2023 年第 5 期 第 18 卷

新型冠状病毒奥密克戎变异株感染患者淋巴细胞计数与预后的相关性研究

Research on the relationship between lymphocyte count and prognosis of patients infected with novel coronavirus Omicron variant

作者：史雨晨1张泽华2王丽琨3秦彦文4郑泽1刘严慈1申学谦1柳景华1

英文作者：Shi Yuchen1 Zhang Zehua2 Wang Likun3 Qin Yanwen4 Zheng Ze1 Liu Yanci1 Shen Xueqian1 Liu Jinghua1

单位：1首都医科大学附属北京安贞医院心内科，北京100029;2贵州医科大学临床医学院，贵阳550004;3贵州医科大学附属医院急诊医学科，贵阳550004；4首都医科大学附属北京安贞医院北京市心肺血管疾病研究所，北京100029

英文单位：1Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2School of Clinical Medicine Guizhou Medical University Guiyang 550004 China; 3Emergency Medicine Department Affiliated Hospital of Guizhou Medical University Guiyang 550004 China; 4Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：新型冠状病毒感染；淋巴细胞计数；奥密克戎变异株

英文关键词：Novelcoronavirusinfection;Lymphocytecount;Omicronvariants

• 摘要：

• 目的 探讨新型冠状病毒奥密克戎变异株感染患者淋巴细胞计数与预后关系。方法 收集首都医科大学附属北京安贞医院2022年12月8日至2023年1月31日在院且于2023年2月1日前出院的新型冠状病毒奥密克戎变异株感染1 313例患者的病历资料；根据淋巴细胞计数三分位数将患者分为3组，T1组（淋巴细胞计数≤0.59×109/L）433例；T2组［淋巴细胞计数（＞0.59～1.07）×109/L］437例；T3组（淋巴细胞计数＞1.07×109/L）443例。比较3组患者一般资料，采用Kaplan-Meier生存曲线分析各组患者生存情况。根据临床预后，将患者分为存活组与死亡组，使用限制性立方样条图分析患者淋巴细胞计数与预后关系，使用Cox回归模型分析不同模型中各指标与患者预后关系。结果  1 313例新型冠状病毒奥密克戎变异株感染患者，存活1 038例（79.1%），死亡275例（20.9%）。T1组死亡比例、男性比例、年龄大于T2、T3组，体重指数小于T2、T3组（均P<0.05）。死亡组患者全程淋巴细胞计数均低于存活组，差异均有统计学意义（均P<0.001）。Kaplan-Meier生存曲线结果显示，T1组累积死亡率显著高于T2、T3组（P＜0.001）。Cox回归分析结果显示，模型1（调整性别、年龄、体重指数）、模型2（模型1+既往病史）、模型3（模型2+血常规指标）校正后入院淋巴细胞计数均与患者预后显著相关（风险比分别为0.32、0.27、0.46，均P＜0.01）。模型3校正后，限制性立方样条图显示，入院淋巴细胞计数与患者预后呈非线性关系（P=0.003）；当入院淋巴细胞计数＜0.844×109/L时，淋巴细胞计数降低与死亡风险升高相关（风险比=0.122，95%置信区间：0.054～0.275，P＜0.001）。结论   新型冠状病毒奥密克戎变异株感染患者入院淋巴细胞计数与预后呈非线性关系，淋巴细胞计数＜0.844×109/L时，淋巴细胞计数越低，患者死亡风险越大。

• Objective  To investigate the relationship between lymphocyte count and prognosis of patients infected with novel coronavirus Omicron variant. Methods The medical records of 1 313 patients infected with novel coronavirus Omicron variant who hospitalized in Beijing Anzhen Hospital, Capital Medical University from December 8, 2022 to January 31, 2023 and discharged before February 1, 2023 were collected. Patients were divided into three groups according to the three quantiles of lymphocyte count, T1 group (lymphocyte count ≤ 0.59×109/L) 433 cases, T2 group ［lymphocyte count(>0.59-1.07)×109/L］ 437 cases and T3 group (lymphocyte count>1.07×109/L) 443 cases. The general data of patients in the three groups were compared, and Kaplan-Meier survival curve were used to analyze the survival situation of patients in each group. According to clinical prognosis, patients were divided into survival group and death group. Cox regression model was used to analyze the relationship between various indicators in different models and the prognosis of patients. ResultsOf 1 313 patients infected with novel coronavirus Omicron variant, 1 038 cases (79.1%) survived and 275 cases (20.9%) died. The proportions of deaths and male and age in T1 group were greater than T2 and T3 groups, and body mass index was less than T2 and T3 groups (all P<0.05). The total lymphocyte count of patients in the death group was lower than that in the survival group（P<0.001）. Kaplan-Meier survival curve results showed that the cumulative mortality rate in T1 group was higher than those in T2 and T3 groups（P＜0.001）. Cox regression analysis results showed that the admission lymphocyte counts of model 1 (adjusted for gender, age and body mass index), model 2 (model 1 and chronic underlying medical conditions history) and model 3 (model 2 and blood routine indicators) after correction were significantly correlated with the prognosis of patients (risk ratios were respectively 0.32, 0.27 and 0.46, all P<0.01). After correction, model 3 showed a non-linear relationship between the admission lymphocyte count and the prognosis of patients (P=0.003). The decreased lymphocyte count was associated with the increased risk of death when the admission lymphocyte count was less than 0.844×109/L (hazard ratio=0.122, 95% confidence interval: 0.054-0.275, P<0.001). Conclusion There is a non-linear relationship between the admission lymphocyte count and the prognosis of patients infected with novel coronavirus Omicron variant. The lower the lymphocyte count, the greater the risk of death in patients when the lymphocyte count was less than 0.844×109/L.