最后审阅: 20 十二月 2021
最后更新: 16 十二月 2021
16 Dec 2021

该更新中有何新内容

奥密克戎变体在部分国家显示出增长优势

  • 奥密克戎变体似乎比 δ 变体具有增长优势,并且在部分国家(包括英国)的传播速度快于 δ 变体。在群体免疫水平较高的国家,这一观察到的快速增长率是否与传播能力提升和/或免疫逃逸具有相关性,尚不得而知。需要获取更多这一新型担忧型变体(variant of concern)数据。

  • 参阅病因学/分类章节,获取更多信息。

目前建议所有成人进行加强剂次 COVID-19 疫苗接种

  • 英国疫苗接种和免疫联合委员会建议,所有 18 岁以上成人均应在完成疫苗基本接种时序至少 3 个月后,接受加强剂次 COVID-19 疫苗接种(辉瑞/BioNTech 疫苗和 Moderna 疫苗应受到同等推荐)。该建议的总体意图是在奥密克戎感染高峰即将到来之前,加快 COVID-19 疫苗部署。

  • 美国疾病预防控制中心建议所有 18 岁以上成人在完成疫苗基本接种时序至少 6 个月后(mRNA 疫苗)或至少 2 个月后(杨森疫苗)接受加强剂次接种。中心亦建议,16 或 17 岁年轻成人也可接受加强剂次接种。

  • 更多信息,参阅预防章节。

COVID-19 疫苗接种后心肌炎和心包炎临床指南发布

  • 英国卫生安全局已制定临床指南,对 COVID-19 疫苗相关性心肌炎和心包炎临床病例的检出和管理提供支持。该指南是一份动态文件,将在获得更多数据时进行分析和更新。

  • 如果疫苗接种 10 天内可疑出现心肌炎或心包炎,指南建议进行 12-导联心电图、炎症血液标志物和肌钙蛋白检查。

  • 更多信息,参阅预防章节。

WHO 不建议使用恢复期血浆治疗 COVID-19

  • 世界卫生组织(World Health Organization, WHO)已对其 COVID-19 治疗动态指南进行更新,其中包括一项新建议,即勿对非重症患者使用恢复期血浆,同时,除非是进行临床试验,否则亦勿对重症或危重患者使用恢复期血浆。

  • 当前证据表明,恢复期血浆无法提升存活率或减少机械通气需要,但其成本却较高。

  • 更多信息,请参阅新兴治疗章节。

sotrovimab 在英国获批用于轻中度疾病治疗

  • 英国药品和医疗产品监管署已批准单克隆抗体 sotrovimab 用于存在出现重症高风险的轻中度疾病患者。该药物通过与 SARS-CoV-2 病毒外部刺突蛋白结合而发挥作用。这是第二个在英国获批用于该适应症的单克隆抗体。

  • 更多信息,请参阅新兴治疗章节。

首个用于暴露前预防的单克隆抗体在美国获批

  • 美国食品药品监督管理局已授予 tixagevimab/cilgavimab 紧急使用授权,用于中重度免疫系统受损,年龄 ≥12 岁(体重 ≥40 kg)的儿童和成人进行暴露前预防,或用于对 COVID-19 疫苗和/或疫苗成分具有严重不良反应史者。它是第一个获批使用的长效单克隆抗体混合物,也是首个同时唯一获批用于暴露前预防的单克隆抗体。

  • 更多信息,请参阅新兴治疗章节。

WHO 建议伴有多系统炎症综合征的住院儿童使用皮质类固醇

  • WHO 已对其 COVID-19 临床管理生活指南进行更新,其中包括一项新的有条件建议,即对多系统炎症综合征住院儿童除给予支持性治疗外,亦可使用皮质类固醇。

  • 更多信息,请参阅并发症章节。

查看流行病学

更新原始来源

小结

定义

病史和体格检查

关键诊断因素

  • 发热
  • 咳嗽
  • 呼吸困难
  • 嗅觉/味觉改变

其他诊断因素

  • 头痛
  • 咽痛
  • 流涕/鼻塞
  • 喷嚏
  • 乏力
  • 肌痛或关节痛
  • 痰液产生/排出
  • 胸闷
  • 胃肠道症状
  • 头晕
  • 神经系统症状
  • 眼部症状
  • 听觉-前庭症状
  • 胸痛
  • 咯血
  • 支气管呼吸音
  • 呼吸急促
  • 心动过速
  • 紫绀
  • 听诊发现湿啰音/啰音
  • 皮肤症状
  • 口腔粘膜病损
  • 下尿路症状

危险因素

  • 与可能或确诊病例产生接触
  • 居住/工作/旅行于传播高风险地区
  • 老年
  • 男性
  • 种族
  • 居住于长期照护机构
  • 合并症的发生
  • 肥胖
  • 心血管疾病
  • 糖尿病
  • 慢性呼吸系统疾病
  • 慢性肾病
  • 慢性肝病
  • 妊娠
  • 吸烟
  • 恶性肿瘤
  • 脑血管病
  • 心理健康障碍
  • 实体器官移植或血液干细胞移植
  • 唐氏综合征或残障
  • 血红蛋白疾患
  • 高血压
  • 痴呆
  • 免疫抑制
  • HIV 感染
  • 物质使用障碍
  • 伴有某些基础疾病的儿童
  • 维生素 D 缺乏
  • 质子泵抑制剂的使用
  • 自身免疫性疾病
  • 甲状腺疾病
  • 帕金森病
  • 缺乏体力活动
  • 血脂异常
  • 手术
  • A 型血和 B 型血
  • 消化道菌群失调
  • 环境因素

诊断性检查

首要检查

  • 实时逆转录聚合酶链反应 (RT-PCR)
  • 脉搏血氧测定
  • 动脉血气分析(ABG)
  • 全血细胞计数(FBC)
  • 生化全项
  • 甲状腺功能检测
  • 血糖水平
  • 凝血筛查
  • 心脏生物标志物
  • 血清 C 反应蛋白
  • 血清红细胞沉降率
  • 血清乳酸脱氢酶
  • 血清白细胞介素-6 水平
  • 血清降钙素原
  • 血清铁蛋白水平
  • 血清淀粉样蛋白 A 水平
  • 血清肌酸激酶和肌红蛋白
  • 血液和痰液培养
  • 胸部 X 线检查

需考虑的检查

  • 胸部计算机体层成像(Computed Tomography, CT)
  • 血清学
  • 抗原检测

新兴检查

  • 逆转录环介导等温扩增(RT-LAMP)
  • 肺部超声
  • 钙卫蛋白

治疗流程

撰稿人

专家顾问

Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H

Consultant and Emeritus Professor of Tropical and Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

利益声明

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

利益声明

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Robert Fowler, MDCM, MS (Epi), FRCP(C)

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

利益声明

RF declares that he has no competing interests.

同行评议者

William A. Petri, Jr., MD, PhD

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

利益声明

WAP declares that he has no competing interests.

Xin Zhang, MD, PhD

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China

利益声明

XZ declares that he has no competing interests.

Ran Nir-Paz, MD

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

利益声明

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

编辑

Adam Mitchell,

Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

Irene Chiwele,

Lead Section Editor, BMJ Best Practice

利益声明

IC declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

专家顾问:合并症

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

利益声明

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

Martin Cowie, MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

利益声明

MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, and Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.

Rachael Evans, MBChB, FRCP (UK), PhD

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

利益声明

RAE has been reimbursed for a GSK Advisory Board meeting on Physical Activity and Asthma in November 2016, and three Chiesi Education meetings for GPs on COPD care in 2019. RAE received a travel award for ERS 2017 from Chiesi and participated in the GSK clinical experience programme - respiratory in August 2018. RAE participated in the BTS/SIGN guidelines for asthma update 2016 (no fee).

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

利益声明

GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.

Sotiris Posporelis, MD, MRCPsych

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

利益声明

SP declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester

Manchester

UK

利益声明

AA and MJ declare that they have no competing interests.

同行评议:合并症

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

Asangaedem Akpan, MPH, FRCP

Consultant Geriatrician

Liverpool University Hospitals NHS Foundation Trust

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

利益声明

AA declares that he has no competing interests.

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