自然杀伤(NK)细胞与2019冠状病毒病(COVID-19)发生发展的研究进展

自然杀伤(NK)细胞在清除病毒,执行免疫调节方面发挥着重要的作用,它通过分泌趋化因子以及与其他天然免疫细胞协同作用,被赋予天然免疫调节功能和获得性免疫反应。随着对严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的2019冠状病毒病(COVID-19)的研究深入,发现NK细胞在其中发挥着重要作用。SARS-CoV-2感染会影响NK细胞的分布和效应功能,NK细胞的免疫应答或可影响新冠肺炎患者的预后。本文总结了近年来NK细胞在COVID-19感染中作用的研究现状,并且讨论了以NK细胞作为治疗剂的可能性,以期为防治SARS-CoV-2的免疫损害提供潜在思路。

基于CiteSpace及VOSviewer的COVID-19相关心律失常的文献计量学分析

目的:分析新型冠状病毒感染(COVID-19)相关心律失常的文献,探索该领域的研究现状、热点并预测未来的趋势,为后来的研究者提供借鉴。方法:选择Web of Science的核心合集数据库,每项研究都进行了文献计量和视觉分析,使用CiteSpace和VOSviewer软件生成知识图谱。结果:共鉴定出768篇文章,发文涉及美国、意大利和中国为首的319个国家/地区和4 366个机构,领先的研究机构是梅奥诊所和哈佛医学院。New England Journal of Medicine是该领域最常被引用的期刊。在6 687位作者中,Arbelo Elena撰写的研究最多,Guo T被共同引用的次数最多,心房纤颤是最常见的关键词。结论:随着COVID-19的暴发,对COVID-19所致新发/进行性心律失常事件的研究蓬勃发展,未来的研究者可能会对COVID-19感染后新发或遗留的快速性心律失常/缓慢性心律失常的发生机制进行进一步的探索。

一类具有脉冲干预措施的COVID-19模型的稳定性分析

建立了一类对易感人群实施脉冲干预措施的COVID-19模型,得出了模型的基本再生数R_(0)和无病周期解。当R_(0)<1时,根据脉冲微分不等式和Lyapunov函数分析了无病周期解的全局稳定性,并数值模拟了这一结论。最后,探讨了脉冲预防策略在COVID-19传染病预防中的效果。

COVID-19型与非COVID-19型ARDS患者炎症反应和细胞免疫的差异性研究

目的探讨新型冠状病毒感染(COVID-19)型急性呼吸窘迫综合征(ARDS)与非COVID-19型ARDS患者炎症反应和细胞免疫的差异性。方法选取2022年1月至2023年12月郑州市第一人民医院收治的COVID-19型ARDS患者120例纳入观察组(中度89例,重度31例),根据1∶1配对原则,另选取同期其他肺部致病菌导致ARDS患者120例纳入对照组,同期健康体检者120例纳入健康组。比较三组受检者及不同病情程度COVID-19型ARDS患者血清炎性相关因子[白介素-6(IL-6)、白介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]及细胞免疫相关因子[T细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))、自然杀伤细胞(NK细胞)]水平,采用Spearman分析炎性及细胞免疫相关因子与COVID-19感染及COVID-19型ARDS患者病情严重程度的相关性,采用偏回归分析COVID-19型患者ARDS发生的影响因素。结果观察组患者血清IL-6、IL-4、TNF-α、CRP水平[(47.52±6.25)ng/L、(21.53±3.59)ng/L、(1.55±0.36)ng/L、(20.69±3.81)mg/L]明显高于对照组[(15.83±2.67)ng/L、(13.68±2.46)ng/L、(1.27±0.30)ng/L、(12.35±2.67)mg/L],且对照组明显高于健康组[(3.12±0.79)ng/L、(2.76±0.54)ng/L、(0.88±0.25)ng/L、(3.98±1.12)mg/L],差异均有统计学意义(P<0.05);观察组患者的CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平[(59.03±3.03)%、(19.56±1.04)%、(27.81±3.97)%、(22.59±3.40)%]明显低于对照组[(64.42±3.26)%、(28.10±1.91)%、(40.11±4.05)%、(35.31±3.97)%],且对照组明显低于健康组[(70.35±4.18)%、(43.38±3.06)%、(50.88±4.67)%、(40.64±4.06)%],差异均有统计学意义(P<0.05);COVID-19型ARDS重度患者的血清IL-6、IL-4、TNF-α、CRP水平[(66.58±6.10)ng/L、(30.66±5.47)ng/L、(1.92±0.45)ng/L、(28.96±3.70)mg/L]明显高于中度患者[(40.88±4.62)ng/L、(18.35±3.07)ng/L、(1.42±0.33)ng/L、(17.81±2.93)mg/L],而CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平[(52.54±4.07)%、(15.20±1.09)%、(22.13±1.81)%、(18.03±1.46)%]明显低于中度患者[(61.29±3.62)%、(21.08±1.35)%、(29.79±2.02)%、(24.18±2.25)%],差异均有统计学意义(P<0.05);Spearman分析结果显示,IL-6(r=0.675、0.609)、IL-4(r=0.632、0.614)、TNF-α(r=0.585、0.566)、CRP(r=0.619、0.587)水平与COVID-19感染及COVID-19型ARDS患者病情严重程度均呈正相关(P<0.05),CD3^(+)(r=-0.539、-0.505)、CD4^(+)(r=-0.592、-0.554)、CD8^(+)(r=-0.588、-0.570)、NK细胞(r=-0.601、-0.592)水平与COVID-19感染及COVID-19型ARDS患者病情严重程度均呈负相关(P<0.05);偏回归分析结果显示,血清IL-6、IL-4、TNF-α、CRP、CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平均是COVID-19型患者发生ARDS的危险因素(P<0.05)。结论炎症及细胞免疫相关因子表达在COVID-19型及非COVID-19型ARDS患者中存在差异性,且与COVID-19感染及COVID-19型ARDS病情严重程度均具有一定相关性,可辅助临床识别COVID-19感染,评估病情严重程度。

2019冠状病毒疾病大流行背景下可逆性后部脑病综合征的特点分析

在2019冠状病毒疾病(COVID-19)大流行背景下,可逆性后部脑病综合征(PRES)的发病率有所增加。我们通过计算机检索Pubmed、中国知网、万方据库,检索时间为建库到2022年6月;检索到COVID-19合并PRES共45例,均排除了PRES的其他危险因素。综合分析显示,COVID-19合并PRES比单纯PRES可能更容易出现脑出血并发症,COVID-19合并PRES病人的脑出血风险与COVID-19病情严重程度有关;低氧可能是PRES的诱因。

Prevention and Control Strategies of Nosocomial Infection and Effectiveness Evaluation in a Tertiary Teaching Hospital during the Epidemic of COVID-19

Objective: To evaluate the role of prevention and control strategies for nosocomial infection in a tertiary teaching hospital during the sudden outbreak of Corona Virus Disease 2019 (COVID-19). Methods: The hospital initiated an emergency plan involving multi-departmental defense and control. It adopted a series of nosocomial infection prevention and control measures, including strengthening pre-examination and triage, optimizing the consultation process, improving the hospital’s architectural composition, implementing graded risk management, enhancing personal protection, and implementing staff training and supervision. Descriptive research was used to evaluate the short-term effects of these in-hospital prevention and control strategies. The analysis compared changes in related evaluation indicators between January 24, 2020 and February 12, 2020 (Chinese Lunar New Year’s Eve 2020 to lunar January 19) and the corresponding lunar period of the previous year. Results: Compared to the same period last year, the outpatient fever rate increased by 1.85-fold (P P Conclusion: The nosocomial infection prevention and control strategies implemented during this specific period improved the detection and control abilities for the COVID-19 source of infection and enhanced the compliance with measures. This likely contributed significantly to avoiding the occurrence of nosocomial infection.

肾上腺皮质功能不全合并COVID-19患者的临床转归及影响因素

目的总结肾上腺皮质功能不全(AI)合并新型冠状病毒感染(COVID-19)患者的临床特征及转归情况,分析影响转归的危险因素。方法回顾性分析2022年12月北京协和医院收治的发生COVID-19的AI患者的临床特征,并对其进行随访以收集其疾病转归情况。结果共纳入28例AI合并COVID-19患者,20例(71.4%)接受糖皮质激素基础替代。18例院外发生COVID-19患者中,11例(61.1%)居家主动加量糖皮质激素。感染后最常见症状为发热(96.4%)、消化道症状(82.1%)、意识障碍(78.6%)。出现重度意识障碍与年龄大、糖皮质激素基础替代剂量低相关(P<0.05)。20例(71.4%)患者发生肾上腺危象(AC),与糖皮质激素基础替代剂量低、低氯血症、嗜酸性粒细胞低、血小板低、活化部分凝血活酶时间(APTT)长相关(P<0.05)。2例患者死亡。26例存活患者中,意识恢复时间大于48小时者占26.3%(5/19),意识延迟恢复与入院收缩压低、血肌酐高、纤维蛋白原高相关(P<0.05)。48.0%(12/25)患者出现疲乏、纳差等长新冠症状。糖皮质激素加量的患者中,50.0%(12/24)于3周内恢复至基线激素剂量。结论AI合并COVID-19患者出现意识障碍及AC的风险较高。AI患者在感染应激期间主动加量糖皮质激素的意识不足,临床应加强对AI患者的“病期规则”教育。

体外功能性肺组织模型构建、调控及在肺纤维化和COVID-19中的应用

肺纤维化是很多肺部疾病发生发展过程中出现的病理现象。近年出现的2019冠状病毒病(coronavirus disease 2019,COVID-19)引发的呼吸系统综合征也会出现弥漫性肺泡损伤,并诱发肺纤维化。因此,开展肺纤维化和COVID-19体外模型构建与调控研究在肺部疾病治疗和药物筛选方面意义重大。目前,现有研究已建立了多种体外肺组织二维、三维细胞培养模型,本文将全面概述这些模型的构建方法,并结合这些模型在肺纤维化及COVID-19中的应用研究,对体外肺组织模型在药物传递、高通量药物筛选及发病机制研究等生物医学领域中的应用前景进行综述,为其进一步研究提供参考。

Symptomatic COVID-19 in University Students: A School-Wide Web-Based Questionnaire Survey during the Omicron Variant Outbreak

Aim: To detect risk and preventive factors associated with the Omicron variant infection in university students, a combination of a web-based survey and multivariate logistic regression analysis was introduced as the front-line initiatives by the school health practitioners. Design: Questionnaire survey. Methods: The school-wide web-based questionnaire survey was conducted among our university students as a part of the annual health check-up in April, 2023. The positive outcome was confined to the first symptomatic COVID-19 onset during the Omicron variant outbreak. Results: In this self-administered survey, risk or protective associations were merely estimated statistically in university students (n = 5406). In measured factors, karaoke and club/group activities could maintain the statistical significance in adjusted odds ratios (ORs) as relative risk factors, and science course, measles/ rubella (MR) vaccination, and COVID-19 vaccination remained as relative protective factors in adjusted OR analyses. Club/group activities with member gathering and karaoke sing-along sessions in university students may frequently have WHO’s three Cs. These risk factors are still important topics for the infection control of COVID-19 in university students. Together with some recent reports from other researchers, the significant protective role of MR vaccine in our survey warrants further clinical investigation. If the breakthrough infection continuously constitutes the majority of infection, real data in test-negative case-control or web-based questionnaire design continue to be important for statistical analysis to determine the minimal requirement of our strategies which may be equivalent to or replace COVID-19 vaccines.

COVID-19 Coronavirus: Is Infection along with <i>Mycoplasma</i>or Other Bacteria Linked to Progression to a Lethal Outcome?

Most patients with COVID-19 disease caused by the SARS-CoV-2 virus recover from this infection, but a significant fraction progress to a fatal outcome. As with some other RNA viruses, co-infection or activation of latent bacterial infections along with pre-existing health conditions in COVID-19 disease may be important in determining a fatal disease course. Mycoplasma spp. (M. pneumonaie, M. fermentans, etc.) have been routinely found as co-infections in a wide number of clinical conditions, and in some cases this has progressed to a fatal disease. Although preliminary, Mycoplasma pneumoniae has been identified in COVID-19 disease, and the severity of some signs and symptoms in progressive COVID-19 patients could be due, in part, to Mycoplasma or other bacterial infections. Moreover, the presence of pathogenic Mycoplasma species or other pathogenic bacteria in COVID-19 disease may confer a perfect storm of cytokine and hemodynamic dysfunction, autoimmune activation, mitochondrial dysfunction and other complications that together cannot be easily corrected in patients with pre-existing health conditions. The positive responses of only some COVID-19 patients to antibiotic and anti-malaria therapy could have been the result of suppression of Mycoplasma species and other bacterial co-infections in subsets of patients. Thus it may be useful to use molecular tests to determine the presence of pathogenic Mycoplasma species and other pathogenic bacteria that are commonly found in atypical pneumonia in all hospitalized COVID-19 patients, and when positive results are obtained, these patients should treated accordingly in order to improve clinical responses and patient outcomes.

The latest research progress of the Corona Virus Disease 2019 mutant strain"Omicron"

Coronavirus disease 2019(COVID-19)that broke out at the end of December 2019 has been raging for 3 years,bringing unpredictable harm to the physical and mental health of all mankind and global economic development.The new type of coronavirus pneumonia is a new type of respiratory infectious disease with a high incidence and fatality rate caused by SARS-CoV-2.Up to now,hundreds of millions of people have been infected with new coronary pneumonia worldwide,and millions of people have died.Due to the specificity of the new coronavirus itself and its high mutation rate,a series of different new coronavirus variants have appeared,which has caused the new crown pneumonia epidemic to repeat.Recently,the World Health Organization(WHO)announced a new variant"omicron"(omicron,B.1.1.529),and declared that the mutant strain may be highly infectious,antibody tolerant and highly resistant to vaccines.This article briefly reviews the latest research progress of the"omicron"variants.

Corona virus disease 2019-associated liver injury in cold regions

The corona virus disease 2019(COVID-19)pandemic has created a global health and economic crisis.Our studies uncovered that in addition to respiratory symptoms,liver damage is also common in COVID-19 patients;however,the cause of liver damage has not been fully elucidated.In this article,we summarize the clinical manifestations and pathological features of COVID-19 reported in published relevant studies and delineate the etiology and pathogenesis of COVID-19-related liver injury.We speculate that cold stimulation may be associated with COVID-19-related liver injury,which should be considered in clinical decision-making and treatment of COVID-19 in cold regions.

COVID-19疫情对厦门市气象因素与流行性感冒发病关联分析的影响

目的目前尚不清楚新型冠状病毒感染(coronavirus disease 2019,COVID-19)疫情是否影响气象因素与流行性感冒(流感)的关联分析,本研究旨在探讨此问题及其影响特征,为今后精确评估气象因素对流感的风险效应提供依据。方法对厦门市气象因素和流感发病的每日数据分为三部分:全年期(2010年1月1日—2021年12月31日)、非COVID-19疫情期(2010年1月1日—2020年1月21日)和COVID-19疫情期(2020年1月22日—2021年12月31日),采用R 4.2.1软件通过分布滞后非线性模型(distributed lag nonlinear model,DLNM)进行气象因素与流感的关联分析。结果非COVID-19疫情期低(<42%)和高(>85%)相对湿度(relative humidity,RH)是流感的危险因素,高RH风险累计效应随滞后时间的增加而增加,随RH的增加而先增加后减弱,RH达到93%滞后14 d时最显著(RR=1.41)。COVID-19疫情期RHU<75%对流感的风险累计效应随RH的减少和滞后时间的增加而增加,RH为35%滞后14 d时最显著(RR=1.86×10^(6))。非COVID-19疫情期降水量(precipitation,PRE)处于25~75 mm对流感的风险累计效应先增加后减少,随滞后时间的增加而增加,滞后14 d,PRE达到40 mm时最显著(RR=1.49)。COVID-19疫情期PRE对流感的风险累计效应随PRE的增加而增加。COVID-19疫情期流感发病数的大幅下降严重影响气象因素与流感发病关联分析,致研究结果与全年期和非COVID-19疫情期差别较大;对全年期的研究结果影响较小。结论COVID-19疫情封控政策导致了厦门市COVID-19疫情期流感数大幅下降,从而显著影响了气象因素与流感发病关联分析客观性和科学性,但对长期多年度的分析结果影响有限。此外,极端天气例如RHU、PRE等对流感发病关联的分析也产生一定影响。

Bibliometric analysis of nursing studies on Corona Virus Disease 2019 in China

Objective:To analysis the current status and research focus of Corona Virus Disease 2019(COVID-19)nursing research in China.Methods:China National Knowledge Infrastructure(CNKI),WanFang,Chinese Scientific Journals Database(VIP)and Chinese Biomedical Literature Service System(SinoMed)databases were searched for the literatures on COVID-19 nursing published from January 1,2020,to May 15,2020.The Bibliographic Items Co-occurrence Matrix Builder was used to perform bibliometric analysis on journals,authors,keywords,etc.of the articles,and SPSS 23.0 was utilized to cluster analysis of high-frequency keywords.Results:A total of 458 related articles and 429 first authors were extracted.There articles were published most in the journal of Chinese General Practice Nursing(12.25%).33 high-frequency keywords were extracted such as“COVID-19”,“nurse”,etc.,accounting for 50.19%of the total frequency.Co-word cluster analysis obtained four research hotspots:the psychological status and psychological care of medical staff fighting COVID-19;the nursing strategy of critically ill patients with COVID-19 and the psychological experience of nurses against COVID-19;operating room emergency management and infection prevention during epidemic;the triage management of novel coronavirus infection in fever clinic.Conclusion:The psychological status,the nursing strategy on critically ill patients,the psychological experience of nurses,operating room emergency management and infection prevention,the triage management of novel coronavirus infection in fever clinic had become hot topics when facing the COVID-19 epidemic.

EPIDEM: A Mobile Application to Contain Coronavirus Disease 2019

With the spread of COVID-19 across the globe, almost 33 million people became sick and almost 1 million have died (WHO). The government of the Philippines, along with the government of other countries declared movement restrictions or lockdown in the attempt to contain the virus. This resulted in loss of job and economic breakdown. The Philippines, in particular, experienced the longest and strictest lockdown. As a down side, a lot of people have lost their jobs and the country is currently facing economic recession. With the aim of containing the virus to reopen the economy, a team of experts developed a mobile application called EPIDEM. The application is available for both Android and Apple smartphones. With the use of EPIDEM, lay people can monitor their infection risk for COVID-19 and isolate themselves or get themselves tested when infection risk is high. Users can also monitor the health risk of other people that they come in contact with, so they can decide if meeting them is safe or risky. Further, the application provides a monitoring map that shows the area that is safe from COVID-19 and area where a possible outbreak might occur. The monitoring map will be helpful to both lay people, so they would know the places to avoid and to government officials, so they can quickly respond to outbreak. The teams of developers are recommending the nationwide implementation of EPIDEM to help contain the COVID-19 outbreak in the country. The application is not a new strategy of containment. Instead, it’s a better wheel that utilizes advanced technology to execute the manual containment strategies that are already being implemented in the country.

Exploration of Infection Prevention and Control Practice of Designated Hospitals in During Corona Virus Disease 2019 Epidemic Period

Corona Virus Disease 2019(COVID-19)is a new infectious disease that appeared in whan in December 2019 Since January23,the national health and fitmess commission has required hospitals to be designated in accordance with the principle of"concentrating patients,experts,resources and treatment".Designated hospitals are often the strength of the general hospital and general hospital complex layers of various kinds of personnel,campus area is large,multi-channel,ordinary outpatient accepts people more,for emergency and severe cases treatment in patients with normal difficulty pressuure big,suspected/confirmed cases,combined with the COVID-19 occurred when the traditional holiday,the country launched the emergency response since,process reform faces a difficult labor,shortage of mampower,protective shortages,short time limit,and many other difficulties,hospital infection prevention and control is facing unprecedented pressure.In this paper,the West China-Guang'an Hospital,Sichuan University(Guang'an people's hospital)as a designated hospital,on the basis of the relevant scheme of the national health committee,epidemic prevention and control of the actual,combined with comprehensive hospital leadership,mampower allocation,protection,security,patient management,disinfection isolation,preview triage,preventive measures,training,monitoring,etc.,with practical experience summary for the COVID-19 diring the hospital infection prevention and control to improve the practice exploration.

Synthesis of Novel Virus-Like Mesoporous Silica-ZnO-Ag Nanoparticles and Quercetin Synergize with NIR Laser for Omicron Mutated Covid-19 Virus Infectious Diseases Treatment

This work shows that novel virus-like mesopore silica-zinc oxide/Ag nanoparticles (SZnOAg) synthesized and professionally collected on NIR laser irradiation with quercetin to improve the elimination the mutated virus as a biomedical application. A unique type of silica nanoparticles with a self-in- flating tubular surface has been successfully synthesized using a novel single-micelle epitaxial growth process. The properties of the nanoparticles can be tuned with respect to their core diameter, tubular length, and outer diameter. Due to their biomimetic appearance, they can rapidly transform living cells into virus-like particles, this SZnOAg nanomaterial has specific elimination effect on bacteriophage and Covid-19. Using epitaxial growth, we can construct virus-like structures that can be used for biomedicine applications. These nanomaterials and NIR laser could open the way to a new range of antiviral materials, due to the low-efficiency cellular uptake of current nanoparticles, their applications in the biomedical field are limited. Herein, it clearly shows that novel mesoporous silica nanoparticles can be easily exhibited superior cellular uptake property.

2019冠状病毒病感染流行期分泌性中耳炎患病人口统计学特征分析

目的 评估2019冠状病毒病(corona virus disease 2019,COVID-19)感染流行期分泌性中耳炎患病年龄构成比的变化特征。方法 回顾性分析2018年12月1日~2019年1月31日在首都医科大学附属北京同仁医院耳鼻咽喉头颈外科就诊的符合诊断与排除标准的分泌性中耳炎病例,称为新冠前组;2022年12月1日~2023年1月31日在该科就诊的符合诊断与排除标准的分泌性中耳炎病例,称为新冠期组。收集患者年龄、性别、发病侧别和听力学检测结果等。并将这两个时期纳入本研究的分泌性中耳炎患者总数、年龄构成比、性别构成比、患病侧别比和听力学检测结果等数据进行统计学分析。结果 新冠前组的患者总人数为1 872例,年龄(30.45±23.17)岁,男性949例,女性923例,其中儿童患者910例,成年患者962例。新冠期组患者总人数1 194例,年龄(48.31±18.92)岁,男性623例,女性571例,其中儿童患者95例,成年患者1 099例。新冠前组与新冠期组之间,总体患病年龄分布不同(Z=-20.820,P<0.001)。儿童患者与成年患者的构成比具有显著性差异(χ2=546.838,P <0.001),儿童患病比率显著减少,成年人患病比率显著增加。新冠期组与新冠前组相比,在儿童组7~18岁年龄段的患病比例明显减少(Z=-5.641,P<0.001),在成年人组46~75岁年龄组的患病比例明显增加(Z=-3.134,P=0.002)。新冠期组与新冠前期组相比成年患者中男性患者增多,具有显著性差异(χ2=5.15,P=0.023)。患病侧别构成比、平均骨气导差值两组之间无显著性差异。结论 新型冠状病毒疫情流行期与疫情之前相比,分泌性中耳炎的患病群体年龄构成比明显改变,儿童所占比例显著降低,成年人所占比例显著增高。

新疆从/执业药师COVID-19知识和心理调查

目的了解新疆地区从业/执业药师对新型冠状病毒肺炎(COVID-19)知识掌握情况和心理健康状况,为后续培训和心理干预提供依据。方法通过微信、QQ等在线发放调查问卷,包括COVID-19知识、心理健康自评问卷(SRQ-20)、患者健康问卷抑郁症状群量表(PHQ-9),对新疆从/执业药师进行调查评估。结果有效回收问卷180份,有效回收率86.96%,COVID-19知识合格率为61.67%,女性、医院药师、执业西药师、中级技术职称与知识得分显著正相关(P<0.05);精神疾病史和医院隔离与其显著负相关(P<0.05);SRQ-20阳性率为23.89%、PHQ-9阳性率为43.89%,精神疾病史、医院隔离与SRQ-20和PHQ-9自评分均具有显著正相关性(P<0.05),而本科及大专学历、COVID-19掌握情况则与之显著负相关性(P<0.05);较未接触患者,可能接触确疑似患者与SRQ-20自评总分均具有显著正相关性(P<0.05)。结论部分执业药师COVID-19知识掌握相对薄弱,易出现心理应激和抑郁症状,需进一步加强学习;特定的药师人群易产生心理问题,宜给予更多关注和支持。

Padua评分联合D-二聚体对COVID-19患者发生静脉血栓栓塞症的预测价值研究

目的Padua评分联合D-二聚体在预测新型冠状病毒感染(COVID-19)患者发生静脉血栓栓塞症(VTE)中的价值。方法收集2022年12月-2023年2月于承德医学院附属医院内科住院的COVID-19患者441例,其中VTE组195例,无VTE组246例。分析两组患者基本资料,绘制Padua评分、D-二聚体以及两者联合时预测COVID-19患者发生VTE的受试者工作特征曲线(ROC曲线),并比较三种方法曲线下面积(AUC)。应用Logistic回归分析探讨Padua评分危险分层(Padua评分≥4分)和D-二聚体水平与VTE发生风险关系。结果VTE组患者Padua评分和D-二聚体均高于无VTE组。Padua评分、D-二聚体预测COVID-19发生VTE的最佳截断值分别为4.5分和1.485μg/mL,约登指数为0.446和0.484,灵敏度为0.641和0.744,特异度为0.805和0.740,AUC为0.789和0.804,两者AUC比较差异无统计学意义(Z=0.512,P=0.609);COVID-19患者,其VTE发生风险随评分(Padua评分≥4分者)的升高而增加,随D-二聚体水平升高而增加,差异均有统计学意义(P<0.05);Padua评分联合D-二聚体预测COVID-19发生VTE的最大约登指数为0.575,灵敏度和特异度分别为0.795和0.780,AUC为0.863,较单独使用Padua评分、D-二聚体的AUC均升高,且差异均有统计学意义(Z=4.655,P<0.001和Z=3.606,P<0.001)。结论Padua评分、D-二聚体水平与COVID-19患者VTE的发生风险可能存在相关,两者联合对COVID-19患者发生VTE可能有较好的预测价值。