疑似新冠肺炎患者临床与流行病学特征分析

Clinical and epidemiological characteristic analyses of patients suspected with new coronary pneumonia

目的研究疑似新型冠状肺炎患病毒者的临床与流行病学特征。方法以2020年1月21日-2月16日新疆医科大学第一附属医院发热门诊接诊并符合疑似新冠肺炎的患者162例为研究对象,根据国家卫生健康委员会颁布的第6版《新型冠状病毒肺炎诊疗方案》及新冠病毒核酸初筛结果分为确诊组和疑似组,比较两组患者流行病学、临床表现、实验室指标及肺部CT特征的差异。结果162例疑似患者中,确诊为患者3例(1.85%)。疑似组中有104例(65.41%)患者有异地旅居史或密切接触史,确诊组中2例(66.67%)有武汉旅居史,1例(33.33%)有四川旅居史。疑似组患者的主要临床表现为发热(79.25%)、咳嗽(47.80%)、乏力(42.14%),确诊组患者主要临床表现为发热(66.67%)、乏力(33.33%)。两组患者血液指标(白细胞计数、淋巴细胞计数、中性粒细胞计数、血红蛋白、血小板、谷丙转氨酶、谷草转氨酶、白介素-6)差异无统计学意义(P>0.05)。与疑似组比较,确诊组患者血液中降钙素原水平降低,差异有统计学意义(P<0.05)。确诊组患者肺部CT以外带渗出样改变为主(66.67%),疑似组患者肺部CT异常改变128例(80.50%),其中双肺病变76例(47.80%),多发病变85例(53.46%),渗出样病变107例(67.30%)。疑似组患者中47例转往专科病区诊治(29.56%),112例居家医学观察14 d(70.44%),经随访目前体温均恢复正常,不适症状得以改善,预后良好。结论新冠肺炎的临床表现及影像学表现多样,易漏诊及误诊,精准诊断需依赖流行病学、临床表现、核酸检测、实验室检查及肺部CT的综合判断。

Objective To summarize and analyze the clinical and epidemiological characteristics of patients with suspected new coronary pneumonia.MethodsA total of 162 patients suspected with novel coronavirus pneumonia were diagnosed and selected as the research objects in center of infectious disease,the First Affiliated Hospital of Xinjiang Medical University from January 21to February 162020.These patients were divided into the diagnostic group and the suspected group according to the sixth edition of the new national coronavirus pneumonia diagnosis and treatment manual and all suspected patients were subjected to the new crown virus nucleic acid screening detection.The epidemiological,clinical manifestations and Laboratory test of the two groups were compared,in addition to the comparison of indexes and CT features of lung.ResultsOf 162 suspected patients,3(1.85%)were diagnosed.In the suspected group,104 patients(65.41%)had a history of living in another place or close contact;in the confirmed group,2 patients(66.67%)had a history of sojourning in Wuhan,and 1 patient(33.33%)had a history of sojourning in Sichuan.The main clinical manifestations were fever(79.25%),cough(47.80%),asthenia(42.14%),fever(66.67%),and asthenia(33.33%).Compared with the suspected group,the level of procalcitonin in the blood of the patients in the confirmed group was decreased;the difference was statistically significant(P<0.05).In the diagnosis group,the extrapulmonary exudate was the main change(66.67%)in terms of CT manifestation;whereas in the suspected group,there were 128 cases(80.50%)were lung CT abnormal,76 cases(47.80%)were bilateral lung lesions,85 cases(53.46%)were multiple lesions,107 cases(67.30%)were exudative lesions.47 patients in the suspected group were transferred to the specialized area for diagnosis and treatment(29.56%)and 112 patients were quarantined under close observation at home for 14 days(70.44%).At present,the body temperature returned to normal,the discomfort symptoms were improved and the prognosis was good.ConclusionNovel coronavirus pneumonia is characterized by various clinical and imaging manifestations.It is subject to misdiagnoses and missed diagnoses.Accurate diagnosis depends on epidemiology,clinical manifestations,nucleic acid detection,laboratory examination and comprehensive evaluation of lung CT.