Follow-up study on long-term prognosis of COVID-19 discharged patients in Xinyang city of Henan province
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目的 旨在通过对信阳地区2020年1月—2020年6月期间新型冠状病毒感染(coronavirus disease 2019,COVID-19)出院患者进行随访调查,描述这些患者12个月、24个月内临床症状及肺功能、胸部影像学检查的发展趋势,并分析相关的危险因素.方法 本项研究为前瞻性、纵向、队列研究,针对2020年1～6月在信阳市第五人民医院和信阳市中心医院住院的COVID-19幸存患者,在患者出院后12个月末和24个月末进行了前瞻性随访调查.拒绝参与研究、患有癌症和慢性呼吸系统疾病,包括哮喘或慢性阻塞性肺疾病的患者被排除在外,随访期间对符合研究条件的患者进行临床症状询问、常规、生化抽血化验、肺功能及胸部高分辨率计算机断层扫描(high-resolution computed tomography,HRCT)和6分钟步行距离测试,以及使用改良英国医学研究委员会呼吸困难问卷进行评估.结果 2020年1月—2020年6月间,在207例符合条件的患者中,169例患者纳入本项研究,其中轻型和普通型为126例(74.6％),重型和危重型为43例(25.4％).其中男100例(59.2％),女69例(40.8％),年龄20～78(50±15)岁.研究发现超半数COVID-19患者康复期12个月有1种或多种后遗症状,其中乏力疲劳[90 例(53.3％)]、失眠[43 例(25.4％)]、焦虑[24 例(14.2％)]、胸闷[29 例(17.2％)]、脱发[35 例(20.7％)]等症状最为普遍.出院2年后,仍有52例(30.8％)患者至少有1种临床症状.COVID-19康复期患者生活质量、心肺功能、运动能力均有不同程度下降.大部分患者肺功能及CT检查结果恢复正常,但仍有少数患者在出院后12个月、24个月仍存在持续的肺功能和影像学异常.肺功能主要表现为弥散功能损伤,一氧化碳弥散能力(diffusion capacity of the lung for carbon monoxide,DLCO)＜80％预计值有 44 例(26.0％),肺部 HRCT 主要表现为单肺/双肺慢性炎症[28例(41.2％)]、单肺/双肺多发结节[23例(33.8％)]、磨玻璃影[10例(14.7％)]等.多变量逻辑回归分析显示高龄女性COVID-19患者出院后更容易出现焦虑症状,且与急性期疾病的严重程度无关.COVID-19病情较重的高龄女性患者在康复期更容易出现DLCO损害症状,且随着时间延长,肺功能逐渐恢复.结论 信阳地区大部分COVID-19患者在康复期健康状况恢复良好,但仍有部分患者遗留乏力疲劳、失眠、焦虑等临床症状,肺部病变吸收缓慢且部分患者伴有肺弥散功能受损.随着康复时间延长,上述症状均有明显改善.
Objective To describe the development trend of clinical symptoms,pulmonary function and chest imaging examination of COVID-19 discharged from Xinyang from January 2020 to June 2020,and analyze the related risk factors.Methods This study was a prospective,longitudinal and cohort study.The survivors of COVID-19 hospitalized in Xinyang Fifth People's Hospital and Xinyang Central Hospital from January to June,2020 were prospectively followed up 12 months and 24 months after discharge.Patients who refused to participate in the study and suffered from cancer and chronic respiratory diseases,including asthma or chronic obstructive pulmonary disease,were excluded.During the follow-up period,the patients who meet the research conditions were asked about clinical symptoms,routine and biochemical blood tests,pulmonary function and chest high-resolution CT(HRCT)and 6-minute walking distance test,and were evaluated with the Dyspnea Scale(mMRC).Results It was found that from January to June,2020,among 207 eligible patients,169 patients participated in this study,including 126 cases of mild and ordinary type(74.6％)and 43 cases of severe and critical type(25.4％).There were 100 males(59.2％)and 69 females(40.8％),aged 20-78 years old(50±15).It was found that more than half of COVID-19 patients had one or more symptoms at the end of 12 months after rehabilitation,including fatigue(90 cases,53.3％),insomnia(43 cases,25.4％),anxiety(24 cases,14.2％),chest tightness(29 cases,17.2％)and alopecia(35 cases,20.7％).Two years after discharge,52 patients(30.8％)still had at least one clinical symptom.The quality of life,cardiopulmonary function and exercise ability of COVID-19 patients in rehabilitation period decreased to varying degrees.Most patients'lung function and CT results returned to normal,but a few patients still had persistent lung function and imaging abnormalities 12 months and 24 months after discharge.Pulmonary function was mainly manifested as diffuse function injury,and the predicted value of carbon monoxide diffusion capacity(DLCO)was less than 80％in 44 cases(26.0％).Pulmonary HRCT mainly showed chronic inflammation in one lung/both lungs(28 cases,41.2％),multiple nodules in one lung/both lungs(23 cases,33.8％)and ground glass shadow(10 cases,14.7％),etc.Multivariate logistic regression analysis showed that female COVID-19 patients with old age were more likely to have anxiety symptoms after discharge,which had nothing to do with the severity of acute disease.Older female patients with severe COVID-19 were more likely to have symptoms of DLCO damage during the recovery period,and their lung function gradually recovered with time.Conclusions Most of COVID-19 patients in Xinyang recovered well during the rehabilitation period,but some patients still had clinical symptoms such as fatigue,insomnia,anxiety,etc.The absorption of lung lesions was slow and some patients were accompanied by impaired pulmonary diffusion function.With the extension of rehabilitation time,the above symptoms have been significantly improved.
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