新型冠状病毒肺炎患者发生重症、危重症危险因素的Meta分析

楼淑萍; 刘攀越; 陈辉

doi:10.16016/j.1000-5404.202003236

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新型冠状病毒肺炎患者发生重症、危重症危险因素的Meta分析

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- 新型冠状病毒肺炎患者发生重症、危重症危险因素的Meta分析
- Risk factors of severe and critical coronavirus disease 2019: a meta-analysis
- 第三军医大学学报 2020年42卷第14期页码：1469-1475
- 作者机构：
  
  1.430030 武汉，华中科技大学同济医学院公共卫生学院：儿少卫生与妇幼保健学系
  2.430030 武汉，华中科技大学同济医学院公共卫生学院：伤害控制研究中心
- 作者简介：
  
  [陈辉，E-mail: chenhui1753@163.comCHEN Hui, E-mail: chenhui1753@163.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202003236
  中图分类号： R181.23;R563.1
- 收稿：2020-03-19，
  
  修回：2020-04-10，
  
  纸质出版：2020-07-30
- 稿件说明：
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楼淑萍, 刘攀越, 陈辉. 新型冠状病毒肺炎患者发生重症、危重症危险因素的Meta分析[J]. 第三军医大学学报, 2020,42(14):1469-1475.

Shuping LOU, Panyue LIU, Hui CHEN. Risk factors of severe and critical coronavirus disease 2019: a meta-analysis[J]. Journal of Third Military Medical University, 2020, 42(14): 1469-1475.
楼淑萍, 刘攀越, 陈辉. 新型冠状病毒肺炎患者发生重症、危重症危险因素的Meta分析[J]. 第三军医大学学报, 2020,42(14):1469-1475. DOI： 10.16016/j.1000-5404.202003236.

Shuping LOU, Panyue LIU, Hui CHEN. Risk factors of severe and critical coronavirus disease 2019: a meta-analysis[J]. Journal of Third Military Medical University, 2020, 42(14): 1469-1475. DOI： 10.16016/j.1000-5404.202003236.

摘要

目的

通过Meta分析研究现有的数据，寻找重/危重型新型冠状病毒肺炎(coronavirus disease 2019

COVID-19)患者的危险因素。

方法

制定原始文献的纳入标准、排除标准，系统检索中国期刊全文数据库(CNKI)、万方数据库、中国生物医学文献服务系统(CBMdisc)、PubMed和EMbase数据库，建立文献库。采用R-3.4.2软件，对符合纳入标准的病例对照文献进行异质性检验，并计算各临床表现和影响因素在重/危重症患者与普通轻型患者中的分布情况、合并效应值(

)和95%可信区间(

)。

结果

本研究共纳入14篇文献共计3 506名患者，分析了31项影响因素，Meta分析的主要结果显示：重/危重型COVID-19患者较普通/轻型患者的年龄大12.62岁(

0.05)，男性(

=1.510)比例更高，入院时乳酸脱氢酶

250 U/L(

=4.177)，胸部CT双侧病变(

=2.260)，患有心血管疾病(

=4.873)、慢阻肺(

=3.425)、高血压(

=2.734)、恶性肿瘤(

=2.629)、糖尿病(2.428)基础疾病的患者发展为重/危重型的可能性更大。入院时，重型组患者临床表现为呼吸困难、发热、乏力、咳痰、干咳，与普通/轻型患者相比差异有统计学意义(

0.05)。

结论

乳酸脱氢酶高、胸部CT双侧病变、患有基础疾病等均是COVID-19重/危重型患者的危险因素，未发现保护因素。

Abstract

Objective

To analyze the risk factors for severe and critical coronavirus disease 2019 (COVID-19) based on current research findings.

Methods

We searched CNKI

Wanfang

CBMdisc

PubMed and Embase databases for original articles according to the prespecified inclusion and exclusion c

riteria. After testing for heterogeneity of all the eligible studies

we analyzed the distribution of the clinical manifestations and the potential risk factors for severe and critical conditions of COVID-19 and calculated the pooled OR with 95%

using R-3.4.2 software.

Results

We retrieved 14 eligible studies from the databases involving a total of 3 506 patients

and analyzed 31 potential risk factors for severe and critical COVID-19. Meta-analysis showed that the patients with severe or critical COVID-19 were 12.62 years older than those with common or mild type of the disease (

0.05). Compared with the patients with common or mild type of COVID-19

the patients in severe or critical conditions were more likely to be male (

=1.510) and had a LDH

250 U/L at admission (

=4.177)

bilateral lesions on chest CT (

=2.260)

and underlying conditions including cardiovascular disease (

=4.873)

COPD (

=3.425)

hypertension (

=2.734)

malignant tumor (

=2.629)

and diabetes (

=2.428). Significant differences were noted in the clinical manifestations including dyspnea

fever

fatigue

sputum

and dry cough between the patients with severe/critical conditions and those with milder conditions when they were admitted (

0.05).

Conclusion

An elevated LDH level (> 250 U/L)

bilateral lesions on chest CT and presence of underlying diseases at admission are all risk factors for severe and critical COVID-19

for which no protective factors have yet been identified.

关键词

Keywords

references

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