54例2型糖尿病患者合并新型冠状病毒感染的死亡原因分析

doi:10.3969/j.issn.1004-583X.2023.09.006

摘要/Abstract

摘要：

目的研究2型糖尿病(T2DM)患者合并新型冠状病毒感染(COVID-19)的死亡患者的临床特点及死亡的可能影响因素。方法回顾性分析2022年12月至2023年2月扬州大学临床医学院T2DM合并COVID-19患者在住院期间发生死亡的情况,详细记录患者一般资料及实验室检查资料,并对患者入院初期的检测指标与入院终末期复查指标进行对比。结果 54例死亡患者平均年龄为(74.31±10.64)岁;50例(92.6%)合并其他基础疾病,74%的患者合并2种以上基础疾病。与入院初期检查结果相比,死亡前最后一次血糖、酸碱度、红细胞计数、白蛋白、球蛋白明显下降。二氧化碳分压(PCO₂)、乳酸、乳酸脱氢酶(LDH)、血钠、肌红蛋白、凝血酶原时间、降钙素原、C反应蛋白、D-二聚体明显升高,差异均有统计学意义( $P$ 均<0.05)。54例死亡患者中有96.3%的患者胸部CT影像学改变为双肺存在大片斑片状阴影及磨玻璃样影,81.5%的患者同时合并双肺胸腔积液。Logistic回归分析结果表明,PCO₂、LDH是T2DM合并COVID-19患者死亡的独立危险因素。结论 T2DM合并COVID-19患者预后不佳,PCO₂、LDH是影响T2DM合并COVID-19患者死亡的独立危险因素。

关键词: 新型冠状病毒感染, 2型糖尿病, 死亡原因, 二氧化碳分压, 乳酸脱氢酶, 危险因素

Abstract:

Objective To analyze the clinical characteristics and possible influencing factors for death of patients with type 2 diabetes mellitus (T2DM) complicated with coronavirus disease 2019 (COVID-19). Methods It was a retrospective analysis involving T2DM patients with COVID-19 who died during hospitalization in the Clinical Medical College of Yangzhou University from December 2022 to February 2023. General information and laboratory examination data of patients were recorded in detail, and the detection indicators in the early stage and end-stage of admission were compared. Results The mean age of 54 T2DM patients with COVID-19 who died during hospitalization was (74.31±10.64) years. There were 50 (92.6%) cases who had other underlying diseases. Among them, 74% had more than two underlying diseases. Compared with the laboratory data in the early stage of admission, the blood glucose, pH, red blood cell count, albumin, and globulin in the last laboratory testing before death significantly decreased, while the partial pressure of carbon dioxide, lactate, lactate dehydrogenase, sodium ions, myoglobin, prothrombin time, procalcitonin, C-reactive protein, and D-dimer increased significantly (P<0.05). Among the 54 patients who died, 96.3% showed large patchy shadows and ground glass shadows in both lungs on chest CT scans, and 81.5% showed pleural effusion in both lungs. Logistic regression analysis results showed that PCO₂ and LDH were independent risk factors for the mortality of T2DM patients combined with COVID-19. Conclusion T2DM patients with COVID-19 have a poor prognosis, and partial pressure of carbon dioxide and lactate dehydrogenase are independent risk factors for their death.

Key words: coronavirus disease 2019, type 2 diabetes mellitus, causes of death, partial pressure of carbon dioxide, lactate dehydrogenase, risk factors

中图分类号:

R563.12

位增, 曹灵, 佘敦敏, 刘彦, 王艳, 张真稳. 54例2型糖尿病患者合并新型冠状病毒感染的死亡原因分析[J]. 临床荟萃, 2023, 38(9): 806-812.

Wei Zeng, Cao Ling, She Dunmin, Liu Yan, Wang Yan, Zhang Zhenwen. The causes of death in 54 patients with type 2 diabetes mellitus complicated with COVID-19[J]. Clinical Focus, 2023, 38(9): 806-812.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.09.006

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I9/806

图/表 3

表1 54例T2DM合并COVID-19死亡患者的临床表现

Tab.1 Clinical manifestations of 54 T2DM patients with COVID-19 who died

临床症状	例数	百分率(%)
胸闷	27	50.00
气喘	25	46.23
咳嗽	16	29.63
咳痰	14	25.93
发热	11	20.37
乏力	8	14.81
意识不清	8	14.81
畏寒	4	7.41
腹痛	3	5.56
昏迷	2	3.70
咯血	2	3.70
呼吸困难	2	3.70
黑便	1	1.85
呼吸急促	1	1.85
头晕	1	1.85
口唇紫绀	1	1.85
胸痛	1	1.85
晕厥	1	1.85
合并临床症状
合并1种及以下临床症状	14	25.93
合并2种及以上临床症状	40	74.07

表2 54例T2DM合并COVID-19死亡患者入院初期及终末期实验室检查指标 [$bar{x} pm s$, M ( P 25 , P 75)]

Tab.2 The detection indicators in the early-stage and end-stage of admission in 54 T2DM patients with COVID-19 who died ($bar{x} pm s$, M [ P 25 , ? P 75 ])

实验室数据	入院初期	终末期	$t$ 或 $Z$ 值	$P$ 值
血糖(mmol/L)	13.987±5.176	9.561±3.887	5.024	0
pH	7.379±0.094	7.323±0.101	2.939	0.004
PO₂(mmHg)	84.077±31.468	75.344±18.394	1.761	0.082
PCO₂(mmHg)	36.189±10.258	44.476±10.751	-4.098	0
Lac(mmol/L)	1.90( 1.38,3.00 )	3.65(2.03,9.63)	-3.965	0
SO₂(%)	96.70( 92.88,98.0)	96.30(87.3,97.5)	-1.355	0.175
RBC(×10¹²/L)	3.509±0.942	2.903±0.880	3.461	0.001
WBC(×10⁹/L)	8.94(6.46,12.19)	9.09(7.08,15.89)	-0.922	0.357
中性粒细胞(×10⁹/L)	6.94(5.21,11.10)	8.19(5.45,15.48)	-0.922	0.357
淋巴细胞(×10⁹/L)	0.60(0.44,0.96)	0.72(0.43,1.20)	-0.722	0.47
NLR	8.87(7.38,23.69)	13.11(5.75,21.58)	-0.381	0.703
单核细胞(×10⁹/L)	0.45(0.30,0.79)	0.45(0.18,0.69)	-0.593	0.553
嗜酸性粒细胞(×10⁹/L)	0.00(0,0.0225)	0.01(0.00,0.052)	-0.746	0.456
PLT(×10⁹/L)	181.667±99.349	151.666±87.670	1.664	0.099
ALB(g/L)	30.167±6.430	27.041±4.961	2.828	0.006
球蛋白(g/L)	29.546±4.957	26.213±5.028	3.469	0.001
白球比值	1.044±0.249	1.076±0.333	-0.579	0.564
ALT(U/L)	24.00(16.50,42.25)	26.50(16.00,49.25)	-0.787	0.431
AST(U/L)	44.50(22,76.25)	48.50(25.00,82.00)	-0.722	0.47
LDH(U/L)	286.50(203.5,352.75)	536(344,763)	-5.77	0
Cr(μmol/L)	166.20(102.78,349.83)	188.65(81.25,393.85)	-0.12	0.905
Ca(mmol/L)	2.055±0.215	2.061±0.311	-0.110	0.912
K(mmol/L)	4.189±0.837	4.349±0.764	-1.034	0.304
Na(mmol/L)	136.487±9.907	142.776±8.348	-3.567	0.001
CTnI(ng/ml)	0.06(0.02,0.24)	0.13(0.04,0.55)	-1.822	0.068
CKMB(ng/ml)	1.90(0.96,3.69)	2.54(1.33,4.34)	-0.719	0.472
Myo(ng/ml)	189.40(111.28,757.7)	511.05(266.63,1394.25)	-3.005	0.003
NT-ProBNP(pg/ml)	3690.00(1035,10625)	4066.50(1238.5,18900)	-1.023	0.306
PT(s)	13.45(12.68,14.7)	14.8(13.4,16.45)	-3.596	0
APTT(s)	32.65(28.05,38.6)	36.2(28.98,43.85)	-1.272	0.203
PCT(ng/ml)	0.48(0.17,2.23)	1.21(0.42,5.06)	-2.237	0.025
CRP(mg/L)	77.15(12.34,124.95)	116.37(56.23,144.80)	-2.547	0.011
DD(mg/L)	1.82(0.83,4.40)	4.6(2,10)	-3.255	0.001

表2 54例T2DM合并COVID-19死亡患者入院初期及终末期实验室检查指标 [$bar{x} pm s$, M ( P 25 , P 75)]

Tab.2 The detection indicators in the early-stage and end-stage of admission in 54 T2DM patients with COVID-19 who died ($bar{x} pm s$, M [ P 25 , ? P 75 ])

实验室数据	入院初期	终末期	$t$ 或 $Z$ 值	$P$ 值
血糖(mmol/L)	13.987±5.176	9.561±3.887	5.024	0
pH	7.379±0.094	7.323±0.101	2.939	0.004
PO₂(mmHg)	84.077±31.468	75.344±18.394	1.761	0.082
PCO₂(mmHg)	36.189±10.258	44.476±10.751	-4.098	0
Lac(mmol/L)	1.90( 1.38,3.00 )	3.65(2.03,9.63)	-3.965	0
SO₂(%)	96.70( 92.88,98.0)	96.30(87.3,97.5)	-1.355	0.175
RBC(×10¹²/L)	3.509±0.942	2.903±0.880	3.461	0.001
WBC(×10⁹/L)	8.94(6.46,12.19)	9.09(7.08,15.89)	-0.922	0.357
中性粒细胞(×10⁹/L)	6.94(5.21,11.10)	8.19(5.45,15.48)	-0.922	0.357
淋巴细胞(×10⁹/L)	0.60(0.44,0.96)	0.72(0.43,1.20)	-0.722	0.47
NLR	8.87(7.38,23.69)	13.11(5.75,21.58)	-0.381	0.703
单核细胞(×10⁹/L)	0.45(0.30,0.79)	0.45(0.18,0.69)	-0.593	0.553
嗜酸性粒细胞(×10⁹/L)	0.00(0,0.0225)	0.01(0.00,0.052)	-0.746	0.456
PLT(×10⁹/L)	181.667±99.349	151.666±87.670	1.664	0.099
ALB(g/L)	30.167±6.430	27.041±4.961	2.828	0.006
球蛋白(g/L)	29.546±4.957	26.213±5.028	3.469	0.001
白球比值	1.044±0.249	1.076±0.333	-0.579	0.564
ALT(U/L)	24.00(16.50,42.25)	26.50(16.00,49.25)	-0.787	0.431
AST(U/L)	44.50(22,76.25)	48.50(25.00,82.00)	-0.722	0.47
LDH(U/L)	286.50(203.5,352.75)	536(344,763)	-5.77	0
Cr(μmol/L)	166.20(102.78,349.83)	188.65(81.25,393.85)	-0.12	0.905
Ca(mmol/L)	2.055±0.215	2.061±0.311	-0.110	0.912
K(mmol/L)	4.189±0.837	4.349±0.764	-1.034	0.304
Na(mmol/L)	136.487±9.907	142.776±8.348	-3.567	0.001
CTnI(ng/ml)	0.06(0.02,0.24)	0.13(0.04,0.55)	-1.822	0.068
CKMB(ng/ml)	1.90(0.96,3.69)	2.54(1.33,4.34)	-0.719	0.472
Myo(ng/ml)	189.40(111.28,757.7)	511.05(266.63,1394.25)	-3.005	0.003
NT-ProBNP(pg/ml)	3690.00(1035,10625)	4066.50(1238.5,18900)	-1.023	0.306
PT(s)	13.45(12.68,14.7)	14.8(13.4,16.45)	-3.596	0
APTT(s)	32.65(28.05,38.6)	36.2(28.98,43.85)	-1.272	0.203
PCT(ng/ml)	0.48(0.17,2.23)	1.21(0.42,5.06)	-2.237	0.025
CRP(mg/L)	77.15(12.34,124.95)	116.37(56.23,144.80)	-2.547	0.011
DD(mg/L)	1.82(0.83,4.40)	4.6(2,10)	-3.255	0.001

表3 54例T2DM合并COVID-19死亡患者危险因素二元Logistic回归分析

Tab.3 Binary logistic regression analysis of risk factors in 54 T2DM patients with COVID-19 who died

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
PCO₂	0.122	0.045	7.310	0.007	1.129	1.034~1.233
LDH	0.07	0.002	11.080	0.001	1.007	1.003~1.011

表3 54例T2DM合并COVID-19死亡患者危险因素二元Logistic回归分析

Tab.3 Binary logistic regression analysis of risk factors in 54 T2DM patients with COVID-19 who died

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
PCO₂	0.122	0.045	7.310	0.007	1.129	1.034~1.233
LDH	0.07	0.002	11.080	0.001	1.007	1.003~1.011

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