自身免疫性疾病（包括风湿和肌肉骨骼疾病）患者感染和重症风险可能升高；但是证据有限。[304]Akiyama S, Hamdeh S, Micic D, et al. Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis. Ann Rheum Dis. 2020 Oct 13 [Epub ahead of print].https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7554412http://www.ncbi.nlm.nih.gov/pubmed/33051220?tool=bestpractice.com[305]Conway R, Grimshaw AA, Konig MF, et al. SARS-CoV-2 infection and COVID-19 outcomes in rheumatic diseases: a systematic literature review and meta-analysis. Arthritis Rheumatol. 2021 Nov 22 [Epub ahead of print].https://onlinelibrary.wiley.com/doi/10.1002/art.42030http://www.ncbi.nlm.nih.gov/pubmed/34807517?tool=bestpractice.com

当前数据并未强烈表明免疫介导性炎性疾病的存在可增加感染或重症风险。部分研究报道的风险升高，可能原因在于免疫介导性炎性疾病相关的合并症或患者正在采用的药物治疗（皮质类固醇、利妥昔单抗）。此类患者住院率升高与死亡率升高不具相关性。[253]Fagni F, Simon D, Tascilar K, et al. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. Lancet Rheumatol. 2021 Oct;3(10):e724-36.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397302http://www.ncbi.nlm.nih.gov/pubmed/34485930?tool=bestpractice.com 与其他治疗方案（例如甲氨蝶呤、硫唑嘌呤、Janus 激酶抑制剂）相比，肿瘤坏死因子（tumour necrosis factor, TNF）-α 抑制剂单药治疗与免疫介导炎症性疾病患者住院或死亡风险降低具有相关性。[306]Izadi Z, Brenner EJ, Mahil SK, et al. Association between tumor necrosis factor inhibitors and the risk of hospitalization or death among patients with immune-mediated inflammatory disease and COVID-19. JAMA Netw Open. 2021 Oct 1;4(10):e2129639.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2785080http://www.ncbi.nlm.nih.gov/pubmed/34661663?tool=bestpractice.com 在一项队列研究中，除利妥昔单抗外，其他风湿病、抗肿瘤或抗代谢治疗未使机械通气或住院死亡风险升高。[307]Andersen KM, Bates BA, Rashidi ES, et al. Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative. Lancet Rheumatol. 2022 Jan;4(1):e33-41.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592562http://www.ncbi.nlm.nih.gov/pubmed/34806036?tool=bestpractice.com

炎性关节炎：证据并未显示炎性关节炎（例如类风湿性关节炎、脊柱关节炎）与感染风险或不良结局（例如住院、重症监护病房收治、需行机械通气或死亡）之间存在密切关联。然而，证据存在冲突。部分研究确实报道了不良结局风险升高，但研究存在局限性。[253]Fagni F, Simon D, Tascilar K, et al. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. Lancet Rheumatol. 2021 Oct;3(10):e724-36.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397302http://www.ncbi.nlm.nih.gov/pubmed/34485930?tool=bestpractice.com

炎症性肠病：炎症性肠病患者的患病率似乎较低。[308]Tripathi K, Godoy Brewer G, Thu Nguyen M, et al. COVID-19 and outcomes in patients with inflammatory bowel disease: systematic review and meta-analysis. Inflamm Bowel Dis. 2021 Oct 27 [Epub ahead of print].https://academic.oup.com/ibdjournal/advance-article/doi/10.1093/ibd/izab236/6412576http://www.ncbi.nlm.nih.gov/pubmed/34718595?tool=bestpractice.com 证据表明，如果患者疾病控制良好且未使用皮质类固醇，则感染风险和重症风险情况与一般人群相似。[253]Fagni F, Simon D, Tascilar K, et al. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. Lancet Rheumatol. 2021 Oct;3(10):e724-36.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397302http://www.ncbi.nlm.nih.gov/pubmed/34485930?tool=bestpractice.com 皮质类固醇使用与重症和重症监护病房收治（但并非死亡）等风险升高具有相关性。[309]Alrashed F, Battat R, Abdullah I, et al. Impact of medical therapies for inflammatory bowel disease on the severity of COVID-19: a systematic review and meta-analysis. BMJ Open Gastroenterol. 2021 Oct;8(1):e000774.https://bmjopengastro.bmj.com/content/8/1/e000774.longhttp://www.ncbi.nlm.nih.gov/pubmed/34725056?tool=bestpractice.com 三分之一炎症性肠病患者需收住院治疗，不到 4% 患者需重症监护病房收治。[308]Tripathi K, Godoy Brewer G, Thu Nguyen M, et al. COVID-19 and outcomes in patients with inflammatory bowel disease: systematic review and meta-analysis. Inflamm Bowel Dis. 2021 Oct 27 [Epub ahead of print].https://academic.oup.com/ibdjournal/advance-article/doi/10.1093/ibd/izab236/6412576http://www.ncbi.nlm.nih.gov/pubmed/34718595?tool=bestpractice.com 较高的疾病活动度和急性发作可导致感染易感性增加和更劣的结局。[310]Bezzio C, Saibeni S, Variola A, et al. Outcomes of COVID-19 in 79 patients with IBD in Italy: an IG-IBD study. Gut. 2020 Jul;69(7):1213-7.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7242872http://www.ncbi.nlm.nih.gov/pubmed/32354990?tool=bestpractice.com 溃疡性结肠炎和使用皮质类固醇、硫嘌呤、氨基水杨酸或联合治疗的患者，其结局（住院、重症监护病房收治和死亡率）更劣。使用生物制剂的患者结局更佳。[308]Tripathi K, Godoy Brewer G, Thu Nguyen M, et al. COVID-19 and outcomes in patients with inflammatory bowel disease: systematic review and meta-analysis. Inflamm Bowel Dis. 2021 Oct 27 [Epub ahead of print].https://academic.oup.com/ibdjournal/advance-article/doi/10.1093/ibd/izab236/6412576http://www.ncbi.nlm.nih.gov/pubmed/34718595?tool=bestpractice.com[311]Singh S, Khan A, Chowdhry M, et al. Risk of severe coronavirus disease 2019 in patients with inflammatory bowel disease in the united states: a multicenter research network study. Gastroenterology. 2020 Oct;159(4):1575-8.https://www.gastrojournal.org/article/S0016-5085(20)34755-7/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/32522507?tool=bestpractice.com[312]Ungaro RC, Brenner EJ, Gearry RB, et al. Effect of IBD medications on COVID-19 outcomes: results from an international registry. Gut. 2021 Apr;70(4):725-32.https://gut.bmj.com/content/early/2020/10/26/gutjnl-2020-322539.longhttp://www.ncbi.nlm.nih.gov/pubmed/33082265?tool=bestpractice.com[313]Singh AK, Jena A, Kumar-M P, et al. Risk and outcomes of coronavirus disease in patients with inflammatory bowel disease: a systematic review and meta-analysis. United European Gastroenterol J. 2021 Mar;9(2):159-76.https://journals.sagepub.com/doi/10.1177/2050640620972602http://www.ncbi.nlm.nih.gov/pubmed/33210980?tool=bestpractice.com 已经开发出一种风险计算器，可以预测哪些炎症性肠病患者出现不良结局的风险更高。[314]Sperger J, Shah KS, Lu M, et al. Development and validation of multivariable prediction models for adverse COVID-19 outcomes in patients with IBD. BMJ Open. 2021 Nov 12;11(11):e049740.https://bmjopen.bmj.com/content/11/11/e049740http://www.ncbi.nlm.nih.gov/pubmed/34772750?tool=bestpractice.com

结缔组织病：多项研究表明，与普通人群和其他免疫介导性炎性疾病患者相比，结缔组织病（例如系统性红斑狼疮、干燥综合征、系统性硬化症、多发性肌炎和皮肌炎）患者感染风险有所升高。这可能是由于皮质类固醇在此类患者中的广泛使用。与结局相关的数据较为缺乏，证据存在冲突。[253]Fagni F, Simon D, Tascilar K, et al. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. Lancet Rheumatol. 2021 Oct;3(10):e724-36.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397302http://www.ncbi.nlm.nih.gov/pubmed/34485930?tool=bestpractice.com 狼疮性肾炎患者出现重症或危重症的风险升高。[315]Sakthiswary R, Chuah HY, Chiang KS, et al. COVID-19 in systemic lupus erythematosus: a pooled analysis and systematic review of case reports and series. Lupus. 2021 Oct;30(12):1946-54.https://journals.sagepub.com/doi/10.1177/09612033211045057http://www.ncbi.nlm.nih.gov/pubmed/34565208?tool=bestpractice.com

银屑病：风险和结局数据令人信服的表明，其与一般人群所观察到的风险状况相当，在队列研究中，亦未见感染或重症易感性增加的报道。[253]Fagni F, Simon D, Tascilar K, et al. COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses. Lancet Rheumatol. 2021 Oct;3(10):e724-36.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397302http://www.ncbi.nlm.nih.gov/pubmed/34485930?tool=bestpractice.com

血管炎：基于有限数据，皮质类固醇使用、高龄、性别为男性、中重度疾病活动度、合并症（例如呼吸系统疾病），以及利妥昔单抗或环磷酰胺的使用，与严重结局具有相关性。[316]Rutherford MA, Scott J, Karabayas M, et al. Risk factors for severe outcomes in patients with systemic vasculitis and COVID-19: a binational, registry-based cohort study. Arthritis Rheumatol. 2021 Sep;73(9):1713-9.https://onlinelibrary.wiley.com/doi/10.1002/art.41728http://www.ncbi.nlm.nih.gov/pubmed/33750043?tool=bestpractice.com[317]Sattui SE, Conway R, Putman MS, et al. Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study. Lancet Rheumatol. 2021 Dec;3(12):e855-64.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8570701http://www.ncbi.nlm.nih.gov/pubmed/34778843?tool=bestpractice.com

多发性硬化：神经功能障碍、高龄、黑种人族裔、心血管合并症、近期皮质类固醇治疗和肥胖为重症危险因素。[318]Louapre C, Collongues N, Stankoff B, et al. Clinical characteristics and outcomes in patients with coronavirus disease 2019 and multiple sclerosis. JAMA Neurol. 2020 Sep 1;77(9):1079-88.https://jamanetwork.com/journals/jamaneurology/fullarticle/2767776http://www.ncbi.nlm.nih.gov/pubmed/32589189?tool=bestpractice.com[319]Salter A, Fox RJ, Newsome SD, et al. Outcomes and risk factors associated with SARS-CoV-2 infection in a North American registry of patients with multiple sclerosis. JAMA Neurol. 2021 Jun 1;78(6):699-708.https://jamanetwork.com/journals/jamaneurology/fullarticle/2777735http://www.ncbi.nlm.nih.gov/pubmed/33739362?tool=bestpractice.com 当前证据并未表明多发性硬化显著增加死亡率。最高住院率和死亡率见于未采用疾病修饰治疗的患者，其次是进行 B 细胞耗竭治疗的患者（例如利妥昔单抗、奥瑞珠单抗）。[320]Barzegar M, Mirmosayyeb O, Gajarzadeh M, et al. COVID-19 among patients with multiple sclerosis: a systematic review. Neurol Neuroimmunol Neuroinflamm. 2021 Jul;8(4):e1001.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142838http://www.ncbi.nlm.nih.gov/pubmed/34016734?tool=bestpractice.com