目的:探讨恶性肿瘤患者感染2019新型冠状病毒奥密克戎突变株临床特征及临床转归情况。方法:回顾性分析2022年3月20日至2022年5月15日我院收治的感染2019新型冠状病毒奥密克戎变异株的恶性肿瘤住院患者,根据不同年龄段1:1匹配,在数据库中随机抽取该年龄段的感染2019新型冠状病毒奥密克戎变异株非恶性肿瘤住院患者,分为恶性肿瘤组和非恶性肿瘤组,分析比较两组患者流行病学资料、实验室检查和临床转归情况,同时观察恶性肿瘤组不同治疗方案对临床转归的影响。结果:收集142例患者,恶性肿瘤组和非恶性肿瘤组分别71例。恶性肿瘤组患者平均年龄62.89 ± 12.79岁,临床表现以咳嗽(36.6%)、乏力(21.1%)、肌肉酸痛(18.3%)、发热(14.1%)为主,临床分为轻型39例(54.9%)、无症状18例(25.4%),有25.4%的恶性肿瘤组病人患有高血压、11.3%的患有冠心病、分别有7%的病人患有糖尿病和慢性阻塞性肺疾病。临床表现和疾病分型两组无差别。恶性肿瘤组患者接种疫苗剂次显著低于非恶性肿瘤组(0.69 ± 1.09剂 vs 1.68 ± 1.31剂)。恶性肿瘤组患者IL-2受体(696.24 ± 442.07 U/ml vs 517.31 ± 210.92 U/ml)、IL-6 (20.75 ± 47.19 pg/ml vs 7.65 ± 14.79 pg/ml)、TNF-α (10.78 ± 9.19 pg/ml vs 7.64 ± 3.48 pg/ml)、CRP (25.13 ± 40.79 mg/L vs 10.51 ± 17.45 mg/L)、血清淀粉蛋白A (71.81 ± 102.64 mg/L vs 42.24 ± 70.52 mg/L)、纤维蛋白原定量(4.06 ± 1.39 g/L vs 3.61 ± 1.01 g/L)均高于非恶性肿瘤组,且均高于正常参考值;两组患者的D-二聚体及肝素结合蛋白均高于正常值范围,但无差别。核酸双阴时间(14.38 ± 6.6 d vs 12.02 ± 4.83 d)、总住院时间(14.21 ± 6.89 d vs 11.8 ± 4.25 d)比较,恶性肿瘤组均多于非恶性肿瘤组。恶性肿瘤组不同治疗方案对临床转归结果显示中药 + Paxlovid组(11.05 ± 3.78 d)在核酸首次转阴时间少于Paxlovid组(16.42 ± 7.65 d)。结论:奥密克戎突变株感染恶性肿瘤患者相比非恶性肿瘤患者存在疫苗接种剂次少、炎症反应重及高凝状态的临床特点,同时核酸转阴及住院时间更长,中医药的全程介入治疗可能对患者的病毒清除有益。 Objective: To investigate the clinical characteristics and clinical outcomes of 2019 novel coronavirus Omicron variant infected malignant tumor patients. Methods: Retrospective analysis of hospitalized patients with malignant tumors infected with 2019 novel coronavirus Omicron variant in our hos-pital from March 20, 2022 to May 15, 2022, according to the principle of 1:1 matching in different age groups; non malignant inpatients infected with the Omicron variant of covid-19 were randomly selected from the database, divided into malignant tumor group and non malignant tumor group. The epidemiological data, laboratory data and clinical outcomes of the two groups were compared, and the effects of different treatment schemes in the malignant tumor group on clinical outcomes were analyzed. Results: A total of 142 patients were collected, including 71 patients in the malig-nant tumor group and 71 patients in the non malignant tumor group. The average age of patients in the malignant tumor group was 62.89 ± 12.79 years. The main clinical symptoms were cough (36.6%), fatigue (21.1%), muscle soreness (18.3%), and fever (14.1%). According to clinical classi-fication, 39 cases (54.9%) were mild and 18 cases (25.4%) were asymptomatic. 25.4% of the pa-tients in the malignant tumor group had hypertension, 11.3% had coronary atherosclerotic heart disease, and 7% had diabetes and chronic obstructive pulmonary disease respectively. There was no difference in clinical symptoms and disease classification between the two groups. The doses of vaccinations in the malignant tumor group were significantly lower than that in the non malignant tumor group (0.69 ± 1.09 doses vs 1.68 ± 1.31 doses). The serum levels of IL-2 receptor (696.24 ± 442.07 U/ml vs 517.31 ± 210.92 U/ml), IL-6 (20.75 ± 47.19 pg/ml vs 7.65 ± 14.79 pg/ml), TNF-α (10.78 ± 9.19 pg/ml vs 7.64 ± 3.48 pg/ml), CRP (25.13 ± 40.79 mg/L vs 10.51 ± 17.45 mg/L), serum amyloid A (71.81 ± 102.64 mg/L vs 42.24 ± 70.52 mg/L), and fibrin (4.06 ± 1.39 g/L vs 3.61 ± 1.01 g/L) in the malignant tumor group were higher than those in the non malignant tumor group, and were higher than the normal reference value. The D-dimer and heparin binding protein of the two groups were higher than the normal reference value range, but there was no difference. Compared with the times of nucleic acid turning negative for two consecutive times (14.38 ± 6.6 d vs 12.02 ± 4.83 d) and the total hospitalization times (14.21 ± 6.89 d vs 11.8 ± 4.25 d), the malignant tumor group was longer than the non malignant tumor group. The clinical outcomes of different treatment schemes in the malignant tumor group showed that the first negative times of nucleic acid in the traditional Chinese Herbal + paxlovid group (11.05 ± 3.78 d) were less than that in the paxlovid group (16.42 ± 7.65 d). Conclusions: Compared with patients with non malignant tumors, patients with malignant tumors infected with 2019 novel coronavirus Omicron variant have the clinical characteristics of less vaccinations, more severe inflammatory reaction and hypercoagulable state. At the same time, nucleic acid turns negative and the hospitalization times are longer. The treat-ment of traditional Chinese medicine may be beneficial to the virus clearance of patients.
目的:探讨恶性肿瘤患者感染2019新型冠状病毒奥密克戎突变株临床特征及临床转归情况。方法:回顾性分析2022年3月20日至2022年5月15日我院收治的感染2019新型冠状病毒奥密克戎变异株的恶性肿瘤住院患者,根据不同年龄段1:1匹配,在数据库中随机抽取该年龄段的感染2019新型冠状病毒奥密克戎变异株非恶性肿瘤住院患者,分为恶性肿瘤组和非恶性肿瘤组,分析比较两组患者流行病学资料、实验室检查和临床转归情况,同时观察恶性肿瘤组不同治疗方案对临床转归的影响。结果:收集142例患者,恶性肿瘤组和非恶性肿瘤组分别71例。恶性肿瘤组患者平均年龄62.89 ± 12.79岁,临床表现以咳嗽(36.6%)、乏力(21.1%)、肌肉酸痛(18.3%)、发热(14.1%)为主,临床分为轻型39例(54.9%)、无症状18例(25.4%),有25.4%的恶性肿瘤组病人患有高血压、11.3%的患有冠心病、分别有7%的病人患有糖尿病和慢性阻塞性肺疾病。临床表现和疾病分型两组无差别。恶性肿瘤组患者接种疫苗剂次显著低于非恶性肿瘤组(0.69 ± 1.09剂 vs 1.68 ± 1.31剂)。恶性肿瘤组患者IL-2受体(696.24 ± 442.07 U/ml vs 517.31 ± 210.92 U/ml)、IL-6 (20.75 ± 47.19 pg/ml vs 7.65 ± 14.79 pg/ml)、TNF-α (10.78 ± 9.19 pg/ml vs 7.64 ± 3.48 pg/ml)、CRP (25.13 ± 40.79 mg/L vs 10.51 ± 17.45 mg/L)、血清淀粉蛋白A (71.81 ± 102.64 mg/L vs 42.24 ± 70.52 mg/L)、纤维蛋白原定量(4.06 ± 1.39 g/L vs 3.61 ± 1.01 g/L)均高于非恶性肿瘤组,且均高于正常参考值;两组患者的D-二聚体及肝素结合蛋白均高于正常值范围,但无差别。核酸双阴时间(14.38 ± 6.6 d vs 12.02 ± 4.83 d)、总住院时间(14.21 ± 6.89 d vs 11.8 ± 4.25 d)比较,恶性肿瘤组均多于非恶性肿瘤组。恶性肿瘤组不同治疗方案对临床转归结果显示中药 + Paxlovid组(11.05 ± 3.78 d)在核酸首次转阴时间少于Paxlovid组(16.42 ± 7.65 d)。结论:奥密克戎突变株感染恶性肿瘤患者相比非恶性肿瘤患者存在疫苗接种剂次少、炎症反应重及高凝状态的临床特点,同时核酸转阴及住院时间更长,中医药的全程介入治疗可能对患者的病毒清除有益。
新型冠状病毒肺炎,奥密克戎突变株,恶性肿瘤,临床特征
Xianjun Sun1,2, Jianhua Huang1, Baojun Liu1,2, Xiaohong Deng1, Huahe Zhu1, Jingcheng Dong1,2*
1Department of Integrative Medicine Huashan Hospital Fudan University, Shanghai
2Institutes of Integrative Medicine, Fudan University (Qingpu Chinese Medicine Hospital), Shanghai
Received: Oct. 19th, 2022; accepted: Jan. 6th, 2023; published: Jan. 13th, 2023
Objective: To investigate the clinical characteristics and clinical outcomes of 2019 novel coronavirus Omicron variant infected malignant tumor patients. Methods: Retrospective analysis of hospitalized patients with malignant tumors infected with 2019 novel coronavirus Omicron variant in our hospital from March 20, 2022 to May 15, 2022, according to the principle of 1:1 matching in different age groups; non malignant inpatients infected with the Omicron variant of covid-19 were randomly selected from the database, divided into malignant tumor group and non malignant tumor group. The epidemiological data, laboratory data and clinical outcomes of the two groups were compared, and the effects of different treatment schemes in the malignant tumor group on clinical outcomes were analyzed. Results: A total of 142 patients were collected, including 71 patients in the malignant tumor group and 71 patients in the non malignant tumor group. The average age of patients in the malignant tumor group was 62.89 ± 12.79 years. The main clinical symptoms were cough (36.6%), fatigue (21.1%), muscle soreness (18.3%), and fever (14.1%). According to clinical classification, 39 cases (54.9%) were mild and 18 cases (25.4%) were asymptomatic. 25.4% of the patients in the malignant tumor group had hypertension, 11.3% had coronary atherosclerotic heart disease, and 7% had diabetes and chronic obstructive pulmonary disease respectively. There was no difference in clinical symptoms and disease classification between the two groups. The doses of vaccinations in the malignant tumor group were significantly lower than that in the non malignant tumor group (0.69 ± 1.09 doses vs 1.68 ± 1.31 doses). The serum levels of IL-2 receptor (696.24 ± 442.07 U/ml vs 517.31 ± 210.92 U/ml), IL-6 (20.75 ± 47.19 pg/ml vs 7.65 ± 14.79 pg/ml), TNF-α (10.78 ± 9.19 pg/ml vs 7.64 ± 3.48 pg/ml), CRP (25.13 ± 40.79 mg/L vs 10.51 ± 17.45 mg/L), serum amyloid A (71.81 ± 102.64 mg/L vs 42.24 ± 70.52 mg/L), and fibrin (4.06 ± 1.39 g/L vs 3.61 ± 1.01 g/L) in the malignant tumor group were higher than those in the non malignant tumor group, and were higher than the normal reference value. The D-dimer and heparin binding protein of the two groups were higher than the normal reference value range, but there was no difference. Compared with the times of nucleic acid turning negative for two consecutive times (14.38 ± 6.6 d vs 12.02 ± 4.83 d) and the total hospitalization times (14.21 ± 6.89 d vs 11.8 ± 4.25 d), the malignant tumor group was longer than the non malignant tumor group. The clinical outcomes of different treatment schemes in the malignant tumor group showed that the first negative times of nucleic acid in the traditional Chinese Herbal + paxlovid group (11.05 ± 3.78 d) were less than that in the paxlovid group (16.42 ± 7.65 d). Conclusions: Compared with patients with non malignant tumors, patients with malignant tumors infected with 2019 novel coronavirus Omicron variant have the clinical characteristics of less vaccinations, more severe inflammatory reaction and hypercoagulable state. At the same time, nucleic acid turns negative and the hospitalization times are longer. The treatment of traditional Chinese medicine may be beneficial to the virus clearance of patients.
Keywords:COVID-19, Omicron Mutants, Malignant Tumor, Clinical Characteristics
Copyright © 2023 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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2019新型冠状病毒(2019 novel coronavirus, 2019-nCoV)引发的新型冠状病毒肺炎(COVID-19)在全球大流行,2019-nCoV历经多次突变,新型冠状病毒奥密克戎(Omicron)变异毒株较以往变异株有更高的传染性,导致其迅速席卷全球,全球已有100多个国家和地区发现奥密克戎变异株感染病例 [
本研究通过复旦大学附属华山医院伦理委员会审核批准(伦理批件号:2022临审第(701)号)。经授权从复旦大学附属华山医院“新型冠状病毒感染疾病专病登记研究”数据库中提取数据,收集2022年3月20日至2022年5月15日复旦大学附属华山医院宝山院区(新冠定点医院)收治的恶性肿瘤感染新型冠状病毒奥密克戎变异株感染的住院患者。
恶性肿瘤组纳入标准
① 符合2022年《新型冠状病毒肺炎诊疗方案(试行第九版)》关于COVID-19诊断标准并能准确临床分型;② 恶性肿瘤组患者有病理明确诊断为恶性肿瘤;③ 恶性肿瘤患者入院前1年内进行过至少一种抗肿瘤治疗,包括化疗、放疗、靶向、免疫、内分泌及手术治疗;④ 有可评估的肺部CT影像和核酸检测结果;⑤ 数据库中有完整的流行病学资料。
非恶性肿瘤组纳入标准
① 符合2022年《新型冠状病毒肺炎诊疗方案(试行第九版)》关于COVID-19诊断标准并能准确临床分型;② 有可评估的肺部CT影像和核酸检测结果;③ 无恶性肿瘤病史;④ 数据库中有完整的流行病学资料。
① 年龄 < 18周岁;② 孕妇或哺乳期的女性;③ 严重肾功能衰竭需要透析者。
参照国家卫健委制定《新型冠状病毒肺炎诊疗方案(试行第九版)》,分为无症状、轻型、普通型、重型、危重型。所有分型患者均需核酸阳性为确诊病例。无症状:患者无任何新冠感染相关临床表现,肺部CT无肺炎表现;轻型:应有发热、干咳、乏力、鼻塞、流涕、咽痛、嗅觉味觉减退或丧失、结膜炎、肌痛和腹泻等临床表现的一种或几种,但症状轻微,肺部CT无肺炎表现。普通型:具有上述临床表现,影像学可见肺炎表现。重型:成人符合下列任何一条:① 出现气促,RR ≥ 30次/分;② 静息状态下,吸空气时指氧饱和度 ≤ 93%;③ 动脉血氧分压(PaO2)/吸氧浓度(FiO2) ≤ 300 mmHg;高海拔(海拔超过1000米)地区应根据以下公式对PaO2/FiO2进行校正:PaO2/FiO2 × [760/大气压(mmHg)]。④ 临床症状进行性加重,肺部影像学显示24~48小时内病灶明显进展 > 50%者。危重型:符合以下情况之一者:① 出现呼吸衰竭,且需要机械通气;② 出现休克;③ 合并其他器官功能衰竭需ICU监护治疗。
分为恶性肿瘤组和非恶性肿瘤组,根据世界卫生组织对年龄段的划分,将恶性肿瘤组按年龄段分为18岁~44岁、45岁~59岁为、60岁~74岁、75岁~89岁及90岁以上5个年龄段,统计每个年龄段的患者例数,恶性肿瘤组共患者72例,1例危重型患者入院第当天因心力衰竭死亡,未能及时完善血液及肺部影像学检查而排除,最终恶性肿瘤组共入组71例患者,在数据库中随机抽取该年龄段的感染新型冠状病毒奥密克戎变异株非恶性肿瘤住院患者,按1:1的比例匹配非恶性肿瘤患者,每组71例,共计142例。
两组患者均随访至出院,观察一般流行病学资料:性别、年龄、基础疾病、临床表现、接种疫苗剂次、疾病诊断分型、核酸Ct值(OFR基因、N基因)。临床血液学指标:白细胞计数、中性粒细胞绝对值、成熟淋巴细胞绝对值、成熟单核细胞绝对值、嗜碱性粒细胞绝对值、嗜酸性粒细胞绝对值、血小板计、MCV、C-反应蛋白、国际标准化比率、凝血酶原时间、部分凝血活酶时间、纤维蛋白原定量、凝血酶时间、D-二聚体、肝素结合蛋、白介素-1β、白介素2受体、白介素-6、白介素-8、白介素-10、肿瘤坏死因子α、血清淀粉样蛋白A。各检测指标的数值为极限值时取其极限值,如该患者C-反应蛋白 < 5 mg/L,则取值为5 mg/L。临床转归指标:核酸首次转阴时间(从发现首次核酸异常开始至核酸OFR基因、N基因值均 ≥ 35 copies/ml)、核酸双阴时间(从发现首次核酸异常开始至核酸OFR基因、N基因值采样时间至少间隔24小时连续2次均 ≥ 35 copies/ml)、总住院时间。
采用SPSS17.0进行统计学处理。计量资料以均数 ± 标准差( x ¯ ± s )表示,组间比较采用两独立样本t检验,组内治疗前后比较采用配对t检验,多组采用单因素方差分析;计数资料以率或构成比表示,组间比较采用χ2检验。以P < 0.05为差异有统计学意义。
71例恶性肿瘤组患者中,肺癌17例,肠癌11例,乳腺癌10例,甲状腺癌7例,胃癌5例,血液系统恶性肿瘤6例,胰腺癌、肝癌、妇科恶性肿瘤分别3例,前列腺癌2例,鼻咽癌、食管癌、肾癌、尤文氏肉瘤分别1例。恶性肿瘤组71例患者中新型冠状病毒肺炎临床分型:轻型39例(54.9%)、无症状18例(25.4%)、普通型14例(19.7%),无重型及危重型,临床表现主要以咳嗽(36.6%)、乏力(21.1%)、肌肉酸痛(18.3%)、发热(14.1%)为主。恶性肿瘤组71例及非恶性肿瘤组71例患者均完成一般流行病学调查,结果显示,两组性别、年龄、合并疾病、临床症状、疾病诊断分型、入院首次核酸Ct值(OFR基因、N基因)经统计学分析,均无明显差别,P > 0.05。恶性肿瘤组接种疫苗为0.69 ± 1.09剂次少于非恶性肿瘤组1.68 ± 1.31剂次,差异有显著统计学意义,P < 0.01。详见表1。
变量 | 合计 (n=142例) | 恶性肿瘤组 | 非恶性肿瘤组 | P值 |
---|---|---|---|---|
性别(例) | 0.063 | |||
男 | 79 (55.6%) | 45 (64.8%) | 34 (47.9%) | |
女 | 63 (44.4%) | 26 (36.6%) | 37 (52.1%) | |
年龄(岁) | 62.89 ± 12.79 | 65.08 ± 15.14 | 0.352 | |
合并疾病(例) | ||||
高血压 | 39 (27.5%) | 18 (25.4%) | 21 (29.6%) | 0.573 |
糖尿病 | 13 (9.2%) | 5 (7%) | 8 (11.3%) | 0.383 |
冠心病 | 15 (10.6%) | 8 (11.3%) | 7 (9.9%) | 0.785 |
脑梗塞 | 9 (6.3%) | 3 (4.2%) | 6 (8.5%) | 0.301 |
慢性阻塞性肺病 | 9 (6.3%) | 5 (7%) | 4 (5.6%) | 0.731 |
接种疫苗(剂次) | 0.69 ± 1.09 | 1.68 ± 1.31 | 0.000 | |
临床症状(例) | ||||
发热 | 19 (13.4%) | 10 (14.1%) | 9 (12.7%) | 0.805 |
咳嗽 | 54 (38%) | 26 (36.6%) | 28 (39.4%) | 0.730 |
肌肉酸痛 | 25 (17.6%) | 13 (18.3%) | 12 (16.9%) | 0.826 |
乏力 | 22 (15.5%) | 15 (21.1%) | 7 (9.9%) | 0.064 |
纳差 | 2 (1.4%) | 1 (1.4%) | 1 (1.4%) | 1.00 |
咽痛 | 1 (0.7%) | 1 (1.4%) | 0 | 0.319 |
味觉或嗅觉异常 | 3 (2.1%) | 1 (1.4%) | 2 (2.8%) | 0.56 |
入院首次核酸Ct值(copies/ml) | ||||
OFR基因 | 29.55 ± 7.32 | 30.38 ± 7.34 | 0.501 | |
N基因 | 26.75 ± 8.29 | 27.71 ± 8.06 | 0.486 | |
疾病分型(例) | ||||
无症状 | 39 (27.5%) | 18 (25.4%) | 21 (29.6%) | 0.573 |
轻型 | 80 (56.3%) | 39 (54.9%) | 41 (57.7%) | 0.735 |
普通型 | 23 (16.2%) | 14 (19.7%) | 9 (12.7%) | 0.255 |
表1. 两组患者一般流行病学资料比较
恶性肿瘤组65例及非恶性肿瘤组71例患者完成血常规、CRP检测,结果显示,两组患者白细胞计数(WBC, Leukocyte)、中性粒细胞绝对值(NEUT, Neutrophil)、成熟淋巴细胞绝对值(LYMPH, Lymphocyte)、成熟单核细胞绝对值(MONO, Monocyte)、嗜碱性粒细胞绝对值(BASO, Basophils)、嗜酸性粒细胞绝对值(EO, Eosinophil)、血小板计数(PLT, Platelets)、平均红细胞体积(MCV, Mean Corpuscular Volume)均无统计学差异,P > 0.05,同时上述指标均值均在正常参考值范围内;结果显示两组C-反应蛋白(CRP, C-Reactive Protein)比较有显著差异,恶性肿瘤组显著高于非恶性肿瘤组,P < 0.01,且两组数值均高于正常参考值(<10.0 mg/L)。详见表2。
组别 | WBC (×10^9/L) | NEUT (×10^9/L) | LYMPH (×10^9/L) | MONO (×10^9/L) | BASO (×10^9/L) | EO (×10^9/L) | PLT (×10^9/L) | MCV (fL) | CRP (mg/L) |
---|---|---|---|---|---|---|---|---|---|
非恶性肿瘤组(n = 71) | 5.61 ± 2.03 | 3.27 ± 1.64 | 1.65 ± 0.66 | 0.56 ± 0.22 | 0.07 ± 0.07 | 0.06 ± 0.06 | 205.68 ± 73.36 | 90.79 ± 5.44 | 10.51 ± 17.45 |
恶性肿瘤组 (n = 65) | 5.89 ± 2.92 | 4.20 ± 3.76 | 1.38 ± 1.00 | 0.55 ± 0.29 | 0.08 ± 0.18 | 0.155 ± 0.69 | 207.49 ± 101.61 | 90.51 ± 6.14 | 25.13 ± 40.79 |
P值 | 0.524 | 0.059 | 0.064 | 0.706 | 0.447 | 0.237 | 0.904 | 0.775 | 0.007 |
表2. 两组患者血常规、CRP比较
恶性肿瘤组45例及非恶性肿瘤组64例患者完成炎性细胞因子检测,结果显示,两组患者IL-1β、IL-8、IL-10均无统计学差异,P > 0.05,同时上述指标均值均在正常参考值范围内;结果显示两组IL-2受体比较有显著差异,恶性肿瘤组显著高于非恶性肿瘤组,P < 0.01,但两组指标均值均在正常参考值范围内(IL-2受体:223~710 U/ml);两组IL-6、TNF-α比较有差异,恶性肿瘤组高于非恶性肿瘤组,P < 0.05,差异有统计学意义,且两组IL-6数值均高于正常参考值,恶性肿瘤组TNF-α数值高于正常参考值,而非恶性肿瘤组在正常范围内(IL-6 < 3.40 pg/ml、TNF-α < 8.10 pg/ml)。恶性肿瘤组23例及非恶性肿瘤组25例患者完成肝素结合蛋白检测,结果显示,两组患者肝素结合蛋白均高于正常值(≤11.4 ng/mL),恶性肿瘤组高于非恶性肿瘤组,但无统计学差异,P > 0.05。恶性肿瘤组63例及非恶性肿瘤组68例患者完成血清淀粉蛋白A检测,结果显示,两组患者血清淀粉蛋白A均高于正常值(0.0~10.0 mg/L),恶性肿瘤组高于非恶性肿瘤组,P < 0.05,差异有统计学意义。详见表3。
恶性肿瘤组62例及非恶性肿瘤组69例患者完成凝血功能检测,结果显示,两组患者国际标准化比值(INR)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)均无统计学差异,P > 0.05,同时上述指标均值均在正常参考值范围内;两组患者纤维蛋白原定量(FIB)比较有差异,恶性肿瘤组高于非恶性肿瘤组,P < 0.05,差异有统计学意义,恶性肿瘤组FIB均值高于正常参考值范围(2.0~4.0 g/L);结果显示两组患者D-二聚体(D-Dimer)比较无统计学差异,P > 0.05,但两组患者D-二聚体均值均高于正常参考值范围(≤0.55 mg/L)。详见表4。
变量 | 例数 | 恶性肿瘤组 | 非恶性肿瘤组 | P值 |
---|---|---|---|---|
IL-1β (pg/ml) | 恶性肿瘤组n = 45 非恶性肿瘤组n = 64 | 5.99 ± 3.02 | 5.56 ± 2.06 | 0.402 |
IL-2受体(U/ml) | 696.24 ± 442.07 | 517.31 ± 210.92 | 0.006 | |
IL-6 (pg/ml) | 20.75 ± 47.19 | 7.65 ± 14.79 | 0.039 | |
IL-8 (pg/ml) | 13.51 ± 12.5 | 10.92 ± 10.27 | 0.256 | |
IL-10 (pg/ml) | 5.96 ± 4.05 | 5.38 ± 1.34 | 0.286 | |
TNF-α (pg/ml) | 10.78 ± 9.19 | 7.64 ± 3.48 | 0.014 | |
肝素结合蛋白(ng/mL) | 恶性肿瘤组n = 23 非恶性肿瘤组n = 25 | 58.96 ± 63.55 | 41.66 ± 40.06 | 0.271 |
血清淀粉蛋白A(mg/L) | 恶性肿瘤组n = 63 非恶性肿瘤组n = 68 | 71.81 ± 102.64 | 42.24 ± 70.52 | 0.049 |
表3. 两组患者炎性细胞因子、肝素结合蛋白、血清淀粉蛋白A比较
组别 | INR | PT (秒) | APTT (秒) | FIB (g/L) | TT (秒) | D-Dimer (mg/L) |
---|---|---|---|---|---|---|
非恶性肿瘤组(n = 69) | 1.03 ± 0.95 | 13.28 ± 0.92 | 35.58 ± 4.54 | 3.61 ± 1.01 | 16.44 ± 0.85 | 1.38 ± 3.99 |
恶性肿瘤组(n = 62) | 1.11 ± 3.86 | 13.93 ± 3.19 | 37.56 ± 10.66 | 4.06 ± 1.39 | 16.49 ± 1.15 | 1.80 ± 3.21 |
P值 | 0.111 | 0.109 | 0.161 | 0.032 | 0.769 | 0.503 |
表4. 两组患者凝血功能各项指标比较
结果显示,71例恶性肿瘤组患者与71例非恶性肿瘤组患者核酸首次转阴时间无明显差别,核酸双阴时间、总住院时间两者比较,肿瘤组均多于非恶性肿瘤组,P < 0.05,有统计学意义。详见表5。
组别 | 核酸首次转阴时间(天) | 核酸双阴时间(天) | 总住院时间(天) |
---|---|---|---|
非恶性肿瘤组(n = 71) | 10.15 ± 4.44 | 12.02 ± 4.83 | 11.8 ± 4.25 |
恶性肿瘤组(n = 71) | 10.7 ± 5.35 | 14.38 ± 6.6 | 14.21 ± 6.89 |
P值 | 0.507 | 0.016 | 0.013 |
表5. 两组患者核酸首次转阴时间、核酸双阴时间、总住院时间比较
为了解恶性肿瘤组不同治疗方案对患者的核酸首次转阴时间、核酸双阴时间、总住院时间影响,我们比较了71例患者中单独应用中药(华山医院防治新冠2号方(益清口服液),方药组成:黄芩20 g、金银花10 g、连翘10 g、贯众10 g、板蓝根15 g、黄芪20 g、白术10 g、防风10 g、柴胡20 g、厚朴10 g、仙灵脾10 g、北沙参15 g、赤芍15 g、陈皮10 g、甘草3 g) 41例患者,单独应用抗病毒药物Paxlovid患者7例,同时应用中药和Paxlovid患者17例,分为中药组、Paxlovid组、中药+Paxlovid组。结果显示,中药 + Paxlovid组在核酸首次转阴时间少于Paxlovid组,P = 0.03,差异有统计学意义。其余各组核酸首次转阴时间、核酸双阴时间、总住院时间比较均无明显差别,P均>0.05。详见表6。
组别 | 核酸首次转阴时间(天) | 核酸双阴时间(天) | 总住院时间(天) |
---|---|---|---|
中药组(n = 41) | 10.59 ± 4.74 | 13.68 ± 6.47 | 13.67 ± 6.64 |
Paxlovid组(n = 7) | 16.42 ± 7.65 | 19.29 ± 8.14 | 16.79 ± 9.49 |
中药 + Paxlovid组(n = 17) | 11.05 ± 3.78 | 14.88 ± 5.60 | 16.5 ± 5.89 |
表6. 恶性肿瘤组不同治疗方案核酸首次转阴时间、核酸双阴时间、总住院时间比较
2019-nCoV是最大的RNA病毒,相比于DNA的双链结构,RNA单链结构的特殊性导致其更不稳定,因此更易发生变异,目前WHO定义了五种“关切变异株”包括Alpha、Beta、Gamma、Delta和Omicron。尽管目前发现奥密克戎BA.2亚系的毒性较弱,但传播能力强,更容易发生免疫逃逸现象 [
本研究显示奥密克戎感染恶性肿瘤患者和非恶性肿瘤患者临床分型及临床表现相似,以轻症为多,普通型即引起肺部炎症者少,临床表现以咳嗽、发热、肌肉酸痛为主,而咽痛、嗅觉/味觉减退或消失这些常见于此前非奥密克戎突变株感染患者的临床症状较少见。这与国外对奥密克戎突变株感染患者临床特点一致 [
研究显示 [
尸检结果表明 [
新型冠状病毒肺炎疫情发生以来,中医药在防治方面发挥了重要作用。上海市的中医治疗原则是“应用尽用”,复旦大学附属华山医院宝山院区新冠定点医院收治患者大部分都是中医全程介入,对于无症状感染者,应观察其体质及不适症状,几天后逐渐出症状,故采取治疗关口前移、先症治疗的措施,截断病势发展 [
本研究对恶性肿瘤新冠病毒奥密克戎变异株感染患者的临床特点进行了初步分析,结果显示奥密克戎感染恶性肿瘤患者临床表现以咳嗽、乏力、发热、肌肉酸痛为主,临床分型以轻症为多;恶性肿瘤患者相比非恶性肿瘤患者存在疫苗接种剂次少、炎症反应重及高凝状态的临床特点,同时核酸转阴及住院时间更长,中医药的早期介入可能对患者的病毒清除有益。
本研究尚存在很多不足,由于研究样本量小,且为单中心的回顾性临床观察,得出的结果未必能全面反映出该类患者的临床特点,尚需要前瞻性、大样本、多中心的临床研究进行证实;由于新冠患者只局限收治于少数的定点医院,样本量少,本研究将不同种类的瘤种同时进行分析,存在一定的局限性,后期尚需开展不同瘤种患者并发新冠的临床特征研究。
孙贤俊,黄建华,刘宝君,邓晓红,朱华贺,董竞成. 恶性肿瘤患者感染2019新型冠状病毒奥密克戎变异株的临床特征分析 Analysis of Clinical Characteristics of the Ma-lignant Tumor Patients Infected with 2019 Novel Coronavirus Omicron Variant[J]. 亚洲肿瘤科病例研究, 2023, 12(01): 1-12. https://doi.org/10.12677/ACRPO.2023.121001