317例奥密克戎变异株急性感染患者自身免疫指标的回顾性观察分析  

Retrospective observation and analysis of autoimmune-related indicators in 317 patients with acute Omicron variant infection

作　　者：郭晓光 罗晓洁 吴本娟[1] 王巍巍[1] 王峪[1] Guo Xiaoguang;Luo Xiaojie;Wu Benjuan;Wang Weiwei;Wang Yu(Department of Emergency,Tianjin First Center Hospital,Tianjin 300192,China)

机构地区：[1]天津市第一中心医院急诊科,天津300192

出　　处：《中华危重病急救医学》2022年第6期581-585,共5页Chinese Critical Care Medicine

摘　　要：目的比较轻型和普通型奥密克戎变异株急性感染患者的临床特征及免疫相关指标的变化,评估新冠疫苗接种对人群的保护作用。方法回顾分析2022年1月22日至2月24日天津市第一中心医院(水西院区)收治的诊断为新型冠状病毒(新冠病毒)奥密克戎变异株(B1.1.529)感染的317例成人患者的临床特征。收集患者的人口统计学特征、疫苗接种情况、基础疾病、流行病学特征及入院时相关实验室检查结果,对比分析轻型和普通型患者的临床特征差异,尤其是免疫相关指标的变化。结果317例奥密克戎变异株急性感染的成人患者中,普通型(203例)老年患者比例及合并高血压、糖尿病和心脑血管疾病患者比例均较轻型(114例)患者明显增多〔年龄≥60岁:27.58%(56/203)比9.65%(11/114),高血压:31.03%(63/203)比19.30%(22/114),糖尿病:15.76%(32/203)比7.89%(9/114),心脑血管疾病:11.33%(23/203)比0.88%(1/114),均P<0.05〕;传播途径以聚会传播为主,首发症状以发热、干咳、乏力、咽痛、鼻塞、流涕等流感症状最为多见;轻型组和普通型组分别有19.30%(22/114)和24.63%(50/203)的患者新冠病毒核酸检测复阳,但差异无统计学意义(P>0.05)。绝大多数轻型及普通型患者炎症指标在正常范围内,如白细胞计数(WBC)、中性粒细胞比例(NEU%)、淋巴细胞计数(LYM)、C-反应蛋白(CRP)、降钙素原(PCT)和白细胞介素-6(IL-6)等,提示奥密克戎变异株感染急性期尚未引起严重的炎症风暴,可能与疫苗接种及病毒变异后致病力减弱有关。轻型组IL-6>7 ng/L的患者比例明显低于普通型组〔1.75%(2/114)比6.40%(13/203),P<0.05〕,提示IL-6升高可能成为评估病情严重程度的指标。两组间淋巴细胞亚群比较差异均无统计学意义,但两组中分别有12.90%(12/93)和11.04%(17/154)的患者辅助T细胞比例降低,18.28%(17/93)和14.28%(22/154)的患者CD4+/CD8+比值升高,提示奥密克戎变异株感染患者存在�Objective To compare the changes of clinical characteristics and immune-related indicators of patients with mild and moderate acute Omicron variant infection,and to evaluate the protective effect of coronavirus disease 2019(COVID-19)vaccination.Methods The study retrospectively analyzed the clinical characteristics of 317 adult patients diagnosed with COVID-19 Omicron variant(B1.1.529)infection admitted to Tianjin First Central Hospital(Shuixi District)from January 22,2022 to February 24,2022.Demographic characteristics,vaccination status,underlying diseases,epidemiological characteristics,baseline data,and relevant laboratory test results on admission were collected,and the differences in clinical characteristics,especially the changes in immune-related indicators,between mild and moderate patients were compared and analyzed.Results Among the 317 adult patients with acute Omicron variant infection,the proportion of elderly,hypertension,diabetes,and cardiovascular or cerebrovascular diseases were significantly higher in moderate group(203 cases)than those of mild group(114 cases)[age≥60 years old:27.58%(56/203)vs.9.65%(11/114),hypertension:31.03%(63/203)vs.19.30%(22/114),diabetes:15.76%(32/203)vs.7.89%(9/114),cardiovascular and cerebrovascular diseases:11.33%(23/203)vs 0.88%(1/114),all P<0.05].The route of transmission was mainly through gatherings and the first symptoms were fever,dry cough,fatigue,sore throat,nasal congestion,runny nose and other flu symptoms;19.30%(22/114)and 24.63%(50/203)of patients in mild and moderate groups were positive for the new coronavirus nucleic acid test,respectively,but the difference was not significant difference(P>0.05).Inflammatory indicators in most mild and moderate patients were within normal range,such as white blood cell count(WBC),neutrophil ratio(NEU%),lymphocyte count(LYM),C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6),etc.,suggesting that the acute phase of Omicron variant infection had not yet caused severe inflammatory storm,which might be rel

关 键 词：奥密克戎 自身免疫 新冠疫苗 

分 类 号：R563.1[医药卫生—呼吸系统]