新型冠状病毒感染合并2型糖尿病患者的临床特征及不良结局危险因素分析  

Analysis of clinical characteristics and risk factors for adverse outcomes in type 2 diabetic mellitus patients with COVID-19

作　　者：杨倩倩 刘师伟 段瑞雪 豆婉荣 杨杰 陈晓琴 高林琳 Yang Qianqian;Liu Shiwei;Duan Ruixue;Dou Wanrong;Yang Jie;Chen Xiaoqin;Gao Linlin(School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Department of Endocrinology,Shanxi Bethune Hospital/Shanxi Academy of Medical Sciences/Tongji Shanxi Hospital/Third Hospital of Shanxi Medical University,Taiyuan 030032,China)

机构地区：[1]山西医科大学公共卫生学院,太原030001 [2]山西白求恩医院、山西医学科学院、山西同济医院、山西医科大学第三医院内分泌科,太原030032

出　　处：《中华临床营养杂志》2024年第1期35-43,共9页Chinese Journal of Clinical Nutrition

基　　金：山西省医学重点科研项目(2021XM23);山西省基础研究计划项目(20210302123487);山西省回国留学人员科研资助项目(2020-180);山西省留学人员科技活动择优资助项目(20200032);山西白求恩医院科研项目(2023xg04);山西省科技创新人才团队(202204051002029);内分泌代谢病山西省重点实验室基金项目(202104010910009)。

摘　　要：目的探讨新型冠状病毒(简称新冠病毒)感染合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者的临床特点,并分析影响其发生不良结局的风险因素。方法纳入2022年12月1日至2023年3月20日在山西白求恩医院住院治疗的2052例确诊新冠病毒感染患者为观察对象,根据是否合并T2DM分为糖尿病组(n=70)及非糖尿病组(n=1982),两组进行1∶1倾向性评分匹配。比较倾向性评分匹配成功后两组患者临床特征、实验室检查资料。根据患者住院期间是否出现不良结局进一步将其分为出现不良结局组和未出现不良结局组。在单因素分析结果的基础上,采用二元Logistic回归模型分析新冠病毒感染合并T2DM患者出现不良结局的危险因素。结果倾向性评分匹配后,糖尿病组及非糖尿病组患者最常见的并存基础疾病均是高血压,且糖尿病组中发生重症或危重症的比例、糖化血红蛋白、空腹血糖、尿素氮、白细胞介素4、白细胞介素6、白细胞介素10、干扰素γ、肿瘤坏死因子α水平显著高于非糖尿病组(P<0.05)。糖尿病组中Logistic回归分析显示,高血压(OR 3.640,95%CI 3.156~4.290)、空腹血糖>11 mmol/L(OR 3.283,95%CI 1.416~7.611)、糖化血红蛋白>10%(OR 2.718,95%CI 1.024~7.213)是新冠病毒感染合并T2DM患者出现不良结局的独立危险因素(P均<0.05)。结论与非糖尿病患者相比,新冠病毒感染合并T2DM患者有更强的炎症反应和更高的炎症细胞因子水平。高血压、空腹血糖及糖化血红蛋白水平升高是新冠病毒感染合并T2DM患者出现不良结局的独立危险因素。Objective The purpose of this study is to explore the clinical characteristics of Coronavirus Disease 2019(COVID-19)in patients with type 2 diabetes mellitus(T2DM),and analyze the risk factors for adverse outcomes.Methods 2052 patients diagnosed with COVID-19 who were hospitalized in Shanxi Bethune Hospital between December 1,2022 and March 20,2023 were included.They were divided into diabetes group(n=70)and non-diabetes group(n=1982)according to the presence or absence of comorbid T2DM.The two groups were matched at 1:1 via propensity score matching.Clinical characteristics and laboratory examination results of the two groups were compared.According to the outcomes during hospitalization,the two groups were further divided into two subgroups respectively.Univariate analysis and subsequent binary Logistic regression was used to analyze the risk factors of adverse outcomes in patients with COVID-19 and type 2 diabetes.Results After the propensity score matching,the most common comorbid condition in diabetes group and non-diabetes group was hypertension.The proportion of patients with severe or critical disease in diabetes group was higher compared with non-diabetes group.The levels of hemoglobin A1c(HbA1c),fasting blood glucose(FBG),blood urea,IL-4,IL-6,IL-10,IFN-γand TNF-αwere significantly higher in the diabetes group(P<0.05).Logistic regression analysis within the diabetes group showed that hypertension(OR=3.640,95%CI:3.156 to 4.290),FBG>11 mmol/L(OR=3.283,95%CI:1.416 to 7.611),HbA1c>10%(OR=2.718,95%CI:1.024 to 7.213)were independent risk factors for adverse outcomes in patients with COVID-19 and type 2 diabetes(all P<0.05).Conclusions Compared with the non-diabetes group,patients with COVID-19 and T2DM have worse inflammatory response and higher levels of inflammatory cytokines.The elevated levels of FBG and HbA1c are related to the adverse outcome in patients with COVID-19 and T2DM.

关 键 词：2型糖尿病 新型冠状病毒感染 免疫炎症因子 LOGISTIC回归分析 

分 类 号：R511[医药卫生—内科学] R587.1[医药卫生—临床医学]