新型冠状病毒疫苗接种对维持性血液透析合并COVID-19患者的价值  

Value of novel coronavirus vaccination for patients on maintenance hemodialysis and COVID-19

作　　者：朱华夏 郭凯琦 王显[1] 吴仲华 刘则文 王伟[3] 卜戈[4] 李小伟[1] ZHU Huaxia;GUO Kaiqi;WANG Xian;WU Zhonghua;LIU Zewen;WANG Wei;BU Ge;LI Xiaowei(Department of Nephrology,Fuyang People's Hospital Affiliated to Anhui Medical University,Fuyang 236012,China;Blood Purification Center,Fuyang People's Hospital Affiliated to Anhui Medical University,Fuyang 236012,China;Department of Clinical Laboratory,Fuyang People's Hospital Affiliated to Anhui Medical University,Fuyang 236012,China;Department of Clinical Laboratory,Fuyang Center for Disease Control and Prevention,Fuyang 236069,China)

机构地区：[1]安徽医科大学附属阜阳人民医院肾内科,安徽阜阳236012 [2]安徽医科大学附属阜阳人民医院血液净化中心,安徽阜阳236012 [3]安徽医科大学附属阜阳人民医院检验科,安徽阜阳236012 [4]阜阳市疾病预防控制中心检验科,安徽阜阳236069

出　　处：《安徽医学》2024年第1期22-27,共6页Anhui Medical Journal

基　　金：安徽省重点研究与开发计划(编号:2022e07020057);阜阳市卫生健康委科研课题(编号:FY2019-030)。

摘　　要：目的探讨接种新型冠状病毒疫苗(新冠疫苗)对维持性血液透析(MHD)患者新型冠状病毒感染(COVID-19)严重程度的影响。方法回顾性分析2022年12月至2023年1月安徽医科大学附属阜阳人民医院肾内科收治的166例终末期肾脏病行MHD合并COVID-19患者的临床资料。依据疫苗接种情况分为未接种组(接种0针)及接种组(接种≥2针)。比较两组患者临床特征及短期预后,并应用logistic回归模型分析患者住院及重症风险增加的独立危险因素。结果166例MHD合并COVID-19患者中,未接种组91例(54.8%),接种组75例(45.2%)。未接种组年龄与吸烟比例高于接种组(P<0.05)。感染新型冠状病毒肺炎后,患者临床表现多样,发热(73.1%)、乏力(65.6%)、食欲减退(57.5%)最常见。接种组使用激素、中心吸氧、住院、重症比例明显减少,治愈患者比例显著增加(P<0.05)。接种新冠疫苗可减少MHD患者住院(OR=0.364,95%CI:0.147~0.901)及重症(OR=0.182,95%CI:0.037~0.901)发生风险。合并糖尿病、冠状动脉粥样硬化性心脏病(冠心病)是MHD合并COVID-19患者住院及重症风险增加的独立危险因素,年龄是其重症风险增加的独立危险因素。结论终末期肾脏病接受MHD合并COVID-19患者临床表现多样,合并糖尿病、冠心病患者住院及重症风险均增加,年龄增加患者重症风险增加,接种新冠疫苗可减少住院及重症风险。Objective To investigate the effects of vaccination against the novel coronavirus on the severity of corona virus disease 2019(COVID-19)in patients on maintenance hemodialysis(MHD).Methods Clinical data of 166 patients with end-stage renal disease who were on MHD and COVID-19 admitted to the Department of Nephrology of Fuyang People's Hospital affiliated with Anhui Medical University from December 2022 to January 2023 were retrospectively analyzed.Based on vaccination status,the group was divided into the unvaccinated group(0 vaccination)and the vaccinated group(≥2 vaccinations).Clinical characteristics and short-term prognosis were compared between the two groups,and logistic regression models were applied to analyze the independent risk factors for the increased risk of hospitalization and serious disease.Results Among the 166 patients with MHD and COVID-19,91 cases(54.8%)were in the unvaccinated group and 75cases(45.2%)were vaccinated.The proportion of age and smoking was higher in the unvaccinated group than in the vaccinated group(P<0.05).After infection with novel coronavirus pneumonia,patients had a variety of clinical manifestations,with fever(73.1%),malaise(65.6%),and loss of appetite(57.5%)being the most common.The proportion of patients using hormones,centralized oxygen,hospitalization,and severe disease was significantly reduced and the proportion of cured patients was significantly increased in the inoculated group(P<0.05).Vaccination reduces the risk of hospitalization(OR=0.364,95%CI:0.147~0.901)and severe disease(OR=0.182,95%CI:0.037~0.901)in patients with MHD.Diabetes mellitus and coronary atherosclerotic heart disease(CHD)are independent risk factors hospitalization and readmission in patients with MHD combined with COVID-19.Age is an independent risk factor for increased risk of severe disease.Conclusions The clinical manifestations of COVID-19 in patients with end-stage renal disease receiving MHD are diverse.The risk of hospitalization and severe disease in patients with diabetes and coronar

关 键 词：新型冠状病毒疫苗 维持性血液透析 糖尿病 终末期肾脏病 

分 类 号：R692.5[医药卫生—泌尿科学] R563.1[医药卫生—外科学]