COVID-19疾病的哮喘表型、相关合并症和长期症状
2021/06/18
摘要
背景：尚不清楚在SARS-CoV-2 的疾病中哮喘及其过敏表型是否是住院或重症患者的危险因素。
方法：所有在2020年3月1日至9月30日期间检测出SARS-CoV-2呈阳性的28天以上患者在斯坦福大学通过电子分析进行了回顾性鉴定和表征。一个子队列前瞻性地随访以评估长期的COVID-19症状。
结果：168,190名患者接受了SARS-CoV-2检测，6,976(4.15%)名患者检测呈阳性。在一个多变量分析显示，哮喘不是住院的独立危险因素（OR 1.12 [95% CI 0.86，1.45]，p=0.40）。在SARS-CoV-2阳性哮喘患者中，过敏性哮喘降低了住院风险并且与非过敏性哮喘相比具有保护作用（OR 0.52 (0.28, 0.91), p=0.026）；以 GINA 为特征的基线药物使用与住院风险之间没有关联。与轻度或轻症患者相比，重症 COVID-19 患者住院期间的嗜酸性粒细胞水平较无症状疾病低，与哮喘状态无关（p=0.0014）。在随后的患者子队列中纵向来看，哮喘患者和非哮喘患者的 COVID-19 症状缓解时间相似，尤其是下呼吸道症状。
结论：哮喘不是更严重的 COVID-19 疾病的危险因素。与非过敏性哮喘患者相比，过敏性哮喘患者只有一半的可能性因 COVID-19 而住院。嗜酸性粒细胞计数（过敏生物标志物）的降低，与更严重的 COVID-19 疾病轨迹图相关。哮喘患者和非哮喘患者的恢复情况相似，超过50% 的患者在感染后三个月报告持续存在下呼吸道症状。
Asthma phenotypes, associated comorbidities, and long-term symptoms in COVID-19.
Eggert LE, He Z, Collins W, et al.
Abstract:
BACKGROUND: It is unclear if asthma and its allergic phenotype are risk factors for hospitalization or severe disease from SARS-CoV-2.
METHODS: All patients over 28 days oldtesting positive for SARS-CoV-2 between March 1 and September 30, 2020, were retrospectively identified and characterized through electronic analysis at Stanford. A sub-cohort was followed prospectively to evaluate long-term COVID-19 symptoms.
RESULTS:168,190 patients underwent SARS-CoV-2 testing, and 6,976 (4.15%) tested positive. In a multivariate analysis, asthma was not an independent risk factor for hospitalization (OR 1.12 [95% CI 0.86, 1.45], p=0.40). Among SARS-CoV-2 positive asthmatics, allergic asthma lowered the risk of hospitalization and had a protective effect compared to non-allergic asthma (OR 0.52 (0.28, 0.91), p=0.026); there was no association between baseline medication use as characterized by GINA and hospitalization risk. Patients with severe COVID-19 disease had lower eosinophil levels during hospitalization compared to patients with mild or asymptomatic disease, independent of asthma status (p=0.0014). In a patient sub-cohort followed longitudinally, asthmatics and non-asthmatics had similar time to resolution of COVID-19 symptoms, particularly lower respiratory symptoms.
CONCLUSIONS:Asthma is not a risk factor for more severe COVID-19 disease. Allergic asthmatics were half as likely to be hospitalized with COVID-19 compared to non-allergic asthmatics. Lower levels of eosinophil counts (allergic biomarkers) were associated with a more severe COVID-19 disease trajectory. Recovery was similar among asthmatics and non-asthmatics with over 50% of patients reporting ongoing lower respiratory symptoms three months post-infection.
背景：尚不清楚在SARS-CoV-2 的疾病中哮喘及其过敏表型是否是住院或重症患者的危险因素。
方法：所有在2020年3月1日至9月30日期间检测出SARS-CoV-2呈阳性的28天以上患者在斯坦福大学通过电子分析进行了回顾性鉴定和表征。一个子队列前瞻性地随访以评估长期的COVID-19症状。
结果：168,190名患者接受了SARS-CoV-2检测，6,976(4.15%)名患者检测呈阳性。在一个多变量分析显示，哮喘不是住院的独立危险因素（OR 1.12 [95% CI 0.86，1.45]，p=0.40）。在SARS-CoV-2阳性哮喘患者中，过敏性哮喘降低了住院风险并且与非过敏性哮喘相比具有保护作用（OR 0.52 (0.28, 0.91), p=0.026）；以 GINA 为特征的基线药物使用与住院风险之间没有关联。与轻度或轻症患者相比，重症 COVID-19 患者住院期间的嗜酸性粒细胞水平较无症状疾病低，与哮喘状态无关（p=0.0014）。在随后的患者子队列中纵向来看，哮喘患者和非哮喘患者的 COVID-19 症状缓解时间相似，尤其是下呼吸道症状。
结论：哮喘不是更严重的 COVID-19 疾病的危险因素。与非过敏性哮喘患者相比，过敏性哮喘患者只有一半的可能性因 COVID-19 而住院。嗜酸性粒细胞计数（过敏生物标志物）的降低，与更严重的 COVID-19 疾病轨迹图相关。哮喘患者和非哮喘患者的恢复情况相似，超过50% 的患者在感染后三个月报告持续存在下呼吸道症状。
（中日友好医院呼吸与危重症医学科 李春晓 摘译 林江涛 审校）
（Allergy, 2021.）
（Allergy, 2021.）
Asthma phenotypes, associated comorbidities, and long-term symptoms in COVID-19.
Eggert LE, He Z, Collins W, et al.
Abstract:
BACKGROUND: It is unclear if asthma and its allergic phenotype are risk factors for hospitalization or severe disease from SARS-CoV-2.
METHODS: All patients over 28 days oldtesting positive for SARS-CoV-2 between March 1 and September 30, 2020, were retrospectively identified and characterized through electronic analysis at Stanford. A sub-cohort was followed prospectively to evaluate long-term COVID-19 symptoms.
RESULTS:168,190 patients underwent SARS-CoV-2 testing, and 6,976 (4.15%) tested positive. In a multivariate analysis, asthma was not an independent risk factor for hospitalization (OR 1.12 [95% CI 0.86, 1.45], p=0.40). Among SARS-CoV-2 positive asthmatics, allergic asthma lowered the risk of hospitalization and had a protective effect compared to non-allergic asthma (OR 0.52 (0.28, 0.91), p=0.026); there was no association between baseline medication use as characterized by GINA and hospitalization risk. Patients with severe COVID-19 disease had lower eosinophil levels during hospitalization compared to patients with mild or asymptomatic disease, independent of asthma status (p=0.0014). In a patient sub-cohort followed longitudinally, asthmatics and non-asthmatics had similar time to resolution of COVID-19 symptoms, particularly lower respiratory symptoms.
CONCLUSIONS:Asthma is not a risk factor for more severe COVID-19 disease. Allergic asthmatics were half as likely to be hospitalized with COVID-19 compared to non-allergic asthmatics. Lower levels of eosinophil counts (allergic biomarkers) were associated with a more severe COVID-19 disease trajectory. Recovery was similar among asthmatics and non-asthmatics with over 50% of patients reporting ongoing lower respiratory symptoms three months post-infection.
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