糖脂代谢在新型冠状病毒肺炎普通型和重型患者中的特点分析及比较

doi:10.3969/j.issn.1674-8115.2021.03.012

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (3): 355-359.doi: 10.3969/j.issn.1674-8115.2021.03.012

糖脂代谢在新型冠状病毒肺炎普通型和重型患者中的特点分析及比较

岳江¹(), 周勇²(), 徐华¹, 刘文¹, 韩晓凤³, 毛青⁴, 张继东⁵, 麻静¹, 蒋捍东⁶(), 刘伟¹()

^1.上海交通大学医学院附属仁济医院内分泌代谢病科，上海 200127
^2.上海交通大学医学院附属仁济医院心血管内科，上海 200127
^3.上海交通大学医学院附属仁济医院血液科，上海 200127
^4.上海交通大学医学院附属仁济医院神经外科，上海 200127
^5.上海交通大学医学院附属仁济医院医务处，上海 200127
^6.上海交通大学医学院附属仁济医院呼吸内科，上海 200127

收稿日期:2020-04-30 出版日期:2021-03-28 发布日期:2021-04-06
通讯作者: 蒋捍东,刘伟 E-mail:rjnfm3083@163.com;15021876139@163.com;jianghd@163.com;sue_liuwei@163.com
作者简介:岳江（1983—），男，主治医师，博士；电子信箱：rjnfm3083@163.com|周勇（1976—），男，副主任医师，博士；电子信箱：15021876139@163.com。

Characteristic analysis and comparison of glycolipid metabolism in patients with coronavirus disease 2019 in common condition and severe cases

Jiang YUE¹(), Yong ZHOU²(), Hua XU¹, Wen LIU¹, Xiao-feng HAN³, Qing MAO⁴, Ji-dong ZHANG⁵, Jing MA¹, Han-dong JIANG⁶(), Wei LIU¹()

^1.Division of Endocrinology and Metabolism, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Division of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^3.Division of Hematology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^4.Division of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^5.Division of Medical Department, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^6.Division of Respiration, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2020-04-30 Online:2021-03-28 Published:2021-04-06
Contact: Han-dong JIANG,Wei LIU E-mail:rjnfm3083@163.com;15021876139@163.com;jianghd@163.com;sue_liuwei@163.com

摘要/Abstract

摘要：

目的·分析比较新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）普通型和重型患者的糖脂代谢特点。方法·2020年2—3月，将武汉雷神山医院普通病房住院的36例COVID-19普通型患者和重症监护室（intensive care unit，ICU）的50例COVID-19重型患者设为普通型患者组和重型患者组，对他们的电子病历进行提取和分析。收集2组的人口学资料、临床资料、实验室检查结果、合并疾病和临床结局，并采用独立样本t检验、非参数检验、χ²检验等比较2组之间的差异。从糖脂代谢角度初步分析COVID-19普通型和重型患者的特点及患者入住ICU的相关因素。结果·2组患者的性别、合并糖尿病或冠心病的人数间无统计学差异；重型患者平均年龄较普通型患者明显偏大（P<0.05）；重型患者组患高血压的比例（52.0%）显著高于普通型患者（22.2%）（P<0.05）；重型患者组淋巴细胞计数明显低于普通型患者组（P<0.05）；2组患者间谷丙转氨酶、谷草转氨酶、血清肌酐、血尿酸值无统计学差异；重型患者组血清白蛋白、校正钙离子浓度、总胆固醇、三酰甘油、高密度脂蛋白和低密度脂蛋白均显著低于普通型患者组（均P<0.05）；重型患者组的空腹血糖水平显著高于普通型患者组（P=0.001）。多因素Logistic回归发现空腹血糖、总胆固醇、高密度脂蛋白、低密度脂蛋白、血清白蛋白水平与COVID-19患者入住ICU存在一定的相关性。结论·COVID-19患者，尤其是重型患者，存在更加严重的糖脂代谢紊乱。空腹血糖、总胆固醇、高密度脂蛋白、低密度脂蛋白和血清白蛋白水平可能与患者入住ICU相关。

关键词: 新型冠状病毒肺炎, 普通型患者, 重型患者, 糖脂代谢

Abstract:

Objective·To analyze and compare the characteristics of glycolipid metabolism between common and severe patients with coronavirus disease 2019 (COVID-19).

Methods·Thirty-six patients with COVID-19 were hospitalized in the general ward of Wuhan Leishenshan Hospital and fifty severe patients with COVID-19 in intensive care unit (ICU) from February to March, 2020. All the patients were divided into two groups: the common patient group and the severe patient group. Their electronic medical records were extracted and analyzed. The demographic data as well as clinical data, laboratory results, comorbidities and clinical outcomes in the two groups were collected and compared by independent sample t test, non-parametric test as well as χ² test. From the metabolic point of view, the characteristics of glucose and lipid metabolism in COVID-19 common and severe patients and the possible related factors for patients staying in ICU were analyzed.

Results·There was no significant difference between the two groups in terms of gender, number of patients with diabetes and coronary heart disease (CAD). The average age of severe patients was significantly older than that of the common patients (P<0.05). The proportion of the severe patients with hypertension (52.0%) was significantly higher than that of the common patients (22.2%) (P<0.05). The lymphocyte count of the severe patients was significantly lower than that of the common patients (P<0.05). There was no significant difference in glutamic-pyruvic transaminase (GPT), glutamic-oxaloacetic transaminase (GOT), serum creatinine (Scr) and blood uric acid (BUA) between the two groups. Blood serum albumin (ALB), adjusted calcium concentration (Ca_c), total cholesterol (TC), triacylglycerols (TAG), high density lipoprotein (HDL) and the low density lipoprotein (LDL) in the severe patients were significantly lower than those in the common patients (all P<0.05). Fasting blood glucose (FBG) in the severe patients was significantly higher than that in the common patients (P=0.001). Multivariate Logistic regression showed that the increase of FBG and the decrease of TC, HDL, LDL, ALB were related to COVID-19 patients staying in ICU.

Conclusion·There are deteriorative disorders in terms of glucose and lipid metabolism among the severe patients with COVID-19. The FBG, TC, HDL, LDL and ALB may related to the admission of ICU.

Key words: coronavirus disease 2019 (COVID-19), common patient, severe patient, glycolipid metabolism

中图分类号:

R373.1

岳江, 周勇, 徐华, 刘文, 韩晓凤, 毛青, 张继东, 麻静, 蒋捍东, 刘伟. 糖脂代谢在新型冠状病毒肺炎普通型和重型患者中的特点分析及比较[J]. 上海交通大学学报(医学版), 2021, 41(3): 355-359.

Jiang YUE, Yong ZHOU, Hua XU, Wen LIU, Xiao-feng HAN, Qing MAO, Ji-dong ZHANG, Jing MA, Han-dong JIANG, Wei LIU. Characteristic analysis and comparison of glycolipid metabolism in patients with coronavirus disease 2019 in common condition and severe cases[J]. JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE), 2021, 41(3): 355-359.

图/表 4

参考文献 14

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Item	Common group (N=36)	Severe group (N=50)	t/χ²value	P value
Gender/n			0.284	0.416
Male	21	32
Female	15	18
Age/year	52±15	68±12	-5.382	0.000
Diabetes/n (%)	5 (13.9)	10 (20.0)	0.543	0.570
Hypertension/n (%)	8 (22.2)	26 (52.0)	7.764	0.005
CHD/n (%)	2 (5.6)	10 (20.0)	3.637	0.066

Item	Common group (N=36)	Severe group (N=50)	t/χ²value	P value
Gender/n			0.284	0.416
Male	21	32
Female	15	18
Age/year	52±15	68±12	-5.382	0.000
Diabetes/n (%)	5 (13.9)	10 (20.0)	0.543	0.570
Hypertension/n (%)	8 (22.2)	26 (52.0)	7.764	0.005
CHD/n (%)	2 (5.6)	10 (20.0)	3.637	0.066

Index	Common group (N=36)	Severe group (N=50)	t value	P value
Lymphocyte count/(10⁹×L^-1)	1.70±0.67	0.77±0.46	7.096	0.000
GPT/(U·L^-1)	34.74±20.41	81.09±232.68	-1.156	0.251
GOT/(U·L^-1)	25.41±13.91	149.93±615.38	-1.178	0.242
Scr/(μmol·L^-1)	61.46±11.54	61.45±13.06	0.002	0.999
BUA/(mmol·L^-1)	336.49±113.64	289.19±102.99	0.119	0.223
ALB/(g·L^-1)	38.89±3.62	29.69±4.62	9.746	0.000
FBG/(mmol·L^-1)	5.25±1.89	8.25±5.40	-3.359	0.001
Ca_c/(mmol·L^-1)	2.25±0.08	2.19±0.16	2.364	0.031
TC/(mmol·L^-1)	4.55±0.94	3.03±1.16	6.332	0.000
TAG/(mmol·L^-1)	1.73±1.23	1.10±0.92	2.627	0.010
HDL/(mmol·L^-1)	1.21±0.33	0.87±0.35	4.457	0.000
LDL/(mmol·L^-1)	2.69±0.64	1.92±0.70	5.065	0.000

Index	Common group (N=36)	Severe group (N=50)	t value	P value
Lymphocyte count/(10⁹×L^-1)	1.70±0.67	0.77±0.46	7.096	0.000
GPT/(U·L^-1)	34.74±20.41	81.09±232.68	-1.156	0.251
GOT/(U·L^-1)	25.41±13.91	149.93±615.38	-1.178	0.242
Scr/(μmol·L^-1)	61.46±11.54	61.45±13.06	0.002	0.999
BUA/(mmol·L^-1)	336.49±113.64	289.19±102.99	0.119	0.223
ALB/(g·L^-1)	38.89±3.62	29.69±4.62	9.746	0.000
FBG/(mmol·L^-1)	5.25±1.89	8.25±5.40	-3.359	0.001
Ca_c/(mmol·L^-1)	2.25±0.08	2.19±0.16	2.364	0.031
TC/(mmol·L^-1)	4.55±0.94	3.03±1.16	6.332	0.000
TAG/(mmol·L^-1)	1.73±1.23	1.10±0.92	2.627	0.010
HDL/(mmol·L^-1)	1.21±0.33	0.87±0.35	4.457	0.000
LDL/(mmol·L^-1)	2.69±0.64	1.92±0.70	5.065	0.000

Index	β value	OR value	P value	95% CI
FBG	0.417	1.518	0.028	1.045?2.205
TC	-1.236	0.290	0.048	0.085?0.990
HDL	-3.191	0.041	0.029	0.002?0.718
LDL	-1.699	0.183	0.015	0.046?0.723
ALB	0.048	1.049	0.010	1.011?1.088

糖脂代谢在新型冠状病毒肺炎普通型和重型患者中的特点分析及比较

Characteristic analysis and comparison of glycolipid metabolism in patients with coronavirus disease 2019 in common condition and severe cases

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Metrics

Index	On admission	Last test before clinical outcome	t value	P value
FBG/(mmol·L^-1)	8.25±5.40	8.61±4.13	-0.198	1.000
TC/(mmol·L^-1)	4.55±0.94	2.44±1.21	4.573	0.000
TAG/(mmol·L^-1)	1.73±1.23	1.09±0.67	3.048	0.009
HDL/(mmol·L^-1)	1.21±0.33	0.63±0.28	4.798	0.000
LDL/(mmol·L^-1)	2.69±0.64	1.54±0.88	4.894	0.000

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