法国比塞特医院Xavier Monnet团队详细分析了COVID-19患者住院后4个月的临床状况。2021年3月17日，该成果发表在《美国医学会杂志》上。

人们对COVID-19的长期后遗症知之甚少。为了描述因COVID-19住院的患者4个月后的临床结局，研究组进行了一项前瞻性、非对照、队列研究，针对2020年3月1日至5月29日期间在法国一所大学医院住院的COVID-19幸存者，在其出院后4个月，即2020年7月15日至9月18日期间进行电话评估随访。有相关症状的患者和所有在重症监护室（ICU）住过院的患者则被邀请在门诊就诊时进行进一步评估。

通过电话、Q3PC认知筛查问卷和症状清单对患者的呼吸、认知和功能症状进行评估。在门诊就诊时，患者接受肺功能测试、肺部计算机断层扫描、心理测量和认知测试（包括36项简式健康调查和20项多维疲劳量表），对于此前在ICU住院或报告有持续症状的患者，则接受超声心动图检查。

在834例符合条件的患者中，有478例通过电话进行评估，平均年龄为61岁，男性201例，女性277例。在电话采访中，244名患者（51%）称至少有一种在COVID-19之前不存在的症状：其中疲劳占31%，认知症状占21%，新发呼吸困难占16%。对177名患者（37%）进行进一步评估，包括142名前ICU患者中的97名。

130例患者的20项多维疲劳量表中，动机降低中位得分4.5分，精神疲劳中位得分3.7分。145例患者的36项简式健康调查表中，分量表“身体问题角色限制”的中位得分为25分。171例患者中有108例（63%）出现肺部CT异常，主要表现为轻微磨玻璃样影。171例患者中有33例（19%）出现纤维化病变，除1例外，所有患者的实质病变均小于25%。

49例急性呼吸窘迫综合征幸存者中有19例（39%）出现纤维化病变。94名前ICU患者中，焦虑、抑郁和创伤后症状分别占23%、18%和7%。83例前ICU患者中有8例（10%）左室射血分数低于50%。2例前ICU患者新发慢性肾脏病。177例门诊患者中，血清学阳性为172例（97%）。

综上，接受COVID-19治疗的患者在住院4个月后，接受访谈的患者常报告以前没有出现过的症状，而在医院接受检测的患者中常见肺部扫描异常。

附：英文原文

Title: Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19

Author: The Writing Committee for the COMEBAC Study Group, Luc Morin, Laurent Savale, Tài Pham, Romain Colle, Samy Figueiredo, Anatole Harrois, Matthieu Gasnier, Anne-Lise Lecoq, Olivier Meyrignac, Nicolas Noel, Elodie Baudry, Marie-France Bellin, Antoine Beurnier, Walid Choucha, Emmanuelle Corruble, Laurent Dortet, Isabelle Hardy-Leger, Franois Radiguer, Sabine Sportouch, Christiane Verny, Benjamin Wyplosz, Mohamad Zaidan, Laurent Becquemont, David Montani, Xavier Monnet

Issue&Volume: 2021-03-17

Abstract:

Importance  Little is known about long-term sequelae of COVID-19.

Objective  To describe the consequences at 4 months in patients hospitalized for COVID-19.

Design, Setting, and Participants  In a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit.

Exposures  Survival of hospitalization for COVID-19.

Main Outcomes and Measures  Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography.

Results  Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n=130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n=145) was 25 (interquartile range, 25.0-75.0) for the subscale “role limited owing to physical problems” (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%).

Conclusions and Relevance  Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. Further research is needed to understand longer-term outcomes and whether these findings reflect associations with the disease.

DOI: 10.1001/jama.2021.3331

Source: https://jamanetwork.com/journals/jama/fullarticle/2777787