高脂血症与新型冠状病毒肺炎住院患者28天全因死亡率的关系

吴斌; 周江华; 汪文鑫; 杨慧琳; 夏盟; 张丙宏; 折志刚; 李红良

doi:10.24920/003866

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高脂血症与新型冠状病毒肺炎住院患者28天全因死亡率的关系

中国医学科学杂志（英文版） 2021年36卷第1期页码：17-26

论著 | Updated：2024-04-10

- 高脂血症与新型冠状病毒肺炎住院患者28天全因死亡率的关系
- Affiliations：
  
  1. 1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430071, China
  2. 2Institute of Model Animal, Wuhan University, Wuhan 430071, China
  3. 3Basic Medical School, Wuhan University, Wuhan 430071, China
  4. 4Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan 430072, China
  5. 5Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Author bio：
  
  * Hongliang Li, E-mail: lihl@whu.edu.cn; phone: 86-27-68759302; Fax: 86-27-68759302.
- Funds：
  
  This work was supported by grants from National Key R&D Program of China;国家重点研发计划重大科学仪器设备开发重点专项2016年度项目基金(2016YFF0101500);the National Natural Science Foundation of China国家自然科学基金。(81970364);the National Natural Science Foundation of China国家自然科学基金。(81770053)
- DOI：10.24920/003866
  中图分类号：
- 收稿日期：2021-02-09，
  
  录用日期：2021-3-5，
  
  网络出版日期：2021-03-17，
  
  纸质出版日期：2021-03-17
- Accepted：
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吴斌, 周江华, 汪文鑫, 等. 高脂血症与新型冠状病毒肺炎住院患者28天全因死亡率的关系[J]. 中国医学科学杂志（英文版）, 2021,36(1):17-26.

Wu Bin, Zhou Jianghua, Wang Wenxin, et al. Association Analysis of Hyperlipidemia with the 28-Day All-Cause Mortality of COVID-19 in Hospitalized Patients[J]. Chinese medical sciences journal, 2021, 36(1): 17-26.
吴斌, 周江华, 汪文鑫, 等. 高脂血症与新型冠状病毒肺炎住院患者28天全因死亡率的关系[J]. 中国医学科学杂志（英文版）, 2021,36(1):17-26. DOI： 10.24920/003866.

Wu Bin, Zhou Jianghua, Wang Wenxin, et al. Association Analysis of Hyperlipidemia with the 28-Day All-Cause Mortality of COVID-19 in Hospitalized Patients[J]. Chinese medical sciences journal, 2021, 36(1): 17-26. DOI： 10.24920/003866.

摘要

目的

本研究旨在确定高脂血症与COVID-19住院患者的临床终点之间的关联

尤其是那些伴随心血管疾病（cardiovascular diseases

CVDs）和糖尿病的COVID-19患者。

方法

这项多中心回顾性队列研究搜集2019年12月31日至2020年4月21日期间中国湖北省21家医院全部确诊COVID-19的住院患者。我们排除了年龄

18岁或≥85岁、处于妊娠期间、患有急性致死性器官损伤（如急性心肌梗塞

严重的急性胰腺炎或急性中风）、甲状腺功能减退、恶性疾病、严重的营养不良以及因服用降脂药物（如他汀类

烟酸

非诺贝特或吉非贝齐

依泽替米贝）而血脂正常的患者。采用1:1倾向性评分匹配（Propensity score matching

PSM）控制高脂血症组和非高脂血症组的患者的基线特征差异

并以相同的PSM策略对不同高脂血症参数亚组进行匹配

包括甘油三酸酯（triglyceride

TG）升高组

低密度脂蛋白胆固醇(low-density lipoprotein cholesterol

LDL-C)升高组和高密度脂蛋白胆固醇（high-density lipoprotein cholesterol

HDL-C）降低组。采取混合效应Cox模型分析总体以及各亚组内高脂血症与COVID-19患者28天全因死亡率之间的相关性

并分别在男性、女性、伴有CVDs及伴有2型糖尿病患者的亚组中对结果进行验证分析。

结果

在10 945例住院的COVID-19患者中

共9822例纳入研究

包括6309例（64.2%）血脂升高患者和3513例（35.8%）血脂正常患者。按1:1的倾向性评分匹配后经混合效应Cox模型分析显示

与血脂正常组相比

高脂血症不显著增加或减少COVID-19患者28天全因死亡风险（

=1.17

95%

0.95~1.44

=0.151）。COVID-19患者预后与血脂各参数异常亦无显著关联

包括TG升高(

=1.23

95%

0.98~1.55

=0.075)

LDL-C升高（

=0.78;95%

0.57~1.07

=0.123）

以及HDL-C降低（

=1.12

95%

0.90~1.39

=0.299）。在伴有心血管疾病、伴有糖尿病的COVID-19患者亚组中

以及在男性或女性COVID-19患者亚组中

高脂血症与COVID-19全因死亡率均无显著相关性。

结论

我们的研究表明

即使在伴有心血管疾病和伴有糖尿病的患者中

脂质分布失衡与COVID-19的28天全因死亡率也无显着相关性。分别对TG

HDL-C及LDL-C脂质参数的高脂血症亚组分析也获得了相似的结果。因此

脂质失衡可能不是导致与心血管代谢性疾病相关的COVID-19不良预后的主要原因。该结果为COVID-19流行期间住院患者的干预提供了参考。

Abstract

Objective

This study aimed to determine the association of hyperlipidemia with clinical endpoints among hospitalized patients with COVID-19

especially those with pre-existing cardiovascular diseases (CVDs) and diabetes.

Methods

This multicenter retrospective cohort study included all patients who were hospitalized due to COVID-19 from 21 hospitals in Hubei province

China between December 31

2019 and April 21

2020. Patients who were aged

18 or ≥ 85 years old

in pregnancy

with acute lethal organ injury (e.g.

acute myocardial infarction

severe acute pancreatitis

acute stroke)

hypothyroidism

malignant diseases

severe malnutrition

and those with normal lipid profile under lipid-lowering medicines (e.g.

statin

niacin

fenofibrate

gemfibrozil

and ezetimibe) were excluded. Propensity score matching (PSM) analysis at 1:1 ratio was performed to minimize baseline differences between patient groups of hyperlipidemia and non-hyperlipidemia. PSM analyses with the same strategies were further conducted for the parameters of hyperlipidemia in patients with increased triglyceride (TG)

increased low-density lipoprotein cholesterol (LDL-C)

and decreased high-density lipoprotein cholesterol (HDL-C). Mixed-effect Cox model analysis was performed to investigate the associations of the 28-days all-cause deaths of COVID-19 patients with hyperlipidemia and the abnormalities of lipid parameters. The results were verified in male

female patients

and in patients with pre-existing CVDs and type 2 diabetes.

Results

Of 10 945 inpatients confirmed as COVID-19

there were 9822 inpatients included in the study

comprising 3513 (35.8%) cases without hyperlipidemia and 6309 (64.2%) cases with hyperlipidemia. Based on a mixed-effect Cox model after PSM at 1:1 ratio

hyperlipidemia was not associated with increased or decreased 28-day all-cause death [adjusted hazard ratio (

)

1.17 (95%

0.95-1.44)

=0.151]. We found that the parameters of hyperlipidemia were not associated with the risk of 28-day all-cause mortality [adjusted

1.23 (95%

0.98-1.55)

= 0.075 in TG increase group; 0.78 (95%

0.57-1.07)

= 0.123 in LDL-C increase group; and 1.12 (95%

0.9-1.39)

= 0.299 in HDL-C decrease group

respectively]. Hyperlipidemia was also not significantly associated with the increased mortality of COVID-19 in patients accompanied with CVDs or type 2 diabetes

and in both male and female cohorts.

Conclusion

Our study support that the imbalanced lipid profile is not significantly associated with the 28-day all-cause mortality of COVID-19 patients

even in those accompanied with CVDs or diabetes. Similar results were also obtained in subgroup analyses of abnormal lipid parameters. Therefore

hyperlipidemia might be not a major causative factor for poor outcome of COVID-19

which provides guidance for the intervention of inpatients during the epidemic of COVID-19.

关键词

Keywords

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