肾上腺皮质功能不全合并COVID-19患者的临床转归及影响因素  

Clinical outcomes and risk factors of COVID-19 patients with adrenal insufficiency

作　　者：周翔 许轶婧 刘艺文 朱惠娟 卢琳 ZHOU Xiang;XU Yijing;LIU Yiwen;ZHU Huijuan;LU Lin(Department of Endocrinology,Key Laboratory of Endocrinology of National Health Commission,State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730;Eight-year Medical Doctor Program,CAMS&PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院、北京协和医学院、北京协和医院内分泌科、国家卫生健康委员会内分泌重点实验室、疑难重症及罕见病国家重点实验室,北京100730 [2]中国医学科学院、北京协和医学院临床医学专业(八年制),北京100730

出　　处：《基础医学与临床》2024年第9期1290-1297,共8页Basic and Clinical Medicine

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-A-156);国家重点研发计划常见多发病防治研究专项(2022YFC2505300,子课题:2022YFC2505304)。

摘　　要：目的总结肾上腺皮质功能不全(AI)合并新型冠状病毒感染(COVID-19)患者的临床特征及转归情况,分析影响转归的危险因素。方法回顾性分析2022年12月北京协和医院收治的发生COVID-19的AI患者的临床特征,并对其进行随访以收集其疾病转归情况。结果共纳入28例AI合并COVID-19患者,20例(71.4%)接受糖皮质激素基础替代。18例院外发生COVID-19患者中,11例(61.1%)居家主动加量糖皮质激素。感染后最常见症状为发热(96.4%)、消化道症状(82.1%)、意识障碍(78.6%)。出现重度意识障碍与年龄大、糖皮质激素基础替代剂量低相关(P<0.05)。20例(71.4%)患者发生肾上腺危象(AC),与糖皮质激素基础替代剂量低、低氯血症、嗜酸性粒细胞低、血小板低、活化部分凝血活酶时间(APTT)长相关(P<0.05)。2例患者死亡。26例存活患者中,意识恢复时间大于48小时者占26.3%(5/19),意识延迟恢复与入院收缩压低、血肌酐高、纤维蛋白原高相关(P<0.05)。48.0%(12/25)患者出现疲乏、纳差等长新冠症状。糖皮质激素加量的患者中,50.0%(12/24)于3周内恢复至基线激素剂量。结论AI合并COVID-19患者出现意识障碍及AC的风险较高。AI患者在感染应激期间主动加量糖皮质激素的意识不足,临床应加强对AI患者的“病期规则”教育。Objective To summarize the clinical characteristics and outcomes of corona virus disease 2019(COVID-19)in patients with adrenal insufficiency(AI),and analyze the risk factors of outcomes.Methods The clinical data of COVID-19 patients with AI in Peking Union Medical College Hospital in December 2022 were analyzed retrospectively and the patients were followed up to collect outcomes of their diseases.Results Among 28 COVID-19 patients with AI,20 cases(71.4%)received basal corticosteroid replacement.Among the 18 patients with community-acquired COVID-19,11 cases(61.1%)increased the corticosteroid dosage proactively at home.The most common symptoms of COVID-19 were fever(96.4%),gastrointestinal symptoms(82.1%)and consciousness disturbance(78.6%).Occurrence of severe consciousness disturbance was associated with older age and lower basal corticosteroid replacement dose(P<0.05).Adrenal crisis(AC)occurred in 20 patients(71.4%),which was associated with lower basal corticosteroid replacement dose,hypochloremia,lower eosinophil,lower platelet,and longer activated partial thromboplastin time(APTT)(P<0.05).2 patients died during hospitalization.26.3%(5/19)of surviving patient′s recovered consciousness longer than 48 hours.Delayed recovery of consciousness was associated with lower systolic pressure,higher blood creatinine,and higher fibrinogen(P<0.05).Long COVID-19 symptoms such as fatigue and poor appetite occurred in 48.0%(12/25)of patients.Among patients with increased corticosteroid dosage,50.0%(12/24)had their dose reduced to baseline within 3 weeks.Conclusions COVID-19 patients with AI have a high frequency of consciousness disturbance and AC.AI patients are lack of awareness of adjusting corticosteroid dosage proactively in case of infection stress,thus education of“sick day rules”for AI patients should be strengthened in clinical practice.

关 键 词：肾上腺皮质功能不全 新型冠状病毒感染 意识障碍 肾上腺危象 

分 类 号：R586.1[医药卫生—内分泌]