26例新型冠状病毒肺炎病例临床特征分析

赵宗豪; 音铭; 殷实; 李文庭; 鲍磊; 王玉; 李宜

doi:10.16462/j.cnki.zhjbkz.2020.05.009

26例新型冠状病毒肺炎病例临床特征分析

doi: 10.16462/j.cnki.zhjbkz.2020.05.009

赵宗豪¹,
音铭²,
殷实³,
李文庭¹,
鲍磊¹,
王玉¹,
李宜^1, ,

1.
230001 合肥, 中国科技大学附属第一医院(安徽省立医院)感染病科
2.
230001 合肥, 中国科技大学附属第一医院(安徽省立医院)感染病院ICU
3.
230001 合肥, 中国科技大学附属第一医院(安徽省立医院)老年病科

详细信息

通讯作者:
李宜, E-mail:liyily2008@sina.com

中图分类号: R181
计量
- 文章访问数: 420
- HTML全文浏览量: 329
- PDF下载量: 26
- 被引次数: 0
出版历程
- 收稿日期: 2020-02-25
- 修回日期: 2020-03-16
- 刊出日期: 2020-05-10

Analysis of clinical characteristics of coronavirus disease 2019 in 26 cases

1.
Department of Infectious Disease, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
2.
Department of ICU, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
3.
Department of Geriatrics, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China

More Information

Corresponding author: LI Yi, E-mail:liyily2008@sina.com

摘要

摘要: 目的分析新型冠状病毒肺炎(coronavirus disease 2019, COVID-19)患者的流行病学特点、临床表现、实验室检查及影像学特征。方法收集26例COVID-19患者的流行病学资料和临床资料, 采用SPSS 19.0软件进行统计分析。结果 11例(42.3%)患者有武汉旅居史, 6例(23.1%)患者与武汉旅居人员有接触史, 6例患者呈家族聚集性发病; 中位潜伏期6 d。26例患者中普通型18例(69.2%), 重型6例(23.1%), 轻型2例(7.7%)。重型患者较普通型出现乏力和胸闷人数更多(均有P < 0.05), 而两组患者发热、干咳、肌肉酸痛、纳差、咽痛、腹痛表现无差异(均有P > 0.05)。将普通型和重型患者实验室指标进行比较, 重型患者淋巴细胞(lymphocyte, Lym)计数、嗜酸性粒细胞(eosinophil, Eos)计数和CD3⁺、CD4⁺、CD8⁺T细胞计数均低于普通型(均有P < 0.05)。C-反应蛋白(C-reactive protein, CRP)和血清淀粉样蛋白A(serum amyloid A, SAA)重型组高于普通型(均有P < 0.05)。23例(88.5%)患者肺部CT出现磨玻璃样改变, 15例(57.7%)出现小叶间隔增厚, 10例(38.5%)患者出现马赛克征, 5例(19.2%)患者肺部有纤维化病灶。结论本组COVID-19患者多为武汉旅居人员或接触武汉旅居患者发病, 影像学主要表现为肺部磨玻璃样病变。普通型病例多见, 患者外周血Lym计数、Eos计数和CD3⁺、CD4⁺、CD8⁺ T细胞减少、CRP和SAA升高预示病情加重。
- 严重急性呼吸道综合征冠状病毒2型 /
- 新型冠状病毒肺炎 /
- 流行病学
Abstract: Objective To analyze the epidemiological characteristics, clinical manifestations, laboratory examinations and imaging characteristics of coronavirus disease 2019(COVID-19). Methods The data of epidemiological characteristics and clinical data were collected for data analysis. SPSS 19.0 software was used for statistical analysis. Results 11 patients(42.3%) had a history of staying in Wuhan, 6 patients(23.1%) had a history of contact with Wuhan residents, and 6 patients had a familial cluster onset; the median incubation period was 6 d. Among the 26 patients, as for the condition, 18 cases were common(69.2%), 6 cases were severe(23.1%), and 2 cases were light(7.7%). More severe patients had higher frequency of fatigue and chest tightness than the common type(all P < 0.05), but there was no significant difference in the incidence of fever, dry cough, muscle soreness, anorexia, sore throat, and abdominal pain between the two groups(allP > 0.05). Comparing the laboratory indicators of common and severe patients, lymphocyte(Lym) count, eosinophil(Eos) count, and CD3⁺, CD4⁺, and CD8⁺ T cell counts of the severe patients were lower than those of the common patients(all P < 0.05). The C-reactive protein(CRP) and serum amyloid A(SAA) severe groups were higher than the common type(allP < 0.05). Ground-glass opacities were seen in the CT of the lungs in 23(88.5%) patients, lobular septal thickening in 15(57.7%), mosaic signs in 10(38.5%) patients, and fibrotic lesions in the lungs in 5(19.2%) patients. Conclusions Most of the COVID-19 patients in this study had a connection with Wuhan. The imaging findings were mainly ground-glass opacities. The majority were common cases. Patients with decreased peripheral blood Lym counts, Eos counts, and CD3⁺, CD4⁺, and CD8⁺ T cells, and elevated CRP and SAA are predictive of exacerbations.
- Severe acute respiratory syndrome coronavirus 2 /
- (SARS-CoV-2) /
- Coronavirus disease 2019

HTML全文

表 1 26例COVID-19患者流行病学[n(%)]

Table 1. Epidemiology of 26 COVID-19 patients[n(%)]

分型	例数	武汉旅居史	与武汉旅居人员有接触史	居住地有COVID-19患者	与SARS-CoV-2感染者有接触史	无明确流行病史
轻型	2	2(100.0)	0(0.0)	0(0.0)	0(0.0)	0(0.0)
普通型	18	7(38.9)	4(22.2)	1(5.6)	3(16.7)	3(16.7)
重型	6	2(33.3)	2(33.3)	0(0.0)	1(1.7)	1(1.7)
合计	26	11(42.3)	6(23.1)	1(3.8)	4(15.4)	4(15.4)

下载: 导出CSV

表 2 普通型和重型COVID-19患者临床表现[n(%)]

Table 2. Clinical manifestations of patients with common and severe COVID-19[n(%)]

分型	发热	干咳	乏力	肌肉酸痛	胸闷	纳差	咽痛	腹痛
普通型	15(83.3)^a	16(100.0)^b	6(37.5)^b	3(18.8)^b	3(18.8)^b	3(18.8)^a	1(6.3)^a	1(6.3)^a
重型	6(100.0)	6(100.0)	5(83.3)	2(33.3)	5(83.3)	2(33.3)	1(16.7)	0(0.0)
注:^a表示与重型相比P > 0.05, ^b表示与重型相比P < 0.05。

下载: 导出CSV

表 3 普通型和重型COVID-19患者实验室检查比较

Table 3. Comparison of laboratory parameters between common and severe cases of COVID-19

实验室项目	普通型人数(n)	重型人数(n)	普通型[M(P₂₅, P₇₅)]	重型[M(P₂₅, P₇₅)]	Z值	P值
WBC(×10⁹/L)	18	6	4, 92(3.49, 5.52)	4.90(3.77, 8.50)	-0.333	0.739
Neu(×10⁹/L)	18	6	3.70(1.93, 3.60)	4.28(2.39, 6.92)	-1.400	0.162
Lym(×10⁹/L)	18	6	1.13(1.05, 1.59)	0.62(0.43, 0.83)	-2.438	0.015
Eos(×10⁹/L)	18	6	0.03(0.01, 0.08)	0.00(0.00, 0.02)	-3.201	0.001
CD3(cell/μl)	16	6	951.00(696.25, 1 670.25)	427.00(209.75, 947.75)	-1.991	0.046
CD4(cell/μl)	16	6	599.05(407.23, 805.75)	216.00(91.75, 520.75)	-2.433	0.015
CD8(cell/μl)	16	6	513.63(332.74, 903.62)	156.66(98.94, 488.79)	-2.212	0.027
LDH(U/L)	16	6	187.00(150.25, 263.25)	353.50(312.5, 408.75)	-3.170	0.002
CK(IU/L)	16	6	65.45(51.88, 111.80)	136.60(56.95, 488.10)	-1.180	0.238
CK-MB(U/L)	16	6	10.75(8.85, 15.63)	15.05(11.33, 18.63)	-1.438	0.150
TnI(μg/L)	15	6	0.08(0.06, 0.09)	0.10(0.07, 1.06)	-1.372	0.170
CRP(mg/ml)	18	6	4.25(0.88, 14.60)	50.40(13.63, 77.63)	-2.740	0.000
SAA(ng/ml)	11	6	88.80(32.80, 177.50)	193.30(115.83, 257.28)	-2.010	0.044
IL-6(pg/ml)	4	4	6.01(4.93, 6.02)	7.61(6.18, 8.18)	-1.452	0.146

下载: 导出CSV

参考文献(9)

[1]	Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle[J]. J Med Virol, 2020, 92(4): 401-402.DOI: 10.1002/jmv.25678.
[2]	Hui DS, I Azhar E, Madani TA, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health-The latest 2019 novel coronavirus outbreak in Wuhan, China[J]. Int J Infect Dis, 2020, 91: 264-266.DOI: 10.1016/j.ijid.2020.01.009.
[3]	Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020, 395(10223): 497-506.DOI: 10.1016/S0140-6736(20)30183-5.
[4]	World Health Organization. Novel Coronavirus(2019-nCoV), Situation report-23, on 12 February, 2020[EB/OL]. (2020-02-12)[2020-02-25]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.
[5]	安徽省卫生健康委会. 2月18日安徽省报告新冠肺炎疫情情况. [EB/OL](2020-02-18)[2020-02-25]. http://wjw.ah.gov.cn/news_details_55070.html. Health Commission of Anhui Province. Epidemic situation of novel coronavirus-infected pneumonia reported in Anhui Province on February 18. [EB/OL](2020-02-18)[2020-02-25]. http://wjw.ah.gov.cn/news_details_55070.html.
[6]	Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses[J]. Nat Rev Microbiol, 2019, 17(3): 181-192.DOI: 10.1038/s41579-018-0118-9.
[7]	Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019[J]. N Engl J Med, 2020, 382(8): 727-733.DOI: 10.1056/NEJMoa2001017.
[8]	Wan SX, Yi QJ, Fan SB, et al. Characteristics of lymphocyte subsets and cytokines inperipheral blood of 123 hospitalized patients with 2019 novel coronavirus pneumonia(NCP)[J/OL]. medRxiv, 2020. https://www.medrxiv.org/content/10.1101/2020.02.10.20021832v1.
[9]	Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China[J]. JAMA, 2020.DOI: 10.1001/jama.2020.1585.