后COVID综合征:临床模式及其对健康相关生活质量的影响

Ashraf Mohamed, L. Shaaban, Mostafa Mahmoud Attia, Waleed Khaleel
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摘要

COVID-19 的管理已从应对一种新型呼吸道病毒性疾病转变为揭开一种全身性疾病的神秘面纱。本研究旨在评估 COVID-19 后幸存者的临床模式及其对生活质量的影响。 本研究招募了 115 名 COVID-19 患者。评估内容包括临床病史,特别关注可归因于 COVID 后遗症的症状。分别使用失眠严重程度指数(ISI)、汉密尔顿焦虑量表(HAM-A)和抑郁评分量表(HAM-D)评估是否存在失眠、焦虑和抑郁。实验室检查包括全血细胞计数(CBC)、肾功能检测、肝功能检测、C反应蛋白(CRP)以及包括血沉、CRP和铁蛋白水平在内的炎症指标。EQ-5D-5L和EQ视觉模拟量表(EQ-VAS)用于评估参与者的总体健康状况和生活质量。 COVID-19患者在急性感染期间最痛苦的症状是咳嗽(76%)、发烧(72.9%)、疲劳(72.9%)、呼吸困难(69.8%)和肌肉/关节疼痛(66.1%)。在 3 个月的评估中,呼吸困难(32.2%)、疲劳(26.1%)、肌肉/关节疼痛(22.6%)、味觉丧失(16.5%)和嗅觉丧失(15.7%)是感染后综合征(PCS)中最常见的症状。46.9%的患者出现了可归因于COVID后综合征的表现。在严重病例(第 2 组)中,发热、咳嗽、嗅觉和味觉丧失、疲劳、焦虑和失眠的持续时间明显较长。重症 COVID 患者的 EQ-5D-5L 领域明显受损。年龄与呼吸困难、肌肉/关节疼痛和抑郁持续时间的延长呈显著正相关。此外,胸部 CT 严重程度评分与呼吸困难、疲劳、肌肉/关节疼痛也有显著相关性(P=0.023、0.012 和 <0.001;分别为 0.023、0.012 和 <0.001)。 COVID后综合征的高发病率是对医疗资源的挑战。PCS 直接影响到患者的行动能力、自理能力、日常活动、疼痛感和焦虑,因此与 COVID 后患者生活质量的降低有关。
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Post-COVID syndrome: Clinical pattern and impact on health related quality of life
COVID-19 management has changed from just dealing with a novel respiratory viral illness to unraveling the mystery of a systemic disease. This study aimed to assess clinical pattern for post-COVID survivors and impact on quality of life. 115 Patients suffering from COVID-19 affection were recruited in this study. The assessment included clinical history with special attention to symptoms attributable to post-COVID manifestations. Evaluation for presence of insomnia, anxiety and depression were done using insomnia severity index (ISI), Hamilton’s anxiety (HAM-A) and depression rating scales (HAM-D), respectively. Laboratory investigations included complete blood count (CBC), kidney function test, liver function test, C-reactive protein (CRP), and inflammatory markers including ESR, CRP and Ferritin level. EQ-5D-5L and EQ visual analogue scale (EQ-VAS) were used to assess participants’ overall health status and quality of life. COVID-19 patients suffered from cough (76%), fever (72.9%), fatigue (72.9%), dyspnea (69.8%) and muscle/joint pain (66.1%) as the most distressing symptoms during period of acute infection. Regarding post-COVID syndrome (PCS); Dyspnea (32.2%), fatigue (26.1%), muscle/joint pain (22.6%), loss of taste (16.5%) and loss of smell (15.7%) were the most prevalent at 3 month evaluation. 46.9% patients developed manifestations attributable to post-COVID syndrome. Fever, cough, loss of smell and taste, fatigue, anxiety and insomnia persisted significantly for longer periods among severe cases (Group 2). EQ-5D-5L domains were significantly impaired among severe COVID patients. Significant positive correlation noticed between age and increased duration of dyspnea, muscle/joint pains and depression. Also, CT chest severity scores showed significant correlation with dyspnea, fatigue, muscle/joint pains (P=0.023, 0.012 and <0.001; respectively). High prevalence of Post-COVID syndrome is a challenge to health care resources. PCS directly impacts mobility, self-care, usual activities, pain perception and anxiety and therefore is associated with lower quality of life among post-COVID patients.
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