体重指数、糖尿病、炎症与COVID-19生存：一项在城市医院中心评估肥胖悖论的回顾性研究
Body mass index, diabetes, inflammation and survival in COVID-19: a retrospective study evaluating the obesity paradox in an urban hospital center.
文献信息
| PMID | 42947684 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Sanah Sadiq |
| 作者单位 | Department of Endocrinology & Metabolism, Lewis Katz School of Medicine at Temple University Hospital, Philadelphia, PA, United States. |
| 期刊 | Frontiers in clinical diabetes and healthcare |
| SCI 分区 | Q2 |
| IF | 3.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 重型2019冠状病毒病（COVID-19）与发病率和死亡率增加相关，尤其是在合并糖尿病和肥胖等共病的患者中。血糖控制、高血糖和体重指数（BMI）对疾病严重程度的共同影响仍不完全清楚，尤其是在医疗服务不足的城市人群中。
方法： 这项回顾性研究评估了2020年3月至5月期间在一家城市学术医疗中心住院的478例确诊COVID-19成人患者，以考察糖尿病、血糖控制和体重指数（BMI）对临床结局的影响。收集的数据包括人口学特征、共病、BMI、糖尿病类型、基线糖化血红蛋白（HbA1c）、炎症标志物、重症监护病房（ICU）入住、机械通气、高血糖和糖皮质激素使用。
结果： 在有可用HbA1c测量的患者中，发生细胞因子风暴的糖尿病患者平均HbA1c显著高于未发生细胞因子风暴者。肥胖和超重非常普遍，45%的患者被归类为肥胖（BMI ≥30 kg/m²），29%被归类为超重（BMI 25-29 kg/m²）。糖尿病与ICU入住、机械通气和类固醇诱导的高血糖增加相关。年龄较大的患者、黑人患者以及合并糖尿病、高血压、高血糖、较多糖皮质激素使用或入住ICU的患者死亡率更高。值得注意的是，与正常体重者相比，超重或肥胖患者表现出更好的生存，这与该城市队列中的肥胖悖论一致。多变量分析确定类固醇诱导的高血糖、阻塞性睡眠呼吸暂停和较高甲泼尼龙使用量是ICU入住的独立预测因素，而较高的BMI与较低的不良结局风险相关。
结论： 糖尿病和高血糖与更严重的COVID-19、ICU使用增加和更高死亡率相关，而较高的BMI提供了潜在的生存获益。这些发现凸显了代谢功能障碍、肥胖和COVID-19结局之间复杂的相互作用，提示住院患者中存在肥胖悖论，并强调早期识别和管理糖尿病及高血糖以改善临床结局的重要性。
英文摘要
BACKGROUND: Severe coronavirus disease 2019 (COVID-19) is associated with increased morbidity and mortality, particularly among patients with comorbidities such as diabetes and obesity. The combined influence of glycemic control, hyperglycemia, and body mass index (BMI) on disease severity remains incompletely understood, particularly in underserved urban populations.
METHODS: This retrospective study evaluated 478 adults hospitalized with confirmed COVID-19 between March and May 2020 at an urban academic medical center to examine the impact of diabetes, glycemic control, and body mass index (BMI) on clinical outcomes. Data collected included demographics, comorbidities, BMI, diabetes type, baseline hemoglobin A1c (HbA1c), inflammatory markers, intensive care unit (ICU) admission, mechanical ventilation, hyperglycemia, and glucocorticoid use.
RESULTS: Among patients with available HbA1c measurements, those with diabetes who developed cytokine storm had significantly higher mean HbA1c than those without cytokine storm. Obesity and overweight were highly prevalent, with 45% of patients classified as obese (BMI ≥30 kg/m²) and 29% classified as overweight (BMI 25-29 kg/m²). Diabetes was associated with increased ICU admission, mechanical ventilation, and steroid-induced hyperglycemia. Mortality was higher among older patients, Black patients, and those with diabetes, hypertension, hyperglycemia, greater glucocorticoid use, or ICU admission. Notably, patients with overweight or obesity demonstrated improved survival compared with those of normal weight, consistent with an obesity paradox in this urban cohort. Multivariable analysis identified steroid-induced hyperglycemia, obstructive sleep apnea, and higher methylprednisolone use as independent predictors of ICU admission, whereas higher BMI was associated with a lower risk of adverse outcomes.
CONCLUSIONS: Diabetes and hyperglycemia were associated with greater COVID-19 severity, increased ICU utilization, and higher mortality, while higher BMI offered potential survival benefits. These findings highlight the complex interplay between metabolic dysfunction, obesity, and COVID-19 outcomes, suggesting the presence of an obesity paradox in hospitalized patients, and emphasize the importance of early recognition and management of diabetes and hyperglycemia to improve clinical outcomes.