多中心横断面研究炎症性肠病患者感染新型冠状病毒的临床表现及因素分析

Clinical manifestation and influence factor analysis of coronavirus disease 2019 infection in inflammatory bowel disease patients:a multicenter cross-sectional study

目的研究炎症性肠病(IBD)患者在新型冠状病毒感染(COVID-19)流行期间感染新型冠状病毒后的症状变化以及IBD治疗用药的情况。方法采用横断面调查研究方法。2022年12月1-31日通过自愿抽样对全国多中心的IBD患者进行问卷调查,收集通过核酸/抗原检测确诊为COVID-19患者的临床资料。根据患者是否自觉IBD症状加重(包括腹部不适、便血加重或出现脓血便、腹泻次数增多等),分为症状加重组和无症状加重组,比较两组年龄、性别、体质量指数(BMI)、基础疾病、新型冠状病毒疫苗(简称新冠疫苗)接种、IBD类型、疾病活动度、COVID-19症状、治疗用药等差异。结果共纳入497例患者,男317例,女180例;年龄(35.27±11.54)岁;克罗恩病355例,溃疡性结肠炎142例;超过50%患者出现发热、肌肉酸痛、乏力、咳嗽、咳痰、鼻塞等呼吸系统症状,部分IBD患者出现消化系统症状和神经系统症状。症状加重组104例(20.93%),无症状加重组393例(79.07%)。两组患者在性别、年龄、BMI、基础疾病、IBD类型及新冠疫苗接种针次差异均无统计学意义(均P>0.05)。与无症状加重组相比,症状加重组处于疾病活动期的患者比例更高[47.12%(49/104)比24.68%(97/393),P<0.001],使用美沙拉嗪/柳氮磺吡啶的比例更高(35.58%比23.41%,P=0.012),出现腹泻、头痛、头晕等COVID-19症状比例均更高(均P<0.05)。237例使用生物制剂的IBD患者中,症状加重患者与无症状加重患者使用的生物制剂类型差异具有统计学意义(χ^(2)=9.351,P=0.031)。240例使用生物制剂患者中,症状加重患者延迟或中断生物制剂治疗的比例高于无症状加重患者,差异具有统计学意义[45.45%(20/44)比23.98%(47/196),χ^(2)=8.235,P=0.004]。47例使用免疫抑制剂的患者中,症状加重患者和无症状加重患者停用免疫抑制剂的比例差异不存在统计学意义(P=0.263)。结论IBD患者确诊COVID-19后的主要表现为呼吸道症状及全身症状,处于疾病活动期、延迟或者停用生物制剂者更容易在感染期间出现IBD症状加重。

Objective To investigate the changes in symptoms of inflammatory bowel disease(IBD)patients infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)during the coronavirus disease 2019(COVID-19)pandemic,as well as the situation of IBD treatment medication use.Methods A cross-sectional survey study method was used.A questionnaire survey was conducted on a voluntary sampling basis for IBD patients of multiple centers nationwide from December 1st to 31st 2022,collecting clinical data of patients diagnosed with COVID-19 through nucleic acid/antigen testing.Patients were divided into symptomatic exacerbation group and asymptomatic exacerbation group based on whether they felt an exacerbation of IBD symptoms including abdominal discomfort,increased bloody stool or the appearance of purulent bloody stool,increased frequency of diarrhea,etc.And the differences in age,gender,body mass index(BMI),underlying disease conditions,SARS-CoV-2 vaccination status,IBD type,disease activity,COVID-19 symptoms,and treatment medication between the two groups were compared.Results A total of 497 patients were included,317 males and 180 females;age(35.27±11.54)years;355 CD patients and 142 UC patients;more than 50%of patients exhibited respiratory system symptoms such as fever,muscle soreness,fatigue,cough,expectoration,nasal congestion,and some IBD patients exhibited digestive system symptoms and nervous system symptoms.The symptomatic exacerbation group consisted of 104 patients(20.93%),and the asymptomatic exacerbation group consisted of 393(79.07%).There were no statistically significant differences in gender,age,BMI,underlying diseases,IBD type,and SARS-CoV-2 vaccine doses between the two groups(all P>0.05).Compared with the asymptomatic exacerbation group,the proportion of patients in the disease active phase was higher[47.12%(49/104)vs.24.68%(97/393),P<0.001],and the proportion of patients using mesalazine/sulfasalazine was higher(35.58%vs.23.41%,P=0.012),and the proportions of COVID-19 symptoms such as diarrhea,headache,and dizziness were all higher(all P<0.05)in the symptomatic exacerbation group.Among the 237 IBD patients using biologics,there was a statistically significant difference in the types of biologics used between the symptomatic and asymptomatic exacerbation groups(χ^(2)=9.351,P=0.031).Among the 240 patients using biologics,the proportion of delaying or interrupting the use of biologics was higher in symptomatic exacerbation group than that of the asymptomatic exacerbation group,and the difference was statistically significant[45.45%(20/44)vs.23.98%(47/196),χ^(2)=8.235,P=0.004].Among the 47 patients using immunosuppressants,there was no statistically significant difference in the proportion of stopping immunosuppressants between the symptomatic and asymptomatic exacerbation groups(P=0.263).Conclusion The main symptoms of IBD patients infected with COVID-19 are respiratory and systemic symptoms,and those in the active phase of the disease or those delaying or withdrawing biologics are more likely to experience an exacerbation of IBD symptoms during the infection.