作者：李新刚1，2，徐艳利1，宋美华1，田地1，张婷玉1，陈志海1

单位：

1.100015北京市，首都医科大学附属北京地坛医院感染性疾病诊疗中心　 2.100015北京市，首都医科大学附属北京地坛医院内分泌科

Units：

1.Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China 2.Department of Endocrinology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

关键词：

新型冠状病毒肺炎；2型糖尿病；危重型；危险因素

Keywords：

COVID-19; Type 2 diabetes mellitus; Critical cases; Risk factors

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.179

Funds：

国家重点研发计划项目（2020YFC0846200）

摘要：

目的　分析新型冠状病毒肺炎（COVID-19）合并糖尿病患者进展为危重型的危险因素。方法　选取2020—2021年在首都医科大学附属北京地坛医院感染性疾病诊疗中心住院的COVID-19合并糖尿病患者41例，根据是否进展为危重型将其分为普通型组（n=30）和危重型组（n=11）。通过临床电子病历获取所有患者的临床资料，包括人口学特征、临床特征、入院后首次实验室检查结果、治疗方案、核酸转阴时间、住院时间及临床转归。COVID-19合并糖尿病患者进展为危重型的影响因素分析采用多因素Logistic回归分析。结果　危重型组首发症状为发热者占比、中性粒细胞分数、C反应蛋白（CRP）、空腹血糖、α-羟丁酸脱氢酶（α-HBDH）高于普通型组，淋巴细胞计数、淋巴细胞分数低于普通型组（P ＜0.05）。多因素Logistic回归分析结果显示，首发症状为发热〔OR =1.076，95%CI（1.003，1.151）〕、CRP〔OR =1.033，95%CI （1.005，1.063）〕、空腹血糖〔OR =1.859，95%CI （1.236，2.794）〕是COVID-19合并糖尿病患者进展为危重型的危险因素（P ＜0.05）。危重型组吸氧、抗生素治疗、糖皮质激素治疗、机械通气治疗者占比高于普通型组，住院时间长于普通型组（P ＜0.05）。两组患者均出院，无死亡病例。结论　首发症状为发热及CRP、空腹血糖升高是COVID-19合并糖尿病患者进展为危重型的危险因素，应引起临床重视。

Abstract：

Objective　To analyze the risk factors for progression to critical cases in patients with COVID-19 complicated with diabetes mellitus.Methods　Forty one patients with COVID-19 complicated with diabetes mellitus who werehospitalized in the Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University from 2020 to 2021 were selected. They were divided into normal cases group (n=30) and critical cases group (n=11) according to whether they progressed to critical cases. The clinical data of all patients were obtained through clinical electronic medical records, including demographic characteristics, clinical characteristics, first laboratory examination results after admission, treatment plan, nucleic acid negative time, length of stay and clinical outcome. Multivariate Logistic regression analysis was used to analyze the influencing factorsfor progression to critical cases in patients with COVID-19 complicated with diabetes mellitus.Results　The proportion of patients whose initial symptoms of fever, neutrophil fraction, C-reactive protein (CRP) , fasting blood glucose, α-hydroxybutyrate dehydrogenase (α-HBDH) of the critical cases group were higher than those of the normal cases group, and lymphocyte count andlymphocyte fraction were lower than those of the normal cases group (P < 0.05) . The multivariate Logistic regression analysis results showed that the initial symptoms of fever [OR =1.076, 95%CI (1.003, 1.151) ] , CRP [OR =1.033, 95%CI (1.005, 1.063) ] , fasting blood glucose [OR =1.859, 95%CI (1.236, 2.794) ] were the risk factors for progression to critical cases in patients with COVID -19 complicated with diabetes mellitus (P < 0.05) . The proportion of patients using oxygen inhalation, antibiotic treatment,glucocorticoid treatment and mechanical ventilation in the critically cases group was higher than that in the normal cases group,and the hospitalization time was longer than that in the normal cases group ( P < 0.05 ) . Both groups were discharged withoutdeath.Conclusion　The initial symptoms of fever, increased CRP and increased fasting blood glucose are the risk factors for progression to critical cases in patients with COVID-19 complicated with diabetes mellitus, and which should be paid attention.

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