新型冠状病毒肺炎后继发肺纤维化危险因素分析

Analysis of Risk Factors for Post-COVID-19 Pulmonary Fibrosis

摘要: 目的：探讨Omicron变异株感染的新型冠状病毒肺炎(COVID-19)患者继发新冠病毒后肺纤维化(PCPF)的危险因素，为早期识别高风险患者和制定个性化干预策略提供依据。方法：回顾性分析2022年11月至2023年12月期间重庆医科大学附属第二医院137例Omicron变异株感染的COVID-19患者。系统收集患者的基本信息、临床特征、实验室指标(包括C反应蛋白、白细胞介素-6等)、新型免疫–炎症指标(C反应蛋白与淋巴细胞比值、中性粒细胞与血小板比值、系统性免疫炎症指数、系统性炎症反应指数、预后营养指数)以及胸部CT影像学表现。通过单因素分析和多因素Logistic回归分析筛选与PCPF相关的危险因素。结果：单因素分析显示，7个指标与PCPF显著相关(P < 0.05)，包括C反应蛋白、白细胞介素-6以及5个新型免疫–炎症指标。多因素Logistic回归分析进一步确定白细胞介素-6 (OR = 1.017, 95%CI: 1.004~1.030)和预后营养指数(OR = 0.907, 95%CI: 0.842~0.969)为PCPF的独立危险因素。非PCPF组和PCPF组在临床特征和CT影像学表现上无显著差异(P > 0.05)。结论：IL-6和PNI是Omicron感染患者继发PCPF的独立危险因素，提示炎症反应和营养免疫状态在PCPF的发生发展中起关键作用，早期识别这些危险因素有助于制定个性化干预策略。

Abstract: Objective: To explore the risk factors for post-COVID-19 pulmonary fibrosis (PCPF) in patients infected with the Omicron variant of COVID-19, and to provide a basis for early identification of high-risk patients and the development of personalized intervention strategies. Methods: A retrospective analysis was conducted on the data of 137 Omicron-infected patients from November 2022 to December 2023. Clinical data, laboratory indicators (including CRP, IL-6, etc.), novel immune-inflammatory markers (CLR, NPR, SII, SIRI, PNI), and CT imaging findings were collected. Univariate and multivariate logistic regression analyses were performed to identify risk factors associated with PCPF. Results: Univariate analysis showed that CRP, IL-6, CLR, NPR, SII, SIRI, and PNI were significantly associated with PCPF (P < 0.05). Multivariate logistic regression analysis indicated that IL-6 (OR = 1.017, 95%CI: 1.004~1.030) and PNI (OR = 0.907, 95%CI: 0.842~0.969) were independent risk factors for PCPF. There were no significant differences in clinical characteristics and CT imaging findings between the non-PCPF and PCPF groups (P > 0.05). Conclusion: IL-6 and PNI are independent risk factors for PCPF in Omicron-infected patients, suggesting that inflammatory responses and nutritional immune status play critical roles in the development of PCPF. Early identification of these risk factors can help in formulating personalized intervention strategies.