恶性肿瘤患者感染2019新型冠状病毒奥密克戎变异株的临床特征分析

Analysis of Clinical Characteristics of the Ma-lignant Tumor Patients Infected with 2019 Novel Coronavirus Omicron Variant

摘要: 目的：探讨恶性肿瘤患者感染2019新型冠状病毒奥密克戎突变株临床特征及临床转归情况。方法：回顾性分析2022年3月20日至2022年5月15日我院收治的感染2019新型冠状病毒奥密克戎变异株的恶性肿瘤住院患者，根据不同年龄段1:1匹配，在数据库中随机抽取该年龄段的感染2019新型冠状病毒奥密克戎变异株非恶性肿瘤住院患者，分为恶性肿瘤组和非恶性肿瘤组，分析比较两组患者流行病学资料、实验室检查和临床转归情况，同时观察恶性肿瘤组不同治疗方案对临床转归的影响。结果：收集142例患者，恶性肿瘤组和非恶性肿瘤组分别71例。恶性肿瘤组患者平均年龄62.89 ± 12.79岁，临床表现以咳嗽(36.6%)、乏力(21.1%)、肌肉酸痛(18.3%)、发热(14.1%)为主，临床分为轻型39例(54.9%)、无症状18例(25.4%)，有25.4%的恶性肿瘤组病人患有高血压、11.3%的患有冠心病、分别有7%的病人患有糖尿病和慢性阻塞性肺疾病。临床表现和疾病分型两组无差别。恶性肿瘤组患者接种疫苗剂次显著低于非恶性肿瘤组(0.69 ± 1.09剂 vs 1.68 ± 1.31剂)。恶性肿瘤组患者IL-2受体(696.24 ± 442.07 U/ml vs 517.31 ± 210.92 U/ml)、IL-6 (20.75 ± 47.19 pg/ml vs 7.65 ± 14.79 pg/ml)、TNF-α (10.78 ± 9.19 pg/ml vs 7.64 ± 3.48 pg/ml)、CRP (25.13 ± 40.79 mg/L vs 10.51 ± 17.45 mg/L)、血清淀粉蛋白A (71.81 ± 102.64 mg/L vs 42.24 ± 70.52 mg/L)、纤维蛋白原定量(4.06 ± 1.39 g/L vs 3.61 ± 1.01 g/L)均高于非恶性肿瘤组，且均高于正常参考值；两组患者的D-二聚体及肝素结合蛋白均高于正常值范围，但无差别。核酸双阴时间(14.38 ± 6.6 d vs 12.02 ± 4.83 d)、总住院时间(14.21 ± 6.89 d vs 11.8 ± 4.25 d)比较，恶性肿瘤组均多于非恶性肿瘤组。恶性肿瘤组不同治疗方案对临床转归结果显示中药 + Paxlovid组(11.05 ± 3.78 d)在核酸首次转阴时间少于Paxlovid组(16.42 ± 7.65 d)。结论：奥密克戎突变株感染恶性肿瘤患者相比非恶性肿瘤患者存在疫苗接种剂次少、炎症反应重及高凝状态的临床特点，同时核酸转阴及住院时间更长，中医药的全程介入治疗可能对患者的病毒清除有益。

Abstract: Objective: To investigate the clinical characteristics and clinical outcomes of 2019 novel coronavirus Omicron variant infected malignant tumor patients. Methods: Retrospective analysis of hospitalized patients with malignant tumors infected with 2019 novel coronavirus Omicron variant in our hos-pital from March 20, 2022 to May 15, 2022, according to the principle of 1:1 matching in different age groups; non malignant inpatients infected with the Omicron variant of covid-19 were randomly selected from the database, divided into malignant tumor group and non malignant tumor group. The epidemiological data, laboratory data and clinical outcomes of the two groups were compared, and the effects of different treatment schemes in the malignant tumor group on clinical outcomes were analyzed. Results: A total of 142 patients were collected, including 71 patients in the malig-nant tumor group and 71 patients in the non malignant tumor group. The average age of patients in the malignant tumor group was 62.89 ± 12.79 years. The main clinical symptoms were cough (36.6%), fatigue (21.1%), muscle soreness (18.3%), and fever (14.1%). According to clinical classi-fication, 39 cases (54.9%) were mild and 18 cases (25.4%) were asymptomatic. 25.4% of the pa-tients in the malignant tumor group had hypertension, 11.3% had coronary atherosclerotic heart disease, and 7% had diabetes and chronic obstructive pulmonary disease respectively. There was no difference in clinical symptoms and disease classification between the two groups. The doses of vaccinations in the malignant tumor group were significantly lower than that in the non malignant tumor group (0.69 ± 1.09 doses vs 1.68 ± 1.31 doses). The serum levels of IL-2 receptor (696.24 ± 442.07 U/ml vs 517.31 ± 210.92 U/ml), IL-6 (20.75 ± 47.19 pg/ml vs 7.65 ± 14.79 pg/ml), TNF-α (10.78 ± 9.19 pg/ml vs 7.64 ± 3.48 pg/ml), CRP (25.13 ± 40.79 mg/L vs 10.51 ± 17.45 mg/L), serum amyloid A (71.81 ± 102.64 mg/L vs 42.24 ± 70.52 mg/L), and fibrin (4.06 ± 1.39 g/L vs 3.61 ± 1.01 g/L) in the malignant tumor group were higher than those in the non malignant tumor group, and were higher than the normal reference value. The D-dimer and heparin binding protein of the two groups were higher than the normal reference value range, but there was no difference. Compared with the times of nucleic acid turning negative for two consecutive times (14.38 ± 6.6 d vs 12.02 ± 4.83 d) and the total hospitalization times (14.21 ± 6.89 d vs 11.8 ± 4.25 d), the malignant tumor group was longer than the non malignant tumor group. The clinical outcomes of different treatment schemes in the malignant tumor group showed that the first negative times of nucleic acid in the traditional Chinese Herbal + paxlovid group (11.05 ± 3.78 d) were less than that in the paxlovid group (16.42 ± 7.65 d). Conclusions: Compared with patients with non malignant tumors, patients with malignant tumors infected with 2019 novel coronavirus Omicron variant have the clinical characteristics of less vaccinations, more severe inflammatory reaction and hypercoagulable state. At the same time, nucleic acid turns negative and the hospitalization times are longer. The treat-ment of traditional Chinese medicine may be beneficial to the virus clearance of patients.