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期刊来源：Ann Intern Med

原文链接：https://doi.org/10.7326/M23-1831

摘要内容如下：

背景

一些数据表明，与未感染患者相比，有COVID-19病史的患者诊断为自身免疫性炎症性风湿病（AIRDs）的发生率更高。然而，这些研究存在方法上的缺陷。

客观

研究COVID-19在不同随访期内对事件长期风险的影响。

设计

两国、纵向、倾向匹配队列研究。

设置

韩国（K-CoV-N队列）和日本（JMDC队列）的全国性索赔数据库。

参与者

1027506名20岁或以上的韩国患者和12218680名20岁或以上的日本患者，包括2020年1月1日至2021年12月31日期间感染COVID-19的患者，与感染流感的患者和未感染的对照患者相匹配。

测量

主要转归是在COVID-19或流感感染后1、6和12个月或未感染对照患者各自的匹配指标日期出现AIRD（根据国际疾病分类第10版的适当编码）。

结果

2020年至2021年，在10027506名韩国参与者中（平均年龄48.4岁[SD，13.4]；50.1%（男性）、394274（3.9%）和98596（0.98%）分别有COVID-19或流感病史。在倾向评分匹配后，超过感染后的前30天，与未感染患者（校正风险比，1.25[95%CI，1.18至1.31]）和流感感染对照患者（校正风险比，1.30[CI，1.02至1.59]）相比，COVID-19患者发生AIRD的风险增加。更严重的急性COVID-19发生事件的风险更高。在日本队列中也观察到了类似的模式。

局限性

大流行导致的转诊偏差；残余混杂。

结论

与无SARS-CoV-2感染或有流感感染的匹配患者相比，SARS-CoV-2感染与发生AIRD的风险增加相关。急性COVID-19的严重程度越高，发生事件的风险越高。

主要资金来源

韩国国家研究基金会。

英文原文如下：

Abstracts

BACKGROUND  Some data suggest a higher incidence of diagnosis of autoimmune inflammatory rheumatic diseases (AIRDs) among patients with a history of COVID-19 compared with uninfected patients. However, these studies had methodological shortcomings.

OBJECTIVE  To investigate the effect of COVID-19 on long-term risk for incident AIRD over various follow-up periods.

DESIGN  Binational, longitudinal, propensity-matched cohort study.

SETTING  Nationwide claims-based databases in South Korea (K-COV-N cohort) and Japan (JMDC cohort).

PARTICIPANTS  10 027 506 Korean and 12 218 680 Japanese patients aged 20 years or older, including those with COVID-19 between 1 January 2020 and 31 December 2021, matched to patients with influenza infection and to uninfected control patients.

MEASUREMENTS  The primary outcome was onset of AIRD (per appropriate codes from the International Classification of Diseases, 10th Revision) 1, 6, and 12 months after COVID-19 or influenza infection or the respective matched index date of uninfected control patients.

RESULTS  Between 2020 and 2021, among the 10 027 506 Korean participants (mean age, 48.4 years [SD, 13.4]; 50.1% men), 394 274 (3.9%) and 98 596 (0.98%) had a history of COVID-19 or influenza, respectively. After propensity score matching, beyond the first 30 days after infection, patients with COVID-19 were at increased risk for incident AIRD compared with uninfected patients (adjusted hazard ratio, 1.25 [95% CI, 1.18 to 1.31]) and influenza-infected control patients (adjusted hazard ratio, 1.30 [CI, 1.02 to 1.59]). The risk for incident AIRD was higher with more severe acute COVID-19. Similar patterns were observed in the Japanese cohort.

LIMITATIONS  Referral bias due to the pandemic; residual confounding.

CONCLUSION  SARS-CoV-2 infection was associated with increased risk for incident AIRD compared with matched patients without SARS-CoV-2 infection or with influenza infection. The risk for incident AIRD was higher with greater severity of acute COVID-19.

PRIMARY FUNDING SOURCE  National Research Foundation of Korea.

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