重庆市渝东北片区143例2019冠状病毒病患者临床特征分析

Clinical features of coronavirus disease 2019 in Northeast area of Chongqing:analysis of 143 cases

目的了解重庆市渝东北片区143例2019冠状病毒病患者临床特征。方法收集2020年1月23日至2月8日重庆市渝东北片区经咽拭子核酸检测新型冠状病毒核酸阳性及胸部CT考虑肺炎的患者共143例。回顾性分析了患者的流行病学史、临床特征等相关信息;同时对各临床分型之间实验室指标的差异进行了对比分析,也对治疗及转归进行了总结。结果143例病例中,从武汉疫区返回76人(53.1%),有疫区人员接触史52人(36.4%),无疫区接触史15人(10.5%)。普通型组107例(74.8%),重型组24例(16.8%),危重型组12例(8.4%)。主要的临床症状有发热、咳嗽、头痛、乏力。其中11例无症状。常见的并发症为高血压、糖尿病,其他并发症有慢性胃炎、乙肝以及肺结核。实验室检查中外周血白细胞下降患者占25.8%,淋巴细胞下降患者占44.8%,随着疾病加重,淋巴细胞计数明显降低,三组间比较有显著性差异(P<0.05)。其他实验室检查指标C-反应蛋白、白介素-6、降钙素原均有不同程度的增高;随疾病程度加重上述指标升高越明显,各组间两两比较差异有统计学意义(P<0.05)。结论2019冠状病毒病临床表现无特异性,甚至还存在无症状患者,但胸部CT早期就可表现多发小斑片影及间质改变。如有确诊2019冠状病毒病的患者接触史或可疑接触史,建议及早筛查病毒核酸及胸部CT。外周血淋巴细胞绝对值下降作为判断疾病严重程度及预后的指标,C-反应蛋白、白介素-6及降钙素原动态随访可用于初期评估患者出现重症的可能性及指导治疗。合并代谢及心血管疾病是预后不良的危险因素。

Objective To explore the clinical features of 143 patients suffering from coronavirus disease 2019(COVID-19)in the Northeast area of Chongqing.Methods A total of 143 COVID-19 patients who were positive to severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)by nucleic acid test in nasopharyngeal swab and had typical CT characteristics of the novel coronavirus-infected pneumonia from Jan.23 to Feb.8 in 2020 were recruited in this study.Their epidemiology and clinical features were collected and retrospectively analyzed.And the differences in laboratory results were compared among the groups of different clinical classification.The treatment and clinical outcomes were also analyzed.Results Among the 143 patients with confirmed COVID-19,76 of them(76/143,53.1%)came from the epidemic area,Wuhan,52(36.4%)had the contact history with the infected cases,and 15(10.5%)had no contact history of with those from epidemic areas.According to their conditions,they were assigned into ordinary group(n=107,74.8%),severe group(n=24,16.8%)and critical group(n=12,8.4%).Their main clinical symptoms were fever,cough,headache and fatigue.And,11 patients had no clinical symptoms.The most common comorbidities were hypertension and diabetes,followed by chronic gastritis,hepatitis B and tuberculosis.Laboratory results indicated that the patients with decreased WBC accounted for 25.8%,and those with decreased for 44.8%in all the patients.The more severe the condition was,the lower lymphocyte count was decreased,and significant differences were seen in the count among the 3 groups(P<0.05).The serum levels of C-reactive protein(CRP),procalcitonin(PCT)and IL-6 rose when compared with the normal levels,and the increments were associated with the severity of the disease,with statistical difference among the 3 groups(P<0.05).Conclusion No specific manifestations are identified in COIVD-19,and some patients may have no symptoms.But chest abnormal views of multiple macular patches and interstitial changes could be observed in early stage of this disease.For those who have contact history with the infected or suspected,nucleic acid test and chest radiology should be performed as early as possible.The absolute decrease of peripheral blood lymphocyte count is an index for the severity and prognosis of the disease.The dynamic follow-up of CRP,IL-6 and PCT can be used to make prediction for severe disease in the early stage and be helpful in guidance of treatment.Complicated metabolic and cardiovascular diseases are the risk factors for poor prognosis.