作者：汤艳芬1，王宇1，关春爽2，谢汝明2，薛天娇1，刘刚1，陈奇1，赵雯1，刘岩岩1，刘菁1，陈融佥1，陈丽1，任爱民1，靳桂芳1

单位：

1.100015北京市，首都医科大学附属北京地坛医院呼吸科 国家传染病医学中心　 2.100015北京市，首都医科大学附属北京地坛医院放射科 国家传染病医学中心

单位（英文）：

1.Department of Respiratory, Beijing Ditan Hospital, Capital Medical University/National Center for Infectious Diseases,Beijing 100015, China 2.Department of Radiation, Beijing Ditan Hospital, Capital Medical University/National Center for Infectious Diseases, Beijing100015, China

关键词：

新型冠状病毒肺炎；新型冠状病毒；疫苗，灭活；Vero细胞；老年人；临床特征

关键词（英文）：

COVID-19; SARS-CoV-2; Vaccines, inactivated; Vero cells; Aged; Clinical feature

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.137

基金项目：

北京市科技计划项目（Z211100002521020）

摘要：

目的　分析接种新型冠状病毒灭活疫苗后感染新型冠状病毒的老年患者的临床特征。方法　回顾性选取2021-07-29至2021-12-19于首都医科大学附属北京地坛医院接受治疗的接种新型冠状病毒灭活疫苗（Vero细胞）后感染新型冠状病毒的患者48例，其中年龄≥60岁24例（老年组），年龄＜60岁24例（非老年组）。收集患者的一般资料，疫苗接种情况，入院后首次实验室检查结果，新型冠状病毒核酸、抗体检测结果，胸部CT检查结果，治疗情况，预后及转归情况。结果　老年组患者高血压、糖尿病、咳痰发生率高于非老年组（P ＜0.05）。疫苗主要来源为北京科兴中维生物技术有限公司（79.2%）；患者均在上臂三角肌区域肌肉注射疫苗；两次注射时间间隔为21~28 d；接种方式主要为两次单剂方式（47例）；末次疫苗接种至新型冠状病毒核酸检测阳性时间为4.5（4.0，5.5）个月。两组患者末次疫苗接种至新型冠状病毒核酸检测阳性时间比较，差异无统计学意义（P ＞0.05）。老年组患者凝血酶原活动度（PTA）、血尿素氮（BUN）、肌酸激酶同工酶（CK-MB）高于非老年组（P ＜0.05）。老年组患者入院后首次、发病1周时IgM、IgG抗体滴度高于非老年组（P ＜0.05）。老年组患者网格影发生率高于非老年组（P ＜0.05）。老年组患者银丹治疗率低于非老年组，银丹联合汤药治疗率高于非老年组（P ＜0.05）。两组患者新型冠状病毒核酸检测转阴时间比较，差异无统计学意义（P ＞0.05）。两组患者经治疗后均康复出院。结论　与非老年患者相比，接种新型冠状病毒灭活疫苗后感染新型冠状病毒的老年患者高血压、糖尿病、咳痰发生率及PTA、BUN、CK-MB较高，IgM、IgG抗体滴度也较高，胸部CT检查多出现网格影改变，多采用银丹联合汤药进行治疗，且预后较好。

英文摘要：

Objective　To analyze the clinical characteristics of elderly patients infected with SARS-CoV-2 afterinoculation with SARS-CoV-2 inactivated vaccine.Methods　A total of 48 patients infected with SARS-CoV-2 after inoculation with SARS-CoV-2 inactivated vaccine (Vero cells) who were treated in Beijing Ditan Hospital, Capital Medical University from 2021-07-29 to 2021-12-19 were retrospectively selected, including 24 cases aged ≥ 60 years (elderly group) , and 24 casesaged < 60 years (non-elderly group) . General data, vaccination, first laboratory examination results after admission, test resultsof SARS-CoV-2 acid and antibody, chest CT test results, treatment, prognosis and outcome of patients were collected.Results　The incidence of hypertension, diabetes and expectoration in the elderly group was higher than that in the non-elderly group(P < 0.05) . The main source of vaccine was Beijing Kexing Zhongwei Biotechnology Co., Ltd (79.2%) . All patients receivedintramuscular injection of vaccine in the upper arm triangle region. The interval between two injections was 21 to 28 days. Theinoculation methods were mainly two single doses (47 cases) . The time from the last vaccination to the nucleic acid detection ofSARS-CoV-2 was 4.5 (4.0, 5.5) months. There was no significant difference in the time from the last vaccination to the nucleicacid detection of SARS-CoV-2 between the two groups (P > 0.05) . The prothrombin activity (PTA) , blood urea nitrogen (BUN)and creatine kinase isoenzyme (CK-MB) in the elderly group were higher than those in the non-elderly group (P < 0.05) .The IgM and IgG antibody titers at the first time after admission and 1 week after onset in the elderly group were higher thanthose in the non-elderly group (P < 0.05) . The incidence of grid shadow in the elderly group was higher than that in the nonelderlygroup (P < 0.05) . The treatment rate of Yindan in the elderly group was lower than that in the non-elderly group, but the treatment rate of Yindan combined with decoction was higher than that in the non-elderly group (P < 0.05) . There was nosignificant difference in the time to negative for SARS-CoV-2 nucleic acid detection between the two groups (P > 0.05) . Patients in both groups recovered and discharged after treatment.Conclusion　Compared with non-elderly patients, the incidence of hypertension, diabetes and expectoration, PTA, BUN, CK-MB, IgM and IgG antibody titers are higher in elderly patients infectedwith SARS-CoV-2 after inoculation with SARS-CoV-2 inactivated vaccin. The chest CT examination often shows grid shadowchanges. They are mostly treated with Yindan combined with decoction, and the prognosis is good.

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