常见慢性疾病与新型冠状病毒肺炎患者重症化风险的系统评价及荟萃分析

目的:探讨合并各种常见慢性疾病与新型冠状病毒肺炎(COVID-19)患者重症化风险的相关性。方法:检索PubMed、Embase、Cochrane等外文数据库,中国知网数据库、万方数据库、中国生物医学文献数据库等中文数据库,以及3个预印文本网站(medRxiv、SSRN和ChinaXiv)中2020年1月24日至3月5日发表的有关重症、非重症COVID-19患者合并慢性疾病的临床和流行病学研究。分析COVID-19患者合并慢性阻塞性肺疾病、糖尿病、高血压、恶性肿瘤、心血管疾病、脑血管疾病、慢性肾脏病和慢性肝脏疾病的患病率,并计算重症患者、非重症患者常见慢性疾病患病率的比值比(odds ratio,OR)和95%可信区间(confidence interval,CI)。采用R 3.6.3软件进行荟萃分析。结果:从2455篇相关文献中筛选纳入19篇文献,共计4792例患者进行分析。COVID-19患者中男性占55.0%(95%CI 40.0%~80.0%),合并慢性疾病的总体患病率为30.4%(95%CI 24.0%~37.0%)。其中最常见的是高血压[16.9%(95%CI 14.0%~20.0%)],其次是糖尿病[8.3%(95%CI 8.0%~9.0%)]。重症COVID-19患者中男性的比例高于非重症患者(64.4%比52.8%,OR=1.49,95%CI 1.08~2.05,Z=4.63,P<0.01)。重症患者合并慢性阻塞性肺疾病、脑血管疾病、糖尿病、慢性肾脏病、高血压、心血管疾病、恶性肿瘤的患病率分别是非重症患者的5.77倍(95%CI 3.80~8.74)、4.47倍(95%CI 2.71~7.38)、3.55倍(95%CI 2.86~4.40)、3.05倍(95%CI 1.76~5.28)、2.82倍(95%CI 1.96~3.97)、2.39倍(95%CI 1.77~3.23)、2.15倍(95%CI 1.27~3.66),两组间差异均有统计学意义(Z=8.37、6.01、11.60、4.20、5.46、5.71、3.12,均P<0.01)。重症患者慢性肝脏疾病的患病率与非重症患者相比差异无统计学意义(OR=1.35,95%CI 0.84~2.17,P=0.11)。结论:伴有慢性疾病的COVID-19患者重症化风险较高,由高到低依次为慢性阻塞性肺疾病、脑血管疾病、糖尿病、慢性肾脏病、高血压、心血管疾病、恶性肿瘤。

A systematic review and meta-analysis of severe risk in patients with common chronic diseases and coronavirus disease 2019

Objective To systematically review the severe risk in common chronic diseases and coronavirus disease 2019(COVID-19)cases.Methods PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure,Wanfang Database,China Biology Medicine disc,medRxiv,SSRN and ChinaXiv were searched for clinical and epidemiological studies that reported chronic diseases in patients with COVID-19.Only studies of severe COVID-19 in comparison with non-severe controls were included.The prevalence rates of chronic diseases including chronic obstructive pulmonary disease(COPD),diabetes mellitus,hypertension,malignant tumor,cardiovascular diseases,cerebrovascular disease,chronic kidney disease,and chronic liver disease were estimated.Pooled odds ratio(OR)with 95%confidence interval(CI)between patients with severe COVID-19 and non-severe groups were calculated.R 3.6.3 software was used for meta-analysis.Results The search yielded 2455 articles.A total of 19 eligible comparative studies with 4792 patients were included in a quantitative analysis.Meta-analysis showed that there was a proportion of 55.0%(95%CI 40.0%-80.0%)male among patients with COVID-19,and the overall pooled prevalence of any chronic diseases in COVID-19 cases was 30.4%(95%CI 24.0%-37.0%).The most prevalent comorbidity was hypertension(16.9%(95%CI 14.0%-20.0%)),followed by diabetes mellitus(8.3%(95%CI 8.0%-9.0%)).The proportion of male patients with severe COVID-19 was higher than that of male patients with non-severe COVID-19(64.4%vs 52.8%,OR=1.49,95%CI 1.08-2.05,Z=4.63,P<0.01).The prevalence rates of COPD,cerebrovascular disease,diabetes mellitus,chronic kidney disease,hypertension,cardiovascular diseases and malignant tumor in severe COVID-19 patients were higher than those of non-severe patients(OR=5.77,95%CI 3.80-8.74;OR=4.47,95%CI 2.71-7.38;OR=3.55,95%CI 2.86-4.40;OR=3.05,95%CI=1.76-5.28;OR=2.82,95%CI=1.96-3.97;OR=2.39,95%CI=1.77-3.23;OR=2.15,95%CI 1.27-3.66,respectively,Z=8.37,6.01,11.60,4.20,5.46,5.71,3.12,all P<0.01).There was no significant difference in the prevalence of chronic liver disease between severe and non-severe patients(OR=1.35,95%CI 0.84-2.17,P=0.11).Conclusion COVID-19 patients with chronic diseases have higher risk of developing severe disease,and the ORs from high to low are COPD,cerebrovascular disease,diabetes mellitus,chronic kidney disease,hypertension,cardiovascular diseases and malignant tumor.