2例新型冠状病毒感染引起的弥漫性结缔组织病患者3年随访观察  

Three years follow-up report of two diffuse connective tissue disease cases caused by SARS-CoV-2 infection

作　　者：温升慧 宋优 刘晓晶 胡慧 杜戎 WENG Shenghui;SONG You;LIU Xiaojing;HU Hui;DU Rong(Department of Rheumatology and Immunology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院风湿免疫科,湖北武汉430022

出　　处：《中国热带医学》2023年第8期893-896,共4页China Tropical Medicine

基　　金：国家自然科学基金项目(No.81900497)。

摘　　要：报道2例由新型冠状病毒(SARS-CoV-2)感染引起的新型冠状病毒肺炎(COVID-19)合并弥漫性结缔组织病患者近3年随访观察情况,了解对患者免疫系统的长期影响。2例患者年龄在81~82岁,均为男性,分别于2020年1月29日和2020年2月10日因发热住院治疗,均经SARS-CoV-2聚合酶链式反应(PCR)检测呈阳性,最终被诊断为COVID-19。均经抗感染、止咳、化痰及对症支持治疗后体温恢复正常,且连续2次SARS-CoV-2 PCR阴性,予办理出院。后因患者反复发热再次就诊,伴有不同程度的风湿性疾病相关症状,相关检查提示存在自身抗体阳性及脏器受累。1例患者在COV⁃ID-19康复后出现反复发热、关节疼痛、肌肉酸痛和皮下结节等症状,随后被确诊为未分化结缔组织病。另1例患者在COVID-19康复后出现反复发热、口腔溃疡和皮疹等症状,随后被确诊为抗中性粒细胞胞浆抗体(Anti-neutrophil cytoplas⁃mic antibody,ANCA)相关性血管炎。予糖皮质激素和免疫抑制剂治疗后症状迅速缓解,后续的实验室和影像学检查提示病情稳定,但因患者自行停药后又迅速复发,再次予糖皮质激素和免疫抑制剂治疗后病情持续稳定,血沉和超敏C反应蛋白位于正常范围,肺部CT提示病灶稳定伴部分吸收。SARS-CoV-2感染可能对患者免疫系统有长期影响,导致异常的免疫反应,引发弥漫性结缔组织病,提示对COVID-19老年患者可能需要进行免疫系统疾病随访观察。To report on two patients with Coronavirus Disease 2019(COVID-19)combined with diffuse connective tissue disease caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection followed for nearly 3 years,in order to understand the long-term effects on the patients'immune system.Both patients were male,aged 81-82 years,and were hospitalized with fever on January 29,2020 and February 10,2020,respectively.Both were diagnosed with COVID-19 after positive SARS-CoV-2 polymerase chain reaction(PCR)tests.After receiving anti-infection treatment,cough suppressants,expectorants,and symptomatic supportive treatment,their body temperature returned to normal and two consecutive PCR tests were negative for SARS-CoV-2,and they were discharged from hospital.However,due to recurring fevers and varying degrees of rheumatic disease-related symptoms,both patients were readmitted to the hospital,indicating the presence of positive autoantibodies and organ involvement.One patient recovered from COVID-19 with recurrent fever,joint pain,muscle aches and subcutaneous nodules,and was subsequently diagnosed with undifferentiated connective tissue disease.The other patient developed recurrent fever,mouth ulcers and rash after recovery from COVID-19 and was subsequently diagnosed with anti neutrophil cytoplasm antibody(ANCA)-associated vasculitis(AAV).The patient was treated with glucocorticoids and immunosuppressive drugs and the symptoms resolved rapidly and subsequent laboratory and imaging examinations showed stable condition.However,due to self-termination of medication,their symptoms quickly relapsed,and further treatment with glucocorticoids and immunosuppressive agents resulted in sustained stability of their condition.The erythrocyte sedimentation rate and hypersensitive C-reactive protein remained within normal limits,and lung CT scans showed stable lesions with partial absorption.SARS-CoV-2 infection may have long-term effects on patients'immune systems,leading to abnormal immune responses and diffuse connective ti

关 键 词：新型冠状病毒肺炎 新型冠状病毒 未分化结缔组织病 弥漫性结缔组织病 抗中性粒细胞胞浆抗体相关性血管炎 

分 类 号：R563.1[医药卫生—呼吸系统]