新冠肺炎（COVID-19）重症康复患者的预后和抗体谱：一项前瞻性多中心队列研究

新冠肺炎（COVID-19）重症康复患者的预后和抗体谱：一项前瞻性多中心队列研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：佟睿   编辑：张中伟   审校：曹莹

  01   背景

有必要评估重症新冠肺炎幸存者的长期预后。

  02   方法

这项前瞻性队列研究纳入了来自中国湖北省4所医院的92名新冠肺炎重症康复患者。在3、6和12个月的随访后，评估多项指标，包括肺功能(肺容量、一氧化碳弥散能力、胸部计算机断层扫描评分和步行能力)；免疫状态(SARS-CoV-2中和抗体和抗SARS-CoV-2的所有免疫球蛋白(Ig)G亚型、对体外抗原肽刺激的免疫细胞和淋巴细胞计数及其亚型)；肝、凝血和肾功能；生活质

量；认知功能；以及精神状态。

  03   结果

在纳入的92名康复患者中，72名(78%)患者需要机械通气。在12个月时，预测的肺一氧化碳弥散量百分比为82%(四分位数范围[IQR]：76-97%)，残留量为77(64-88)%。随着时间的推移，其他肺功能参数和6分钟步行试验逐渐改善，到12个月时几乎恢复正常。免疫球蛋白G滴度和新冠肺炎中和抗体滴度在12个月时仍高于未感染新冠肺炎的对照组(P<0.001)，而中和抗体滴度从6月时的29.99(19.43-53.93)AU·ml-1下降到19.75(13.1-29.8)AU·ml-1(P<0.001)。总体而言，随着时间的推移，肝脏、肾脏、身体和精神功能也有所改善。

    0 4 结论

新冠肺炎的重症康复患者表现出一些持续性的长期肺功能损害。然而，这些测试中的大多数在12个月时都是正常的。这些患者在12个月时仍有可检测到的针对SARS-CoV-2和所有类型的免疫球蛋白的中和抗体水平，但在这段时间内水平有所下降。

  0 5 原始文献来源

Xiao Yang, Zhifeng Li, Binbin Wang, et al. Prognosis and antibody profiles in survivors of critical illness from COVID-19: a prospective multicentre cohort study.[J]British Journal of Anaesthesia,128 (3): 491-500 (2022).

英文原文    

Prognosis and antibody profiles in survivors of critical illness from

COVID-19: a prospective multicentre cohort study

Abstract

Background: There is a need to assess the long-term outcomes of survivors of critical illness from COVID-19.

Method: Ninety-two survivors of critical illness from COVID-19 from four hospitals in Hubei Province, China participated in this prospective cohort study. Multiple characteristics, including lung function (lung volumes, diffusing capacity for carbon monoxide, chest computed tomography scores, and walking capacity); immune status (SARS-CoV-2-neutralising antibody and all subtypes of immunoglobulin (Ig) G against SARS-CoV-2, immune cells in response to ex vivo antigen peptide stimuli, and lymphocyte count and its subtypes); liver, coagulation, and kidney functions; quality of life; cognitive function; and mental status, were assessed after 3, 6, and 12 months of follow-up.

Results: Amongst the 92 enrolled survivors, 72 (78%) patients required mechanical ventilation. At 12 months, the predicted percentage diffusing capacity of lung for carbon monoxide was 82% (inter-quartile range [IQR]: 76-97%) with a residual volume of 77 (64-88)%. Other lung function parameters and the 6-min walk test improved gradually over time and were almost back to normal by 12 months. The titres of IgG and neutralising antibody to COVID-19 remained high at 12 months compared with those of controls who were not infected with COVID-19, although IgG titres decreased significantly from 34.0 (IQR: 23.8-74.3) to 15.0 (5.8-24.3) AU ml-1 (P<0.001), whereas neutralising antibodies decreased from 29.99 (IQR: 19.43-53.93) AU ml-1 at 6 months to 19.75 (13.1e29.8) AU ml-1 (P<0.001) at 12 months. In general, liver, kidney, physical, and mental functions also improved over time.

Conclusion: Survivors of critical illness from COVID-19 show some persistent long-term impairments in lung function. However, a majority of these tests were normal by 12 months. These patients still had detectable levels of neutralising antibodies against SARS-CoV-2 and all types of IgG at 12 months, but the levels had declined over this time period.

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