分析和比较确诊和疑似新型冠状病毒肺炎患者的临床特征

Analysis and comparison on clinical features of confirmed and suspected patients with corona virus disease 2019

目的分析上海市松江区新型冠状病毒肺炎(简称新冠肺炎)确诊病例与疑似病例的流行病学史、临床特征、实验室特点,探讨两者之间的流行病学史、临床特征及实验室特点的区别,为新冠肺炎的鉴别诊断、预防控制及诊治提供借鉴.方法收集2020年1月12日至2月4日上海交通大学附属第一人民医院松江南院发热急诊收治的确诊及疑似新冠肺炎成人患者的一般资料、流行病学史、临床特征、实验室资料,描述并比较新冠肺炎确诊组与疑似组的流行病学史、临床症状特征及实验室特点的区别.结果截至2020年2月4日,共入选22例患者,其中7例经新型冠状病毒(2019-nCoV)核酸检测确诊为新冠肺炎患者,15例为疑似患者.在7例确诊患者中主要易感人群以中老年和男性为主,其中1例为重症患者,1例存在聚集性发病,绝大部分患者具有近14d内去过武汉、接触过肺炎或发热患者等流行病学史,所有患者均未去过武汉华南海鲜市场.新冠肺炎确诊患者从有流行病学接触史至出现症状时间为1~10d,平均(5.4±3.8)d;从症状发作至首次就诊时间为5.0(3.0,6.0)d;主要临床症状为:发热7例(100%)、干咳6例(85.7%)、胸闷3例(42.9%),腹泻2例(28.6%)、全身乏力或肌肉酸痛1例(14.3%)、呼吸困难1例(14.3%).新冠肺炎确诊组干咳发生率明显高于新冠肺炎疑似组〔85.7%(6/7)比20.0%(3/15),P<0.05〕,其余临床症状特点比较差异均无统计学意义.新冠肺炎确诊组入院时白细胞计数、淋巴细胞计数、淋巴细胞减少患者数均略低于新冠肺炎疑似组,丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶、D-二聚体水平、肌红蛋白均略高于新冠肺炎疑似组,但差异均无统计学意义,其余实验室指标比较差异均无统计学意义.结论临床症状和实验室检查可为2019-nCoV感染和常见冬季呼吸道疾病的鉴别诊断提供帮助,但单凭临床症状和实验室检查较难与冬季呼吸道疾病区分,临床诊断仍需结合患者流行病学史、影像学特点及2019-nCoV核酸检测结果.

Objective To analyze the epidemiological,laboratory and clinical characteristics of confirmed and suspected corona virus disease 2019(COVID-19)patients in Songjiang District,Shanghai in 2019 and discuss the clinical and laboratory characteristics between the two groups,so as to provide a reference for the differential diagnosis,prevention and treatment for COVID-19.Methods The general information,epidemiological,laboratory and clinical characteristics of the confirmed and suspected COVID-19 adult patients admitted to the emergency department of fever in the South Hospital of Shanghai General Hospital Affiliated to Shanghai Jiao Tong University from January 12,2020 to February 4,2020 were collected.Then the differences in epidemiological,laboratory and clinical characteristics between the two groups were described and compared.Results By February 4,2020,a total of 22 patients were enrolled,among which 7 cases had been identified as 2019 novel corona virus(2019-nCoV)positive and confirmed as COVID-19 patients,15 cases were suspected patients.The main susceptible population of 7 confirmed patients were middle-aged and elderly and men,1 case was critical and 1 case was cluster outbreak.Most of the confirmed patients had been to Wuhan or had been exposed to patients with COVID-19 or fever.No body had been exposed to Wuhan Huanan Seafood Market.The time from the history of epidemiological exposure to the onset of symptoms was 1-10 days,with average of(5.4±3.8)days;the median time from onset of symptoms to first hospital admission was 5.0(3.0,6.0)days.The main clinical symptoms were fever(7[100%]),dry cough(6[85.7%]),chest tightness(3[42.9%]),diarrhoea(2[28.6%]),myalgia or fatigue(1[14.3%]),and dyspnoea(1[14.3%]).The incidence of dry cough in comfirmed group was significantly higher than that in suspect group[85.7%(6/7)vs.20.0%(3/15),P<0.05],without significant difference in other symptoms.Compared with COVID-19 suspected group,the COVID-19 confirmed group had lower white blood cell count,lymphocyte count and lymphopenia cases;while alanine aminotransferase,aspartate aminotransferase,lactic dehydrogenase,D-dimer and myoglobin were higher in COVID-19 confirmed group,but the difference did not reach statistical significance.There was no significant difference in other laboratory indexes.Conclusions Clinical symptoms and laboratory tests could help clinicans differentiate 2019-nCoV infection from common winter respiratory diseases,but it was difficult to distinguish it from winter respiratory diseases based on clinical symptoms and laboratory tests alone.Clinical diagnosis still needs to be combined with imaging characteristics and result of 2019-nCoV nucleic acid test.