多发性硬化患者新型冠状病毒感染后临床情况分析  

Analysis of COVID-19 Infection in Patients with Multiple Sclerosis

作　　者：张包静子 黄文娟 谭红梅 李文玉 夏君慧 王敏[3,6] 卢家红 周磊[1,2,3] 赵重波 董强 全超 许雅芳 ZHANGBAO Jing-zi;HUANG Wen-juan;TAN Hong-mei;LI Wen-yu;XIA Jun-hui;WANG Min;LU Jia-hong;ZHOU Lei;ZHAO Chong-bo;DONG Qiang;QUAN Chao;XU Ya-fang(Department of Neurology,Huashan Hospital,Shanghai Medical College,Fudan University,Shanghai 200040,China;National Center for Neurological Disorders(NCND),Shanghai 200040,China;Pan-Yangtze River Delta Alliance for Demyelinating Disease,Shanghai 200040,China;Department of Neurology,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310020,China;Department of Neurology,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,China;Department of Ophthalmology and Vision Science,Eye and ENT Hospital,Shanghai Medical College,Fudan University,Shanghai 200031,China;Department of Nursing,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院神经内科,上海200040 [2]国家神经疾病医学中心,上海200040 [3]泛长三角多发性硬化诊疗协作组,上海200040 [4]浙江大学医学院附属邵逸夫医院(浙江省邵逸夫医院)神经内科,杭州310020 [5]温州医科大学附属第一医院神经内科,温州325015 [6]复旦大学附属眼耳鼻喉科医院青光眼与视神经疾病学科,上海200031 [7]复旦大学附属华山医院护理部,上海200040

出　　处：《中国临床神经科学》2023年第5期517-525,共9页Chinese Journal of Clinical Neurosciences

基　　金：国家自然科学基金资助项目(编号:81801196)。

摘　　要：目的探讨多发性硬化(MS)患者不同疾病修正治疗(DMT)药物与严重新型冠状病毒(简称新冠病毒)感染风险的相关性。方法选择截止2023年1月31日于泛长三角MS诊疗协作组各医疗中心接受治疗的MS患者,通过问卷形式收集2022年12月至2023年1月中国新冠病毒感染高峰期间患者的感染情况,进行回顾性和横断面分析。结果336例MS患者的平均年龄(34.14±10.21)岁,女性70.54%。治疗包括:特立氟胺86例,鞘氨醇-1-磷酸受体调节剂99例,CD20单抗37例,其他治疗43例,未接受任何治疗71例。接种过新冠病毒疫苗138例(41.07%),发生新冠病毒感染244例(72.62%)。最常见的感染症状有发热、咳嗽、疲劳;21例发生严重新冠病毒感染,其中15例经肺部CT诊断为肺炎,需急诊或住院治疗9例,1例入住ICU,2例使用呼吸机。6例在新冠病毒感染后发生MS复发。不同DMT药物对新冠病毒严重感染的风险差异无显著性(P=0.671)。未接种新冠病毒疫苗的MS患者发生严重新冠病毒感染的风险是接种疫苗的患者的2.37倍(P=0.034);无法独立行走的MS患者发生严重新冠病毒感染的风险是能独立行走患者的3.26倍,但差异无显著性(P=0.052)。结论MS患者感染新冠病毒后转化为严重感染及导致复发的风险较低;不同DMT药物在新冠病毒流行期间具有较高安全性;未接种新冠疫苗及无法自主行走的MS患者严重新冠病毒感染的风险增加,推荐MS患者及时接种新冠疫苗并接受规范治疗。Aim To describe the incidence of COVID-19 infection and severe COVID-19 infection in patients with multiple sclerosis,and explore the correlation of different disease modifying therapy(DMT)treatment with the risk of severe COVID-10 infection.Methods Patients with multiple sclerosis who visit the medical centers of the Pan-Yangtze River Delta Alliance for Demyelinating Disease before Jan.31st,2023 were selected.The information of demographics and incidence of COVID-19 infection from Dec.2022 to Jan 2023 were collected by issuing questionnaires.Retrospective and cross-sectional analysis was conducted based on the collected information.Results The mean age of 336 MS patients was(34.14±10.21)years old and 70.54%female,the treatments included teriflunomide in 86 cases,sphingosine-1-phosphate receptor modulator in 99 cases,anti-CD20 monoclonal antibody in 37 cases.Other treatments were in 43 cases and no treatment was in 71 cases.A total of 138(41.07%)patients had been vaccinated against COVID-19.A total of 244 cases(72.62%)had COVID-19.Fever(85.25%),cough(63.52%)and fatigue(50.00%)were the most common symptoms.Among them,21 cases(8.61%)had severe COVID-19 infection,including 15 cases of pneumonia confirmed by lung CT,9 cases of emergency infusion or hospitalization,1 case of ICU admission,and 2 cases of ventilator use.Six patients had MS relapse after COVID-19 infection.There was no significant difference in the risk of severe COVID-19infection between the different DMT administration(P=0.671).The risk of severe COVID-19 infection in MS patients without 2019-nCoV vaccination was 2.37 times that of vaccinated patients(P=0.034).The risk of severe COVID-19 infection in MS patients who could not walk independently was 3.26 times higher than that in patients who could walk independently,but the difference was not significant(P=0.052).Conclusion The risk of severe COVID-19 infection and relapse in MS patients infected with COVID-19is low.Different DMT treatments all have high safety.Unvaccinated and unable to walk independ

关 键 词：多发性硬化 新型冠状病毒 感染 疾病修正治疗 影响因素 

分 类 号：R744.51[医药卫生—神经病学与精神病学]