重型与非重型新型冠状病毒肺炎患者临床特征及预后的差异分析

Clinical characteristics and prognosis of COVID-19:Severe type versus non-severe type

目的分析重型与非重型新型冠状病毒肺炎患者临床特征差异。方法回顾性分析2020年1月21日-2020年2月24日首都医科大学附属北京佑安医院收治的95例新型冠状病毒肺炎患者的临床资料,其中非重型患者(轻型和普通型)57例,重型患者(重型和危重型)38例,分析两组患者的临床特征及预后差异。结果重型患者中位年龄66岁,显著高于非重型患者的中位年龄43岁(P<0.001);喘憋症发生率78.95%,显著高于非重型患者的19.30%。重型患者合并高血压(50.00%vs11.76%,P<0.001)、冠心病(21.05%vs 5.26%,P=0.019)比例显著高于非重型患者。与非重型患者比较,入院时重型患者的淋巴细胞计数更低(P<0.05),C反应蛋白、降钙素原、乳酸、肌酸激酶、肌酸激酶同工酶、肌红蛋白和肌钙蛋白I等指标均更高(P均<0.05)。随着病情进展,重型患者在入院后C反应蛋白和乳酸水平均较入院时进一步增高,而淋巴细胞计数进一步下降(P均<0.05)。死亡患者均为重型,病死率为18.42%。结论高龄和患有高血压、冠心病的新型冠状病毒肺炎患者,易发展为重型病例。重型患者疾病进展过程中,淋巴细胞计数进行性下降,C反应蛋白、乳酸进行性增高,这三项指标可能起到预警作用。与非重型患者相比,重型患者炎症反应更明显,更易出现心肌损伤,导致死亡。

Objective To investigate the difference of clinical characteristics and prognosis between severe and non-severe type of COVID-19.Methods Clinical data about 95 COVID-19 inpatients in Beijing YouAn Hospital,Capital Medical University from January 21,2020 to February 24,2020 were analyzed retrospectively.Of the 95 cases,57 cases were in non-severe group(mild and common),and 38 cases were in severe group(severe and critically severe),the differences in clinical characteristics and prognosis between the two groups were analyzed.Results The median age of severe patients was 66 years,which was significantly higher than the median age of non-severe patients(43 years)(P<0.001).More severe patients had shortness of breath(78.95%vs 19.30%,P<0.001),hypertension(50.00%vs 11.76%,P<0.001)and coronary heart disease(21.05%vs 5.26%,P=0.019),with significant difference.Compared with those in non-severe group,the lymphocyte count of severe patients was significantly lower,while the levels of C-reactive protein(CRP),procalcitonin(PCT),lactic acid(LA),creatine kinase(CK),creatine kinase isoenzyme(CK-MB),myoglobin(MYO)and troponin I(TNI)were significantly higher(all P<0.05).Compared with the levels on admission,the CRP and LA levels in severe group further increased with the progressing of the disease,while the lymphocyte count decreased(P<0.05,respectively).All the death occurred in the severe group with the mortality rate of 18.42%.Conclusion Patients with older age and suffering from hypertension and coronary heart disease are susceptible to severe type of COVID-19.In the course of disease progression in severe patients,the lymphocyte count decreases,while the levels of C-reactive protein and lactic acid increase progressively,which might play early warning roles.Compared with non-severe patients,severe patients have more obvious inflammatory response and are more prone to have myocardial injury,which is one of the causes of death.