探索适应性肺通气后 COVID-19 相关肺纤维化的重要预后因素

Q2 Medicine
Medical Journal of the Islamic Republic of Iran Pub Date : 2023-11-07 eCollection Date: 2023-01-01 DOI:10.47176/mjiri.37.118
Mirkhoshim Mirsaliyev, Khadisha Kashikova, Aisulu Zholdybayeva, Botakoz Myrzakhmetova, Akmaral Isbassarova, Natalya Petrova, Dana Kozhamberdiyeva
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引用次数: 0

摘要

背景:对 2019 年冠状病毒(COVID-19)住院幸存者的研究数据表明,在初次感染数月后,症状、放射学异常和生理紊乱仍然存在。鉴于目前大流行病的规模,预计会有大量患者伴有严重的残留肺纤维化(PF)和氧依赖。目前,正在寻找与中度至重度 COVID-19 后出现纤维化放射学异常相关的风险因素。此外,计算机断层扫描(CT)数据与出院后症状和身体功能的相关程度仍不清楚。本研究旨在描述出院后出现持续性肺部后果的患者的特征。我们研究了 COVID-19 感染后肺纤维化的临床、放射学和实验室预测因素:我们对COVID-19幸存者的肺纤维化样改变及其预后因素进行了回顾性评估。我们的研究纳入了在 2020 年 11 月至 12 月期间在阿拉木图市第一临床医院接受住院治疗的 77 例经实验室确诊的 COVID-19 患者。我们在疾病急性期对患者进行了评估,并在出院后 6 至 8 个月再次使用高分辨率计算机断层扫描(CT)对患者进行了评估。根据对随后添加的断层图像进行的半定量分析,我们将患者分为两组--有放射性纤维化样异常的患者(主要组)和已经康复的患者(对照组):结果:在所有 COVID-19 患者中,实质性条索、不规则界面、网状结构和牵引性支气管扩张是常见的 CT 检查结果。我们的研究侧重于发病后 1 个月内出现肺纤维化的患者。6 至 8 个月后,49.35% 的患者(先导组)肺部纤维化样改变持续存在,而 50.65% 的患者(对照组)病情缓解。年龄、体重指数、高白细胞介素-6(IL-6)水平、低 IO 水平和需要机械通气被确定为肺纤维化持续存在的预后指标:我们的研究表明,超过半数的 COVID-19 患者在感染开始 8 个月后肺功能可恢复正常。尽管 COVID-19 治疗取得了进展,但在处理长期影响,尤其是肺纤维化方面仍存在巨大的知识差距。继续开展有关 COVID-19 后肺纤维化的临床试验和研究对于防止这些患者因长期影响而过早死亡至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring Prognostically Significant Factors in COVID-19-Associated Pulmonary Fibrosis after Adaptive Lung Ventilation.

Background: Research data on hospitalized coronavirus 2019 (COVID-19) survivors indicate the persistence of symptoms, radiological abnormalities, and physiological disorders months after the initial infection. Given the scale of the ongoing pandemic, a substantial number of patients with severe residual pulmonary fibrosis (PF) and oxygen dependence are anticipated. Currently, the search for risk factors associated with the development of fibrotic radiological abnormalities after moderate to severe COVID-19 is underway. Furthermore, the extent to which computed tomography (CT) data correlate with postdischarge symptoms and physical functions remains unclear. This study aimed to characterize patients experiencing persistent pulmonary consequences after hospital discharge. We examined clinical, radiological, and laboratory predictors of pulmonary fibrosis after COVID-19 infection.

Methods: We retrospectively evaluated fibrosis-like lung changes and their prognostic factors in COVID-19 survivors. Our study included 77 patients with laboratory-confirmed COVID-19 who received inpatient treatment at City Clinical Hospital No. 1 in Almaty between November and December 2020. We assessed patients during the acute phase of the disease and again 6 to 8 months after discharge using high-resolution computed tomography (CT). Patients were classified into 2 cohorts based on semi-quantitative analysis of subsequently added tomograms-those with radiological fibrosis-like abnormalities (main group) and those who had recovered (control group).

Results: Parenchymal cords, irregular interfaces, reticulation, and traction bronchiectasis were common CT findings among all COVID-19 patients. Our study focused on patients who developed pulmonary fibrosis within 1 month after the onset of the disease. After 6 to 8 months, fibrosis-like lung changes persisted in 49.35% of patients (leading group), while 50.65% showed disease resolution (control group). Age, body mass index, high interleukin-6 (IL-6) levels, low IO levels, and the need for mechanical ventilation were identified as prognostic indicators for the persistence of pulmonary fibrosis.

Conclusion: Our study revealed that pulmonary function can return to normal in over half of COVID-19 patients 8 months after infection onset. Despite advancements in COVID-19 treatment, there remains a significant knowledge gap in managing long-term effects, especially pulmonary fibrosis. Continued clinical trials and research on post COVID-19 fibrosis are essential to prevent early mortality due to the long-term impacts on these patients.

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