摘要
目的 了解多发性骨髓瘤(MM)合并新型冠状病毒感染(COVID-19)的情况以及COVID-19 患者的临床特征及转归.方法 通过查询病例资料和电话随访,回顾性调研了 2022 年 8 月—2023 年 1 月就诊于苏州弘慈血液病医院的MM患者在国内新型冠状病毒(新冠病毒)流行高峰期间COVID-19 的发生率,重点收集了 27 例MM合并COVID-19 住院患者的临床表现、实验室指标及预后信息,分析其临床特征.结果 共调研116例MM患者,中位年龄69(38,86)岁,87例(75.0%)患者在流行高峰期间感染了新冠病毒:轻型12例(13.8%)、中型49例(56.3%)、重型20例(23.0%)、危重型6例(6.9%),合并COVID-19 患者的死亡率为 4.6%(4/87).住院的 27 例患者中,男性 16 例(59.3%).MM合并COVID-19 初发临床表现主要为咳嗽 26 例(96.3%)、乏力 20 例(74.1%)、胸闷 17 例(63.1%)、咽痛 17 例(63.1%)、发热 11 例(40.7%)和头痛 6 例(22.2%).27 例患者合并的COVID-19 均为中-危重型.感染新冠病毒后MM患者的白细胞和淋巴细胞计数均明显下降,而IL-6、CRP和D-二聚体则明显升高(P＜0.05).重/危重型较中型患者的淋巴细胞及血Na+水平下降更为明显;而D-二聚体、IL-6、LDH及CRP则升高(P＜0.05).MM合并COVID-19 后患者的病毒抗体转阳中位天数为14(11,19)d,其中IgM抗体滴度中位数为 3.25(2.06,4.69)S/CO,IgG抗体滴度中位数为 6.41(2.06,9.50)S/CO.27 例患者中新冠病毒抗原/核酸转阴的中位天数为22(16,30)d.25例(92.6%)好转出院,中位住院天数为20(11,33)d.结论 MM合并COVID-19 较2020年死亡率明显下降,但仍易进展为重型/危重型,病毒清除慢.
Abstract
Objective To understand the incidence,clinical features,and outcomes of COVID-19 in patients with multiple myeloma(MM).Methods The data of patients were collected by searching the hospital database and telephone follow-up to retrospectively investigate the incidence of COVID-19 in MM patients who visited Soochow Hopes Hematology Hospital from August 2022 to January 2023 during the peak period of COVID-19 in China.The data for analysis included clinical manifestations,laboratory test results,and outcomes,especially the data of 27 patients complicated COVID-19 pneumonia.Results A total of 116 MM patients were identified.The median age of these patients was 69 years old(range:38-86).Overall,87(75.0%)of the patients were complicated with COVID-19 during the epidemic peak,including mild cases(12,13.8%),moderate cases(49,56.3%),severe cases(20,23.0%),and critical cases(6,6.9%).The mortality rate was 4.6%(4/87)for the patients complicated with COVID-19.Overall,27 patients were admitted to hospital,including 16 males(59.3%).The initial symptoms of COVID-19 in MM patients were cough in 26 cases(96.3%),fatigue in 20 cases(74.1%),chest tightness in 17 cases(63.1%),pharyngalgia in 17 cases(63.1%),fever in 11 cases(40.7%),and headache in 6 cases(22.2%).All the 27 hospitalized patients had moderate to critical disease.COVID-19 was associated with significantly decreased levels of white blood cells and lymphocytes and significantly increased levels of IL-6,C-reactive protein(CRP)and D-dimer(P<0.05)in MM patients.The severe/critical patients showed significantly lower levels of lymphocyte count and serum Na+ but significantly increased levels of D-dimer,IL-6,lactate dehydrogenase(LDH),and CRP compared to other patients(P<0.05).The median(P25,P75)time to positive conversion of anti-SARS-CoV-2 antibody was 14(11,19)days after infection in MM patients.The median titer of IgM antibody was 3.25(2.06,4.69)S/CO,and the median titer of IgG antibody was 6.41(2.06,9.50)S/CO.The median time from infection to negative conversion of novel coronavirus antigen/nucleic acid was 22(16,30)days in the 27 hospitalized patients.Overall,25 of the 27 patients(92.6%)recovered from COVID-19.The median hospital stay was 20(11,33)days.Conclusions The mortality rate of COVID-19 in MM patients was significantly lower than that in 2020.However,COVID-19 may readily progress to severe/critical condition in MM patients,associated with slow clearance of the virus.
NETL
NSTL
维普
万方数据