多中心横断面研究炎症性肠病患者感染新型冠状病毒的临床表现及因素分析  

Clinical manifestation and influence factor analysis of coronavirus disease 2019 infection in inflammatory bowel disease patients:a multicenter cross-sectional study

作　　者：黄天璐 彭春艳[1] 梁洁 陈焰[3] 王梅[4] 欧阳春晖[5] 王晓蕾[6] 李晴晴[7] 王宏刚[8] 李玥[9] 刘文佳 郝艳萍 张晓琦[1] Huang Tianlu;Peng Chunyan;Liang Jie;Chen Yan;Wang Mei;Ouyang Chunhui;Wang Xiaolei;Li Qingqing;Wang Honggang;Li Yue;Liu Wenjia;Hao Yanping;Zhang Xiaoqi(Department of Gastroenterology,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China;Department of Gastroenterology,Xijing Hospital,Air Force Medical University,Xi′an 710032,China;Department of Gastroenterology,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Gastroenterology,Affiliated Hospital of Yangzhou University,Yangzhou 225012,China;Department of Gastroenterology,the Second Xiangya Hospital,Central South University,Changsha 410011,China;Department of Gastroenterology,the Tenth People′s Hospital,Tongji University,Shanghai 200072,China;Department of Gastroenterology,Changzhou Hospital of Traditional Chinese Medicine,Changzhou 213003,China;Department of Gastroenterology,Huaian First People′s Hospital,Huai′an 223300,China;Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Gastroenterology,the Third Affiliated Hospital of Nanjing Medical University(Changzhou Second People′s Hospital),Changzhou 213003,China;Department of Gastroenterology,Yancheng First People′s Hospital,Yancheng 224006,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008 [2]空军军医大学西京医院消化内科,西安710032 [3]浙江大学医学院附属第二医院消化内科,杭州310009 [4]扬州大学附属医院消化内科,扬州225012 [5]中南大学湘雅二医院消化内科,长沙410011 [6]同济大学附属第十人民医院消化内科,上海200072 [7]常州市中医医院消化内科,常州213003 [8]淮安市第一人民医院消化内科,淮安223300 [9]中国医学科学院,北京协和医学院,北京协和医院消化内科,北京100730 [10]南京医科大学附属第三医院(常州市第二人民医院)消化内科,常州213003 [11]盐城市第一人民医院消化内科,盐城224006

出　　处：《中华炎性肠病杂志（中英文）》2024年第4期267-273,共7页Chinese Journal of Inflammatory Bowel Diseases

基　　金：国家自然科学基金项目(62006113)。

摘　　要：目的研究炎症性肠病(IBD)患者在新型冠状病毒感染(COVID-19)流行期间感染新型冠状病毒后的症状变化以及IBD治疗用药的情况。方法采用横断面调查研究方法。2022年12月1-31日通过自愿抽样对全国多中心的IBD患者进行问卷调查,收集通过核酸/抗原检测确诊为COVID-19患者的临床资料。根据患者是否自觉IBD症状加重(包括腹部不适、便血加重或出现脓血便、腹泻次数增多等),分为症状加重组和无症状加重组,比较两组年龄、性别、体质量指数(BMI)、基础疾病、新型冠状病毒疫苗(简称新冠疫苗)接种、IBD类型、疾病活动度、COVID-19症状、治疗用药等差异。结果共纳入497例患者,男317例,女180例;年龄(35.27±11.54)岁;克罗恩病355例,溃疡性结肠炎142例;超过50%患者出现发热、肌肉酸痛、乏力、咳嗽、咳痰、鼻塞等呼吸系统症状,部分IBD患者出现消化系统症状和神经系统症状。症状加重组104例(20.93%),无症状加重组393例(79.07%)。两组患者在性别、年龄、BMI、基础疾病、IBD类型及新冠疫苗接种针次差异均无统计学意义(均P>0.05)。与无症状加重组相比,症状加重组处于疾病活动期的患者比例更高[47.12%(49/104)比24.68%(97/393),P<0.001],使用美沙拉嗪/柳氮磺吡啶的比例更高(35.58%比23.41%,P=0.012),出现腹泻、头痛、头晕等COVID-19症状比例均更高(均P<0.05)。237例使用生物制剂的IBD患者中,症状加重患者与无症状加重患者使用的生物制剂类型差异具有统计学意义(χ^(2)=9.351,P=0.031)。240例使用生物制剂患者中,症状加重患者延迟或中断生物制剂治疗的比例高于无症状加重患者,差异具有统计学意义[45.45%(20/44)比23.98%(47/196),χ^(2)=8.235,P=0.004]。47例使用免疫抑制剂的患者中,症状加重患者和无症状加重患者停用免疫抑制剂的比例差异不存在统计学意义(P=0.263)。结论IBD患者确诊COVID-19后的主要表现为呼吸道症Objective To investigate the changes in symptoms of inflammatory bowel disease(IBD)patients infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)during the coronavirus disease 2019(COVID-19)pandemic,as well as the situation of IBD treatment medication use.Methods A cross-sectional survey study method was used.A questionnaire survey was conducted on a voluntary sampling basis for IBD patients of multiple centers nationwide from December 1st to 31st 2022,collecting clinical data of patients diagnosed with COVID-19 through nucleic acid/antigen testing.Patients were divided into symptomatic exacerbation group and asymptomatic exacerbation group based on whether they felt an exacerbation of IBD symptoms including abdominal discomfort,increased bloody stool or the appearance of purulent bloody stool,increased frequency of diarrhea,etc.And the differences in age,gender,body mass index(BMI),underlying disease conditions,SARS-CoV-2 vaccination status,IBD type,disease activity,COVID-19 symptoms,and treatment medication between the two groups were compared.Results A total of 497 patients were included,317 males and 180 females;age(35.27±11.54)years;355 CD patients and 142 UC patients;more than 50%of patients exhibited respiratory system symptoms such as fever,muscle soreness,fatigue,cough,expectoration,nasal congestion,and some IBD patients exhibited digestive system symptoms and nervous system symptoms.The symptomatic exacerbation group consisted of 104 patients(20.93%),and the asymptomatic exacerbation group consisted of 393(79.07%).There were no statistically significant differences in gender,age,BMI,underlying diseases,IBD type,and SARS-CoV-2 vaccine doses between the two groups(all P>0.05).Compared with the asymptomatic exacerbation group,the proportion of patients in the disease active phase was higher[47.12%(49/104)vs.24.68%(97/393),P<0.001],and the proportion of patients using mesalazine/sulfasalazine was higher(35.58%vs.23.41%,P=0.012),and the proportions of COVID-19 symptoms such as diarrhea,h

关 键 词：炎症性肠病 克罗恩病 溃疡性结肠炎 新型冠状病毒感染 新型冠状病毒 疾病活动 停药 症状加重 

分 类 号：R574[医药卫生—消化系统] R511[医药卫生—内科学]