠状病毒(新冠)流行期间感染新冠病毒后发生肺炎的临床特征。方法回顾性纳入2021年1月以来北京协和医院诊断并规律随诊6个月以上的ILA患者,统计2022年12月至2023年1月患者新冠病毒肺炎的发生情况,共纳入34例感染新冠的ILA患者,其中男20例,女14例,年龄41~80(64.0±8.8)岁。根据是否发生肺炎将患者分为肺炎组(12例,12/34,35.3%)与非肺炎组(22例),分析两组疫苗接种情况、疾病临床特征及转归等资料。结果本组ILA患者的特征为:近胸膜纤维化性ILA 7例,近胸膜非纤维化性ILA 10例,远离胸膜的ILA 17例;基线自然状态下指氧饱和度为96%~99%(97.38%±0.87%);肺功能用力肺活量(FVC)占预计值%为65%~132%(97.6%±18.1%),一氧化碳弥散率(D_(L)CO)占预计值%为53%~108%(76.2%±16.3%)。34例中19例接种了3剂新冠疫苗,其中肺炎组5例(5/12,41.7%),非肺炎组14例(14/22,63.6%);1例接种1剂新冠疫苗(非肺炎组);14例未接种新冠疫苗,其中肺炎组7例(7/12,58.3%),非肺炎组7例(7/22,31.8%)。肺炎组12例患者中6例为重症,6例为普通型,无危重症患者;1例并发下肢深静脉血栓。6例重症患者均接受系统性糖皮质激素(简称激素)治疗,病情好转,目前仍维持小剂量激素治疗;6例普通型患者均好转或痊愈:2例未接受激素治疗,1例给予复方倍氯米松注射液1剂后好转,2例因临床症状明显曾口服激素治疗。结论ILA患者在新冠病毒感染后发生肺炎比例为1/3,且易进展为重症。

Objective To describe the clinical characteristics of SARS-CoV-2 infected patients with interstitial lung abnormalities(ILA)during the COVID-19 pandemic.Methods We respectively enrolled ILA patients who had been regularly followed up in Peking Union Medical College Hospital for more than six months since January 2021.Clinical data of these ILA patients were collected after the outbreak of COVID-19 pandemic(from December 2022 to January 2023),thirty-eight patients with preexisting ILA were enrolled.Among them,there were 34 ILA patients(20 males and 14 females)who were infected with SARS-CoV-2 during this period,with an average age of(64.0±8.8)years old(range:41-80).There were 12(35.3%)ILA patients who were suffered from COVID-19(pneumonia group)and others were the non-pneumonia group.The clinical characteristics,including vaccination status,features of COVID-19 and outcomes of the two groups were compared.Results Regarding the subcategories of ILA,there were 7 cases of subpleural fibrotic ILA,10 cases of subpleural non-fibrotic ILA,and 17 cases of non-subpleural ILA.Before SARS-CoV-2 infection,the average pulse oxygen saturation at rest was(97.38±0.87)%(range:96%-99%);average forced vital capacity(FVC)was(97.6±18.1)%predicted(range:65%-132%);and average diffusion capacity for carbon monoxide(D_(L)CO)was(76.2±16.3)%predicted(range:53%-108%).Nineteen patients had been vaccinated with 3 doses of SARS-CoV-2 vaccines,and 5 of them developed COVID-19.One patient had received one dose of vaccine and did not develop COVID-19.The other 14 patients had not been vaccinated,and seven of them developed COVID-19.Of the 12 patients with COVID-19,six were diagnosed with severe COVID-19,and the other 6 ILA patients were diagnosed with moderate COVID-19.Among them,1 patient was complicated by deep vein thrombosis of left lower limb.All 6 patients with severe COVID-19 who were cured after systemic corticosteroids.As for the other six moderate COVID-19 patients,all were cured and/or improved greatly:two were treated with short-term oral corticosteroids,one was prescribed a dose of compound betamethasone,and the other two were not treated with systemic corticosteroids.Conclusion Patients with ILA were predisposed to develop COVID-19 after infection with SARS-CoV-2,and more than half of them had severe COVID-19.