摘要
目的总结普通型和重型冠状病毒肺炎(COVID-19)康复患者的流行病学和临床特征,以提高对该疾病的认识,协助临床早期诊断,为疫情防控提供参考。方法回顾性分析截至2020年2月6日在武汉市金银潭医院住院治疗并康复出院的463例普通型和重型COVID-19患者的临床资料。结果463例患者中,普通型282例,重型181例;男244例,女219例,年龄范围15~90岁,年龄51(43,60)岁。其中,255例患者(55.08%)≥50岁;12例为家庭聚集性病例;205例患者(44.28%)合并高血压、糖尿病、冠心病、COPD等基础疾病。入院时常见症状为发热415例(89.63%)、咳嗽356例(76.89%)、呼吸困难194例(41.90%)、乏力130例(28.08%);咽痛、流涕等上呼吸道感染症状和腹泻等消化道症状均低于3%。入院时53.56%(248/463)的患者外周血淋巴细胞减少,40.36%(67/166)的患者CD4^+T细胞减少(<350/μL);低白蛋白血症和FGB升高者分别占27.00%(125/463),40.18%(182/453);56.77%(260/458)的患者乳酸脱氢酶水平升高,75.81%(351/463)的患者出现低钙血症。入院时,常见的胸部CT影像学表现为磨玻璃样阴影(57.37%,253/441)和小斑片状阴影(51.70%,228/441)。与普通型组比较,重型组患者更多表现为发热和呼吸困难,体温≥39℃的患者比例更高(49.17%比30.14%,P<0.05);重型组ESR、CRP、降钙素原、血清淀粉样蛋白A等感染学标志物水平更高(P值均<0.05),心肌损伤更多见。重型组患者的严重淋巴细胞减少和CD4^+T细胞减少的比例高于普通型组,且肺部影像学更多表现为磨玻璃样阴影和大片实变影。本组所有患者经积极抗病毒、抗感染、氧疗,以及对症支持治疗好转后出院,住院天数为12(9,14)d。结论中老年人,低白蛋白血症,患有高血压、糖尿病、冠心病、COPD等基础疾病的患者是COVID-19的高危人群。即使无发热,但出现淋巴细胞减少或符合流行病学特征的患者也应尽早完善胸部CT检查和2019-nCoV核酸检测以早期诊治。
Objective To summarize the epidemiological and clinical characteristics of common and severe coronavirus disease 2019(COVID-19),so as improve the understanding of the disease and promote early diagnosis,prevention and control.Methods Clinical data of 463 patients with common and severe COVID-19,who were discharged from the Wuhan Jinyintan Hospital before February 6,2020,were retrospectively analyzed.Results Of all the 463 patients,282 were diagnosed with common COVID-19 and 181 with severe COVID-19.There were 244 males and 219 females with a median age of 51(43,60)years(range,15-90 years).There were 255(55.08%)patients aged≥50 years.Twelve cases were clustered in families.There were 205(44.28%)patients with one or more basic diseases,such as hypertension,diabetes,coronary heart disease,and chronic obstructive pulmonary disease.The most common symptoms were fever(89.63%,415/463),cough(76.89%,356/463),dyspnea(41.90%,194/463),and fatigue(28.08%,130/463).Upper respiratory tract infection symptoms and digestive tract symptoms were less than 3%.On admission,lymphopenia and CD4^+T cell decrease(<350/μL)were found in 53.56%(248/463)and 40.36%(67/166)patients,respectively;hypoalbuminemia and increased fasting blood glucose accounted for 27.00%(125/463)and 40.18%(182/453),respectively;56.77%(260/458)of patients had increased lactate dehydrogenase,and 75.81%(351/463)had hypocalcemia;ground-glass opacity(57.37%,253/441)and small patch shadows(51.70%,228/441)were the most common radiologic findings on chest computed tomography(CT).Compared with the common group,the severe group showed more fever and dyspnea,and had a higher proportion of high fever(≥39℃,49.17%vs.30.14%).The abnormal proportions of erythrocyte sedimentation(ESR),C-reactive protein(CRP),procalcitonin,serum amyloid A and other infection indicators were significantly higher in severe group than those in the common group(P<0.05).Myocardial damage was more likely to occur in the severe group.The proportion of patients with severe lymphocytopenia and CD4^+T lymphocytopenia in the severe group was higher than that in the common group;so was the incidence of ground-glass shadows and large-scale consolidation shadows.All the patients were cured after antiviral,anti-infection,symptomatic and supportive treatment.The median hospitalization time was 12(9,14)days.Conclusion The middle-aged and elderly patients with hypoalbuminemia,hypertension,diabetes,coronary heart disease and chronic obstructive pulmonary disease are at high risk of COVID-19.Patients without fever,who have lymphocytopenia or meet epidemiological characteristics,should receive chest CT and 2019-nCoV nucleic acid tests as early as possible for early diagnosis and treatment.
出处
《上海医学》
CAS
北大核心
2020年第4期224-232,共9页
Shanghai Medical Journal
作者简介
通信作者:周新,电子邮箱为xzhou53@163.com;通信作者:张定宇,电子邮箱为1813886398@qq.com;通信作者:郑军华,电子邮箱为zhengjh0471@sina.com;共同第一作者:程克斌;共同第一作者:魏明
