感染新型冠状病毒的血液透析患者的临床特征

doi:10.19723/j.issn.1671-167X.2024.02.010

摘要/Abstract

摘要：

目的: 分析北京市单中心感染新型冠状病毒的血液透析患者的临床特征。方法: 选取2022年11月30日至2023年1月4日在北京大学第三医院血液透析中心进行规律透析且感染新型冠状病毒的患者作为研究对象，用问卷星的形式调查患者新型冠状病毒阳性期间出现的临床症状、症状严重程度和持续时间等信息，通过查阅病历收集患者基本资料以及感染前后血液检验(血常规、血生化等)结果、透析治疗和疾病的转归情况等。结果: 共纳入研究对象203例，其中轻型148例(72.91%)、中型23例(11.33%)、重型及危重型32例(15.76%)，随访期间死亡16例(7.88%)。临床症状以呼吸道症状(81.77%咳嗽，68.97%咳痰)和发热(81.28%)、乏力(65.52%)为主，且疲乏无力持续的时间在所有症状中最长，为9(5，15) d。26例(12.8%)患者主动减少了透析次数1(1，2)次，25例(12.32%，27例次)患者有提前结束透析治疗的行为，减少透析时间30.0(20.0，30.5) min。单因素分析结果显示，患者在新型冠状病毒感染后血红蛋白、血肌酐、尿素氮及超滤量均明显低于感染前(P＜0.05)；不同临床分型患者的年龄、白蛋白、血红蛋白、血肌酐水平、血管通路类型，以及感染期间透析次数变化、发热、咳痰、乏力程度差异均有统计学意义(P＜0.05)。多因素Logistic回归分析结果显示，经发热、咳痰和乏力程度等因素矫正后，患者的年龄(OR=1.051，95%CI：1.017~1.086，P=0.003)、白蛋白水平(OR=0.905，95%CI：0.803~1.019，P=0.098)仍与发生肺炎有关。结论: 感染新型冠状病毒的血液透析患者肺炎患病率和死亡比例均较高，且临床症状持续时间较长；感染期间患者透析相关并发症发生率增加，血红蛋白和营养状况下降；高龄、低白蛋白血症的患者感染后发生肺炎的风险较高。

关键词: 血液透析, 新型冠状病毒感染, 肺炎, 危险因素

Abstract:

Objective: To analyze the clinical characteristics of hemodialysis patients with corona virus disease 2019 (COVID-19) in a single-center from Beijing. Methods: Patients with COVID-19 who received regular hemodialysis at Peking University Third Hospital from November 30, 2022 to January 4, 2023 were selected as the study objects. Clinical symptoms, severity and duration of symptoms during the period of virus positive were investigated in the form of questionnaires, and the basic information of the patients, as well as the results of blood tests (routine blood and blood biochemistry, etc.) before and after infection, dialysis treatment and the outcome of the disease were collected by consulting medical records. Results: A total of 203 subjects were included in this study, including 148 mild cases (72.91%), 23 medium cases (11.33%), 32 severe and critical cases (15.76%), and 16 (7.88%) deaths occured during the follow-up. Clinical symptoms mainly included respiratory symptoms (among which 81.77% had cough, 68.97% had expectoration), fever (81.28%) and fatigue (65.52%), and fatigue and weakness had the longest duration [9 (5, 15) days] among all symptoms. Twenty-six patients (12.8%) reduced the dialysis sessions [1 (1, 2) times], 25 patients (12.32%) had the behavior of early finishing dialysis (27 times), reducing the dialysis time by 30.0 (20.0, 30.5) minutes. Univa-riate analysis showed that the hemoglobin, creatinine, urea nitrogen and ultrafiltration decreased signi-ficantly after infection (P < 0.05). There were significant differences in age, albumin, hemoglobin, creatinine levels and vascular access types among the patients with different clinical subtypes, and the changes of dialysis sessions, fever, expectoration and fatigue degree were also different among the patients with different clinical subtypes (P < 0.05). Multivariate Logistic regression analysis showed that age (OR=1.051, 95%CI: 1.017-1.086, P=0.003) and albumin levels (OR=0.905, 95%CI: 0.803-1.019, P=0.098) corrected by fever, expectoration and fatigue levels were still associated with the occurrence of pneumonia. Conclusion: The morbidity of pneumonia and the proportion of deaths in hemodialysis patients with COVID-19 were higher, and some clinical symptoms lasted for a longer time than the general population. During the infection period, the incidence of dialysis-related complications increased, hemoglobin and nutritional status decreased. Elderly patients and patients with low albumin level had a higher risk of developing pneumonia after infection.

Key words: Hemodialysis, COVID-19, Pneumonia, Risk factors

中图分类号:

R459.52

朱金荣,赵亚娜,黄巍,赵微微,王悦,王松,苏春燕. 感染新型冠状病毒的血液透析患者的临床特征[J]. 北京大学学报（医学版）, 2024, 56(2): 267-272.

Jinrong ZHU,Yana ZHAO,Wei HUANG,Weiwei ZHAO,Yue WANG,Song WANG,Chunyan SU. Clinical characteristics of COVID-19 infection in patients undergoing hemodialysis[J]. Journal of Peking University (Health Sciences), 2024, 56(2): 267-272.

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Symptom	n(%)	Lasting days, M(P₂₅, P₇₅)	Symptom	n(%)	Lasting days, M(P₂₅, P₇₅)
Cough	166 (81.77)	7.00 (3.00, 12.00)	Hypogeusia	77 (37.93)	7.00 (4.00, 14.00)
Fever	165 (81.28)	2.00 (1.00, 3.00)	Loss of appetite	67 (33.00)	7.00 (3.00, 12.00)
Expectoration	140 (68.97)	7.00 (3.00, 12.00)	Nausea and vomiting	64 (31.53)	3.00 (1.00, 6.25)
Fatigue	133 (65.52)	9.00 (5.00, 15.00)	Diarrhea	59 (29.06)	3.00 (2.00, 5.00)
Muscular soreness	105 (51.72)	5.00 (3.00, 7.00)	Hyposmia	58 (28.57)	7.00 (3.00, 12.00)
Throat pain	89 (43.83)	5.00 (3.00, 7.00)	Conjunctivitis	18 (8.87)	4.00 (3.00, 10.00)
Nasal congestion and runny nose	81 (39.90)	6.00 (3.00, 8.00)	Hearing loss	3 (1.48)	8.50 (1.75, 13.75)

Variable	Pre-infection	Post-infection	t	P
Hemoglobin/(g/L)	113.71±12.35	102.38±13.29	8.562	＜0.001
Creatinine/(μmol/L)	1 012.24±264.22	976.52±290.59	3.209	0.002
Urea nitrogen/(mmol/L)	26.45±5.87	25.49±6.56	2.068	0.040
Ultrafiltration/L	2.65±0.94	2.10±0.88	8.880	＜0.001

Items	Mild type(n=148)	Medium type(n=23)	Severe and critical type (n=32)	χ²/F/Z	P
Pre-infection clinical data
Age	59.00±13.05	60.04±12.96	73.66±9.87	17.962	＜0.001
Albumin/(g/L)	38.08±3.22	37.44±2.99	34.96±4.01	11.253	＜0.001
Hemoglobin/(g/L)	114.83±12.69	107.39±14.01	113.31±10.38	3.540	0.031
Creatinine/(μmol/L)	1 025.80±266.36	1 031.13±332.01	793.38±251.05	9.074	＜0.001
Vascular access				10.745	0.016
Arteriovenous fistula	133 (89.86)	17 (73.91)	23 (71.88)
Graft fistula	5 (3.38)	3 (13.04)	4 (12.50)
Central venous catheter	10 (6.76)	3 (13.04)	5 (15.63)
Post-infection clinical data
Variation of dialysis frequency	-0.10±0.48	-0.52±1.38	0.00±1.00	3.919	0.021
Cases of early termination of dialysis	12 (8.11)	7 (30.43)	6 (18.75)	9.056	0.011
Degree of fever				18.391	0.010
None	19 (12.84)	1 (4.35)	1 (4.35)
Slight	46 (31.08)	4 (17.39)	4 (17.39)
Moderate	55 (37.16)	7 (30.43)	8 (34.78)
Relatively serious	25 (16.89)	10 (43.48)	6 (26.09)
Very serious	3 (2.03)	1 (4.35)	4 (17.39)
Degree of expectoration				23.176	0.001
None	42 (28.38)	4 (17.39)	1 (4.35)
Slight	60 (40.54)	4 (17.39)	12 (52.17)
Moderate	33 (22.30)	9 (39.13)	4 (17.39)
Relatively serious	10 (6.76)	5 (27.78)	3 (13.04)
Very serious	3 (2.03)	1 (4.35)	3 (13.04)
Degree of fatigue				27.786	＜0.001
None	37 (25.00)	6 (26.09)	2 (8.70)
Slight	38 (25.68)	0	2 (8.70)
Moderate	44 (29.73)	6 (26.09)	7 (30.43)
Relatively serious	23 (15.54)	7 (30.43)	6 (26.09)
Very serious	6 (4.05)	4 (17.39)	6 (26.09)

Variable	Assignment value
Vascular access	Arteriovenous fistula: z1=0, z2=0, z3=0; Graft fistula: z1=0, z2=1, z3=0; Central venous catheter: z1=0, z2=0, z3=1
Degree of fever	0=none; 1=slight; 2=moderate; 3=relatively serious; 4=very serious
Degree of expectoration	0=none; 1=slight; 2=moderate; 3=relatively serious; 4=very serious
Degree of fatigue	0=none; 1=slight; 2=moderate; 3=relatively serious; 4=very serious
Whether pneumonia occured	1=yes; 0=no

Items	β	SE	Wald value	OR (95%CI)	P value
Constant	-2.714	2.761	8.985	0.066	0.326
Age	0.050	0.017	2.738	1.051 (1.017-1.086)	0.003
Albumin	-0.100	0.061	10.604	0.905 (0.803-1.019)	0.098
Degree of fever	0.686	0.211	6.812	1.985 (1.314-3.000)	0.001
Degree of fatigue	0.424	0.162	0.967	1.528 (1.111-2.100)	0.009