《柳叶刀》发现：武汉大多数新冠治愈者，六个月后还存在什么症状？

编辑翻译：奇奇

译文校对：菁菁

文献在2020年1月最新的瑞士医学学术期刊《柳叶刀》（The Lancet）首次刊发，文献关注了中国武汉COVID-19治愈者的长期症状，发现大多数人在痊愈后较长时间仍存在健康问题。

一项新研究可能会再次引起人们对COVID-19治愈者“长期”症状的担忧。研究发现，中国武汉COVID-19治愈者中，有四分之三的人在六个月后依然被至少一个健康问题所困扰。

中国的这项研究涉及了1700多名患者，这些患者大都是2020年1月至5月在武汉被检测出COVID-19，然后研究人员对病例持续追踪到同年6月至9月。研究人员报告说，在初次感染的六个月后，有76％的患者依然还存在至少一种症状。

最常见的症状有疲劳或肌肉无力（63％）、伴有睡眠困难（26％），以及焦虑或抑郁（23％）。

来自北京中日友好医院国家呼吸医学中心和首都医科大学的曹彬主任说：“由于COVID-19是一种新疾病，我们才刚刚了解它对患者健康的某些长期影响。”他的研究小组于1月8日在《柳叶刀》上刊登公布了这一发现。

“我们的研究分析表明，大多数患者出院后仍会受到病毒的一些影响。同时研究强调了出院后护理的必要性，尤其是对那些经历过严重感染的患者来说。”曹彬在一篇文献中说到，“我们工作的着重点是在广泛的患者人群中进行长期的跟踪研究，来了解COVID-19对人类的全部影响。”

中国研究人员说，COVID-19重症患者初次感染六个月后肺功能频繁受损，以及胸部X线检查出现异常，可以表明器官受到了损害。

研究人员表示，肾脏也时常会受到影响。根据实验室的分析测验，在住院期间肾功能正常的患者中，约有13%的患者在COVID-19康复后出现了肾功能下降。

一位美国专家表示，COVID-19治愈后的“恢复”仍然是一个持续的、尚未结束的过程。

“Long COVID是一种逐步发展的综合症。尽管当前文献对早期相关症状的描述已经非常详细，但我们对其长期影响的结果却知之甚少。”纽约史坦顿岛大学医院医学副教授Thomas Gut博士说。他所在医院的患者中也出现了类似的问题。“正如研究所述，我们COVID康复中心的绝大多数患者也都会因为出现的疲劳或脑雾而困扰，这些现象与该研究相吻合。

他说：“自COVID发生以来，我们的许多患者都出现了新发病症状，或者是症状的明显恶化。随着时间的流逝，大多数患者的症状逐渐得到改善，但有些患者在感染后的近一年仍然受到病毒的持续影响。对于许多患者来说，即使经过大量的测试，目前仍无法明确解释他们的持续症状，甚至也没有确切的治疗方案。

还有一位专家认为，医疗护理中心需要为“Long COVID”患者的入住做好准备。

“我们的医疗系统将迎来一些‘Long COVID’患者，这就要求为患者提供持续的护理和康复帮助。”纽约勒诺克斯山医院(Lenox Hill Hospital)的急诊医生 Robert Glatter说，“我们不仅要通过发展卓越中心为此做好计划，也要为这些病人的研究和护理分配好必要的联邦资金。”

Glatter还补充说道，除了经历COVID后的身体问题外，“康复过程中还有心理上的代价，这将直接影响人们恢复生活的方式。在急性感染后漫长痛苦的几个月里，为患者提供适当、充足的资源对帮助其恢复是至关重要的。”

武汉的这项研究还追踪记录了治愈者对COVID-19的长期免疫力。研究发现，六个月后，在感染高峰期进行过免疫反应检测的94名患者中，针对新冠病毒的中和抗体水平下降了一半以上（52.5％）。

这一发现增加了人们对治愈者再次感染病毒的担忧。

Glatter说：“目前，尚不清楚COVID-19感染后的免疫力持续时间。”

但他也指出，在周四的《科学》杂志上发表的另一项研究表明“对COVID-19的天然免疫可能会持续长达八个月，这降低了再次感染的可能性。这是一系列复杂的反应，涉及到抗体、记忆B细胞和不同类型的T细胞。”但是，所有的这一切也意味着，即使对于已经治愈COVID-19的人，仍然有必要接种疫苗。

他说：“我们现在仍然对长期免疫所知甚少，这也让疫苗接种成为应对大流行疾病的重要公共卫生手段之一。疫苗是安全有效的，疫苗接种是实现群体免疫的最有效途径。”

当人群中有足够多的人(约70%)对病毒产生了免疫力，进而有效地阻止病毒的进一步传播，此时就会出现群体免疫。

【英文原文】

Six months later,most Wuhan COVID survivors still have health issues

Concerns about "long-haul" symptoms in COVID-19 survivors may be reignited by a new study: It finds that 3 out of 4 patients from Wuhan, China—where the pandemic originated—were still suffering at least one lingering health problem six months later.

The study from China involved more than 1,700 patients first diagnosed with the virus in Wuhan between January and May, and then followed to June and September.

Researchers report that 76% of these patients had at least one symptom six months after symptoms began.

The most common symptoms were fatigue or muscle weakness (63%) along with trouble sleeping (26%) and anxiety or depression (23%).

"Because COVID-19 is such a new disease, we are only beginning to understand some of its long-term effects on patients' health," said researcher Dr. Bin Cao, from the National Center for Respiratory Medicine at the China-Japan Friendship Hospital and Capital Medical University, both in Beijing. His team published the findings in The Lancet journal Jan. 8.

"Our analysis indicates that most patients continue to live with at least some of the effects of the virus after leaving the hospital, and highlights a need for post-discharge care, particularly for those who experience severe infections," Cao said in a journal news release. "Our work also underscores the importance of conducting longer follow-up studies in larger populations in order to understand the full spectrum of effects that COVID-19 can have on people."

People who had been severely ill with COVID-19 more often had impaired lung function, as well as abnormalities seen in chest X-rays, which could indicate organ damage, six months after symptoms began, the Chinese researchers said.

Kidneys were also often affected. Based on lab tests, about 13% of patients who'd had normal kidney function while they'd been hospitalized showed reduced kidney function after they'd recovered from COVID-19, the researchers said.

One U.S. expert said post-COVID-19 "recovery" remains an ongoing, unfolding story.

"Long COVID is an evolving syndrome. Although the constellation of earlier associated symptoms is fairly well described, little is known about long-term outcomes," said Dr. Thomas Gut, associate chair of medicine at Staten Island University Hospital in New York City. And he's seen similar issues among patients at his hospital.

"As noted in this study, the vast majority of patients seen at our Post-COVID Recovery Center are for complaints of fatigue or brain fog, which both have overlap features with the complaints seen in this study," Gut said.

"Many of our patients report either new onset symptoms since COVID, or significantly worsened symptoms," he noted. "Most of our patients are seeing gradual improvement in symptoms as time passes, but some are still experiencing lingering effects nearly a year after infection. For many patients, there is little clear explanation for their persistent symptoms even after extensive testing and even less clear treatment options at this point."

Another expert believes health care centers need to be prepared for a wave of long COVID patients.

"There will be a wave of patients with long COVID entering our medical systems that will require continuing care and rehabilitation," said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. "We must not only plan for this, by developing centers of excellence, but allocate the necessary federal funds for research and care of these patients."

Beyond the physical issues experienced post-COVID, there's a "psychological toll on recovery, which directly impacts how people are able to resume their lives," Glatter added. "Having appropriate resources in place is essential for aiding recovery in the painful and long months after acute infection."

The Wuhan study also tried to track survivors' longer-term immunity against COVID-19. It found that levels of neutralizing antibodies against the new coronavirus fell by more than half (52.5%) after six months in 94 patients whose immune response was tested at the peak of the infection.

That finding increases concern about the possibility of survivors being reinfected by the virus.

"At this time, the duration of immunity after COVID-19 infection is unclear," Glatter said.

However, he pointed to another study released Thursday in the journal Science that "indicates that natural immunity to COVID-19 may last up to eight months, making the potential for reinfection less likely. It's a complex response involving antibodies, memory B-cells, and different types of T-cells."

But all of this means vaccination is still imperative, even for people who already had COVID-19, Glatter said.

"We still don't know the full picture of longer-term immunity, making vaccination an essential part of the public health approach to this pandemic," he said. "The vaccine is safe and effective and represents the most effective way to reach herd immunity."

Herd immunity occurs when enough people (about 70%) in a population have gained immunity against a virus, effectively stopping its further spread.

参考文献

Chaolin Huang, et al. (2021). 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet. 397(10270), pp. 220-232

本文内容由振东健康网整理发布