中日友好医院曹彬教授团队研究了新冠肺炎出院患者6个月后的健康结局。20212年1月8日，该研究发表在《柳叶刀》杂志上。

COVID-19的长期健康后果在很大程度上尚不明确。这项研究的目的是描述出院COVID-19患者的长期健康预后，并调查相关危险因素，尤其是疾病的严重程度。

研究组对2020年1月7日至5月29日从武汉市金银潭医院出院的确诊COVID-19患者进行了双向研究。排除随访前死亡或因精神疾病等难以随访的患者。所有患者均接受了一系列问卷调查，以评估症状及与健康相关的生活质量，接受了身体检查和6分钟的步行测试，并接受了血液检查。

采用分层抽样程序，按照住院期间分别为3、4和5-6的最高7级量表对患者进行抽样，以接受肺功能检查，胸部高分辨率CT和超声检查。在中国参加了洛匹那韦抑制SARS-CoV-2试验的入选患者接受了SARS-CoV-2抗体检测。对疾病严重程度与长期健康结局之间的关联进行评估。

研究组共纳入1733例COVID-19出院患者，中位年龄为57.0岁，男性占52％。随访研究于2020年6月16日至9月3日进行，症状发作后的中位随访时间为186.0天。最常见的症状为疲劳或肌肉无力（63％）和睡眠困难（26％）。23％的患者感到焦虑或抑郁。严重度等级3级的患者中位6分钟步行距离小于正常范围下限的比例为24％，严重度等级4级的患者为22％，严重度等级5-6级的患者为29％。

严重度等级3级、4级和5-6级弥散障碍患者的相应比例分别为22%、29%和56%，3级、4级和5-6级CT中位数分别为3.0、4.0和5.0。经过多变量校正后，严重度等级4级与3级患者弥散障碍的比值比（OR）为1.61，5–6级与3级的OR为4.60；4级与3级患者焦虑抑郁的OR值为0.88，5-6级和3级相比，OR值为1.77；4级和3级患者疲劳或肌无力的OR值为0.74，5–6级和3级的OR值为2.69。

在94名接受随访的血液抗体检查的患者中，中和抗体的血清阳性率（96.2％与58.5％）和中值滴度（19.0与10.0）与急性期相比显著降低。822名无急性肾损伤的参与者中有107名在急性期肾小球滤过率（eGFR）估计为90 mL / min 1.73 m²或更高，随访时eGFR低于90 mL / min 1.73 m² 。

总之，急性感染后6个月，COVID-19存活者主要表现为疲劳或肌无力、睡眠困难、焦虑或抑郁。住院期间病情较重的患者肺弥散功能受损较重，胸部影像学表现异常，是长期康复干预的主要目标人群。

附：英文原文

Title: 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

Author: Chaolin Huang, Lixue Huang, Yeming Wang, Xia Li, Lili Ren, Xiaoying Gu, Liang Kang, Li Guo, Min Liu, Xing Zhou, Jianfeng Luo, Zhenghui Huang, Shengjin Tu, Yue Zhao, Li Chen, Decui Xu, Yanping Li, Caihong Li, Lu Peng, Yong Li, Wuxiang Xie, Dan Cui, Lianhan Shang, Guohui Fan, Jiuyang Xu, Geng Wang, Ying Wang, Jingchuan Zhong, Chen Wang, Jianwei Wang, Dingyu Zhang, Bin Cao

Issue&Volume: 2021-01-08

Abstract:

Background

The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.

Methods

We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences.

Findings

In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up.

Interpretation

At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.

DOI: 10.1016/S0140-6736(20)32656-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32656-8/fulltext