基于网络调查问卷的骨髓增殖性肿瘤患者感染新型冠状病毒后病情影响因素分析  

Analysis of the factors influencing the severity of coronavirus disease 2019 in patients with myeloproliferative neoplasms based on an online questionnaire

作　　者：齐飞扬 宝梅 高汉林 江倩[1,2] Qi Feiyang;Bao Mei;Gao Hanlin;Jiang Qian(Peking University People′s Hospital,Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing 100044,China;Peking University People's Hospital Qingdao Hospital,Qingdao 266109,China)

机构地区：[1]北京大学人民医院、北京大学血液病研究所、国家血液系统疾病临床医学研究中心,北京100044 [2]北京大学人民医院青岛医院,青岛266109

出　　处：《中华内科杂志》2024年第4期371-377,共7页Chinese Journal of Internal Medicine

基　　金：国家自然科学基金(81970140)。

摘　　要：目的探究新型冠状病毒SARS-CoV-2奥密克戎变异株大流行期间骨髓增殖性肿瘤(MPN)患者发生新型冠状病毒感染(COVID-19)的影响因素。方法横断面研究。2022年12月15日至2023年3月15日在SARS-CoV-2奥密克戎变异株大流行期间通过在线问卷调查收集于北京大学人民医院就诊的MPN患者的COVID-19相关数据, 所有问卷和临床资料经医疗助理进行核对后, 通过多因素logistic回归分析探究COVID-19的患病率及疾病严重程度的影响因素。结果共纳入239例MPN患者, 包括原发性血小板增多症(ET)90例(37.7%)、真性红细胞增多症(PV)50例(20.9%)、骨髓纤维化(MF)99例(41.4%)。MF中原发性MF 87例(87.9%), PV后MF 5例(5.1%), ET后MF 7例(7.1%)。在此次疫情期间, 239例(100%)患者均罹患COVID-19, 其中轻型226例(94.6%), 普通型、重型、危重型分别有4例(1.7%)、7例(2.9%)、2例(0.8%);死亡2例(0.8%), 均为重型, 分别为MF和ET患者。多因素分析显示, 年龄增加(OR=2.36, 95%CI 1.24~4.49)、MPN分型为MF(OR=10.22, 95%CI 1.13~92.80)、伴除MPN外的其他慢性疾病(OR=5.25, 95%CI 1.25~22.03)是MPN患者发生普通型、重型或危重型COVID-19的影响因素。在MF患者中, MF风险分层与COVID-19严重程度显著相关, 风险分层更高的患者COVID-19严重性更高(P=0.034)。结论 SARS-CoV-2奥密克戎变异株大流行期间, 年龄较大、患MF(尤其是高风险分层)或伴除MPN外的其他慢性疾病是MPN患者发生普通型、重型或危重型COVID-19的危险因素。Objective To explore the variables associated with the severity of coronavirus disease 2019(COVID-19)caused by the SARS-CoV-2 omicron variant during the epidemic in patients with myeloproliferative neoplasms(MPN).Methods A cross-sectional study.During the SARS-CoV-2 omicron variant pandemic from December 15,2022,to March 15,2023,COVID-19 related data for patients with MPN who were treated at Peking University People′s Hospital were collected through an online questionnaire-based survey.All questionnaires and clinical data were checked by medical assistants.Logistic multivariate analysis was used to explore the prevalence and variables associated with the severity of COVID-19 in patients with MPN.Results A total of 239 patients with MPN,including 90(37.7%)presenting with essential thrombocythemia(ET),50(20.9%)with polycythemia vera(PV),and 99(41.4%)with myelofibrosis(MF),were enrolled in the study.The 99 patients with MF included 87(87.9%)with primary MF,5(5.1%)with post-PV MF,and 7(7.1%)with post-ET MF.Overall,239(100%)patients reported that they experienced COVID-19 during the pandemic.Of these,226(94.6%)had mild disease,4(1.7%)had moderate disease,7(2.9%)had severe disease,and 2(0.8%)had critical disease.Two(0.8%)patients with severe COVID-19 died,one of which suffered from MT and the other from PV.Multivariate analysis showed that older age(OR=2.36,95%CI 1.24-4.49),MF(OR=10.22,95%CI 1.13-92.80),or comorbidity(OR=5.25,95%CI 1.25-22.03)were associated with a significantly higher risk of developing moderate,severe,or critical COVID-19.Among patients with MF,higher risk stratification reflected an increased risk of developing moderate,severe,or critical COVID-19(P=0.034).Conclusion During the omicron pandemic,older age,MF(especially higher-risk categories),and comorbidity were associated with a higher risk of developing moderate,severe,or critical COVID-19.

关 键 词：骨髓增殖性疾病 新型冠状病毒感染 Logistic模型 骨髓增殖性肿瘤 SARS-CoV-2奥密克戎变异株 

分 类 号：R733.3[医药卫生—肿瘤] R511[医药卫生—临床医学]