新型冠状病毒暴发流行期间江苏省维持性血液透析患者感染情况的流行病学调查  

Epidemiological investigation of SARS-CoV-2 infection in maintenance hemodialysis patients in Jiangsu province during the outbreak of SARS-CoV-2

作　　者：杨光 葛益飞 黄耀禹 楼季庄[2] 蒋春明[3] 卢国元[4] 陈凤玲[4] 沈建松 陈晓岚[6] 戴厚永[6] 刘昌华[7] 杨敏[8] 李秀荣[8] 孙铸兴[9] 王凉[9] 刘斌[9] 郑东辉[10] 徐永[10] 陈茂杰[11] 王玲[12] 张以来 章旭[14] 何建强[15] 张立元[16] 万慧婷 郭红磊 杨家慧 徐玮 邢昌赢 毛慧娟 Yang Guang;Ge Yifei;Huang Yaoyu;Lou Jizhuang;Jiang Chunming;Lu Guoyuan;Chen Fengling;Shen Jiansong;Chen Xiaolan;Dai Houyong;Liu Changhua;Yang Min;Li Xiurong;Sun Zhuxing;Wang Liang;Liu Bin;Zheng Donghui;Xu Yong;Chen Maojie;Wang Ling;Zhang Yilai;Zhang Xu;He Jianqiang;Zhang Liyuan;Wan Huiting;Guo Honglei;Yang Jiahui;Xu Wei;Xing Changying;Mao Huijuan(Department of Nephrology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Blood Purification Center,the Affiliated First Hospital of Nanjing Medical University,Nanjing 210012,China;Department of Nephrology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China;Department of Nephrology,First Affiliated Hospital of Soochow University,Suzhou 215031,China;Department of Nephrology,Yancheng First People's Hospital,Yancheng 224006,China;Department of Nephrology,Affiliated Hospital of Nantong University,Nantong 226006,China;Department of Nephrology,Subei People's Hospital of Jiangsu Province,Yangzhou 225009,China;Department of Nephrology,Changzhou First People's Hospital,Changzhou 213001,China;Department of Nephrology,Wuxi People's Hospital,Wuxi 214023,China;Department of Nephrology,Huai'an Second People's Hospital,Huai'an 223399,China;Department of Nephrology,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Nephrology,Xuzhou First People's Hospital,Xuzhou 221002,China;Department of Nephrology,Shuyang County Hospital of Traditional Chinese Medicine,Jiangsu Province,Suqian 223601,China;Department of Nephrology,Taixing People's Hospital,Jiangsu Province,Taizhou 225499,China;Department of Nephrology,Affiliated Hospital of Jiangsu University,Zhenjiang 212013,China;Department of Nephrology,Lianyungang First People's Hospital,Lianyungang 222002,China)

机构地区：[1]南京医科大学第一附属医院(江苏省人民医院)肾内科,南京210029 [2]南京医科大学附属南京第一医院血液净化中心,南京210012 [3]南京大学医学院附属鼓楼医院肾内科,南京210008 [4]苏州大学附属第一医院肾内科,苏州215031 [5]盐城市第一人民医院肾内科,盐城224006 [6]南通大学附属医院肾内科,南通226006 [7]江苏省苏北人民医院肾内科,扬州225009 [8]常州市第一人民医院肾内科,常州213001 [9]无锡市人民医院肾内科,无锡214023 [10]淮安市第二人民医院肾内科,淮安223399 [11]徐州市中心医院肾内科,徐州221009 [12]徐州市第一人民医院肾内科,徐州221002 [13]江苏省沭阳县中医院肾内科,宿迁223601 [14]江苏省泰兴市人民医院肾内科,泰州225499 [15]江苏大学附属医院肾内科,镇江212013 [16]连云港市第一人民医院肾内科,连云港222002

出　　处：《中华肾脏病杂志》2023年第12期895-902,共8页Chinese Journal of Nephrology

摘　　要：目的调查2022年12月7日至2023年1月27日新型冠状病毒(又称为严重急性呼吸综合征冠状病毒2型,severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)暴发流行期间江苏省维持性血液透析(maintenance hemodialysis,MHD)患者SARS-CoV-2感染情况的流行病学,并分析全因死亡的影响因素。方法本研究系多中心横断面调查,通过结构化调查问卷,由各血液透析中心(室)的医护人员作为调查人员收集患者信息,部分人口学和实验室检查数据来源于江苏省血液透析数据信息系统。纳入SARS-CoV-2感染暴发期间江苏省各级医疗机构的血液透析中心(室)以及独立血液透析机构的MHD患者,并分析确诊和疑似SARS-CoV-2感染病例的临床特点和全因死亡情况。结果共完成407个血液透析中心(室)57278例患者的问卷调查和数据分析,占全省同期MHD在透患者(63357例)的90.41%。其中SARS-CoV-2感染确诊病例24038例(41.97%),疑似感染病例14805例(25.85%),这些病例广泛分布于江苏省各透析中心。对38843例确诊和疑似SARS-CoV-2感染病例进行临床分型,其中重型和危重型病例3662例,占感染和疑似感染病例的9.43%。完成问卷调查患者中,共1812例患者发生全因死亡,全因死亡率为3.16%。多因素Logistic回归分析结果显示,高龄(以≤50岁作为参照,51~59岁:OR=1.583,95%CI 1.279~1.933,P=0.001;60~69岁:OR=3.972,95%CI 3.271~4.858,P<0.001;70~79岁:OR=7.236,95%CI 5.917~8.698,P<0.001;≥80岁:OR=11.738,95%CI 9.459~14.663,P<0.001)、男性(OR=1.371,95%CI 1.229~1.529,P<0.001)和合并乙型肝炎病毒(hepatitis B virus,HBV)现症感染(血清HBV表面抗原阳性,OR=0.629,95%CI 0.484~0.817,P<0.001)是全因死亡的独立影响因素。受试者工作特征曲线分析显示,男性、年龄、HBV现症感染预测全因死亡的曲线下面积(AUC)分别为0.529(P<0.001)、0.724(P<0.001)、0.514(P=0.042),其中年龄预测全因死亡风险的截断值为65.5岁。与不伴HBV现症感染的MHD患者比较Objective To investigate the epidemiology of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)infection in patients with maintenance hemodialysis(MHD)in Jiangsu province during SARS-CoV-2 pandemic in China from December 7,2022 to January 27,2023,and to analyze the influencing factors of all-cause death.Methods It was a multi-center cross-sectional investigation.Structured questionnaire was used to collect patient information by medical staff of each hemodialysis center(room)as investigators.Part of the demography data and laboratory examination data came from the Jiangsu Province Hemodialysis Data Information System.MHD patients from hemodialysis centers(rooms)at all levels of medical institutions and independent hemodialysis institutions in Jiangsu province during the outbreak of SARS-CoV-2 infection were included,and the clinical characteristics and all-cause mortality of confirmed and suspected cases of SARS-CoV-2 infection were analyzed.Results Questionnaire surveys and data analysis on 57278 patients in 407 hemodialysis centers(rooms)were completed,accounting for 90.41%of the total number of MHD patients(63357 cases)in Jiangsu province during the same period.There were 24038 cases(41.97%)of SARS-CoV-2 infection and 14805 cases(25.85%)of suspected infection,which were widely distributed in all dialysis centers in Jiangsu province.After clinical classification of 38843 confirmed and suspected SARS-CoV-2 infection cases,3662 cases were severe and critical cases,accounting for 9.43%of the infected and suspected cases.Among the patients who had completed the questionnaires,there were 1812 all-cause deaths,with an all-cause mortality rate of 3.16%.Multivariate logistic regression analysis showed that elderly(taking≤50 years as a reference,51-59 years:OR=1.583,95%CI 1.279-1.933,P=0.001;60-69 years:OR=3.972,95%CI 3.271-4.858,P<0.001;70-79 years:OR=7.236,95%CI 5.917-8.698,P<0.001;≥80 years:OR=11.738,95%CI 9.459-14.663,P<0.001),male(OR=1.371,95%CI 1.229-1.529,P<0.001),and co-infection with hepatitis B vi

关 键 词：新型冠状病毒 肾透析 流行病学研究 死亡 

分 类 号：R692.5[医药卫生—泌尿科学] R181.3[医药卫生—外科学]