40例新型冠状病毒肺炎的流行病学及临床特征分析

Epidemiological and clinical characteristics of 40 patients with coronavirus disease 2019 outside Hubei

目的探讨新型冠状病毒肺炎(简称新冠肺炎)患者的流行病学特点、临床表现、实验室检查、影像学表现。方法收集2020年1月21日到2020年2月18日17例陕西省咸阳市中心医院及23例山东省聊城市传染病医院收治的经SARS-CoV-2核酸检测确诊的40例新冠肺炎患者。收集患者流行病学情况、年龄、发病时间、首发症状、白细胞、淋巴细胞计数、降钙素原(PCT)、血清淀粉样蛋白A(SAA)、C反应蛋白(CRP)及胸部CT表现等信息并进行分析。结果 40例患者中40.0%与武汉市或湖北其他地区具有明确接触史,60.0%无明确接触史;60.0%为聚集性发病,40.0%为输入性病例;平均就诊时间为(4.9±3.5)d,35.0%患者具有基础疾病;75.0%患者初始症状为发热,7.5%初始症状为咳嗽,5.0%咽痛,2.5%头痛,10.0%初始无任何症状;实验室检查中77.5%的患者白细胞正常,45.0%患者淋巴细胞计数下降,72.5%和55.0%患者SAA和CRP升高,92.5%患者PCT正常;92.5%患者初次核酸检测为阳性,72.5%患者胸部CT表现为单肺或双肺多发磨玻璃样病灶,初次核酸检测与胸部CT检查阳性符合率达92.5%;入组患者90.0%为普通型,治疗上均给予α-干扰素雾化吸入联合洛匹那韦/利托那韦片口服治疗,62.5%给予了抗菌药物治疗,15.0%使用糖皮质激素进行治疗;所有患者病情好转,14例患者治愈出院。结论 SARS-CoV-2人群普遍易感,家庭聚集性感染及无症状感染者可能是湖北省外的主要播散方式,轻型及普通型多见,实验室检查无特异性改变,治疗后均病情稳定。

Objective To explore the epidemiological characteristics, clinical manifestations, laboratory examination and imaging findings of patients with coronavirus disease 2019(COVID-19) outside Hubei Province in 2019.Methods From January 21, 2020 to February 18, 2020, 17 patients with COVID-19 diagnosed by SARS-CoV-2 nucleic acid test in Xianyang Central Hospital of Shaanxi Province and 23 patients in Liaocheng Infectious Disease Hospital of Shandong Province were collected. The information of epidemiology, age, time of onset, first symptom, white blood cell,lymphocyte count, procalcitonin(PCT), serum amyloid protein A(SAA), C-reactive protein(CRP) and chest CT were collected and analyzed. Results 40.0% of the 40 patients had a clear history of contact with Wuhan or other areas of Hubei, 60.0% had no clear exposure history, 60.0% were aggregative diseases, 40.0% were imported patients;the average visit time was(4.9±3.5) d, 35% of the patients had underlying diseases;75.0% of the patients had fever, 7.5% of the initial symptoms were cough, 5.0% pharyngitis, 2.5% headache, and 10.0% were asymptomatic. In the laboratory examination, 77.5% of the patients’ white blood cells were normal, 45.0% of the patients’ lymphocyte count could be decreased, 72.5% and 55.0% of the patients’ SAA and CRP increased respectively, 92.5% of the patients’ PCT was normal,92.5% of the patients were positive for the first nucleic acid test, and 72.5% of the patients’ chest CT showed multiple ground glass lesions in one or both lungs, and the positive coincidence rate between the initial nucleic acid test and the chest CT test was 92.5%. 90% of the patients in the group were common type, and all patients were treated with aerosol inhalation of α-interferon combined with lopinavir/ritonavir tablets, 62.5% were treated with antibiotics and 15.0% were treated with glucocorticoid. All patients were improved and 14 patients were cured and discharged from hospital.Conclusions SARS-COV-2 is highly contagious, family aggregation infection and asymptomatic infection may be the main mode of transmission outside Hubei Province, mild and common types are common, there are no specific changes in laboratory examination, and the condition is stable after treatment.