新型冠状病毒肺炎51例临床特征

Clinical features of 51 patients with corona virus disease 2019

目的探讨武汉市新型冠状病毒肺炎患者的临床特征,研究患者血清中炎症因子与病情轻重程度的相关性。方法回顾性分析51例患者的临床资料,包括临床症状、血液检验及胸部CT,根据新型冠状病毒肺炎诊疗方案(试行第5版)分为3组:普通型32例、重型9例、危重型10例。比较3组患者入院时的外周血白细胞计数、淋巴细胞计数、C反应蛋白(CRP)、肝肾功能等指标。结果①患者就诊时的主要症状为发热(42例,82.35%),咳嗽、咳痰(39例,76.47%)、胸闷、气短(24例,47.06%),个别患者以腹泻、头痛为主诉入院;伴随症状包括乏力、肌肉酸痛、头痛、恶心、呕吐、腹泻,住院前发病时间1~21 d,中位数7 d;住院时间3~30 d,中位数12 d;②外周血结果一般表现为CRP升高(80.39%)、淋巴细胞计数降低(68.63%)、乳酸脱氢酶(LDH)升高(52.94%);白细胞计数、中性粒细胞计数、谷氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ谷氨酰转肽酶(γ-GT)、总胆红素(TBIL)、直接胆红素(DBIL)、尿素氮(BUN)、肌酐(Cr)一般正常。③胸部CT特点为:双肺多发、肺野外带多见;以毛玻璃样结节、斑片影为主、呈间质性肺炎改变;病程中病灶可增多、扩大、密度增高;病灶不形成空洞;无胸腔积液改变,病灶不易致气管、支气管堵塞。④普通型淋巴细胞计数表达水平高于重型、危重型,差异有统计学意义(H=3.656,P=0.001;H=5.572,P<0.001);重型与危重型淋巴细胞计数表达水平差异无统计学意义(H=1.391,P=0.493)。3组患者CRP表达水平差异有统计学意义(F=5.220,P=0.009);危重型CRP表达水平高于重型、普通型,差异有统计学意义(P均<0.05);重型与普通型CRP表达水平差异无统计学意义(P>0.05)。危重型LDH表达水平高于普通型,差异有统计学意义(H=-2.961,P=0.009);危重型与重型、普通型与重型差异无统计学意义(H=-1.051,P=0.879;H=-1.484,P=0.414)。3组患者两两比较,白细胞计数、中性粒细胞计数、ALT、AST、γ-GT、TBIL、DBIL、BUN、Cr表达水平差异均无统计学意义(P>0.05)。结论①多数新型冠状病毒肺炎患者起病初期症状不严重,主要症状为发热、咳嗽,部分患者同时伴随消化道系统或其他系统症状。②危重型患者淋巴细胞计数、CRP及LDH均出现异常,上述指标有助于判断病情严重程度。

Objective To investigate the clinical characteristics of corona virus disease 2019(COVID-19)patients in Wuhan City,and the correlation between inflammatory factors and severity.Methods According to the COVID-19 diagnosis and treatment plan(trial version fifth),the clinical data,including clinical symptoms,blood tests and chest CT,of 51 patients were retrospectively analyzed.The patients were divided into 3 groups:32 cases of general type,9 cases of severe type and 10 cases of critical type.Results①The main symptoms were fever(42 cases,82.35%),cough,expectoration(39 cases,76.47%),chest distress,shortness of breath(24 cases,47.06%),diarrhea and headache(few cases);the accompanying symptoms included fatigue,muscle ache,headache,nausea,vomiting and diarrhea.The number of days before hospitalization was 1-21,with a median of 7;the number of days of hospitalization was 3-30,with a median of 12.②The results of peripheral blood generally showed that,CRP was increased(80.39%),lymphocyte count was decreased(68.63%),lactate dehydrogenase(LDH)was increased(52.94%),and the leukocyte count,neutrophil count,alanine transaminase(ALT),aspartate aminotransferase(AST),γ-glutamyl transpeptidase(γ-GT),total bilirubin(TBIL),direct bilirubin(DBIL),blood urea nitrogen(BUN)and creatinine(Cr)were normal.③The characteristics of chest CT showed that the foci were multiple in double lung and field lung,with mainly ground-glass opacity and patchy shadow,showing interstitial pneumonia change.During the course of the disease,the focus could increase,expand and increase in density,and did not form cavity.There was no pleural effusion change,and the focus was not easy to cause blockage of trachea and bronchi.④The lymphocyte count in general type was higher than those in severe type and critical type(H=3.656,P=0.001;H=5.572,P<0.001);the lymphocyte count showed no statistical difference between severe type and critical type(H=1.391,P=0.493).The CRP levels among the three groups were statistically different as a whole(F=5.220,P=0.009);The CRP level in critical type was higher than those in general type and severe type(both P<0.05),while that between general type and severe type exhibited no statistical difference(P>0.05).The LDH level in critical type was higher than that in general type(H=-2.961,P=0.009);Compared with the severe type,the LDH levels in general type and critical type exhibited no statistical difference(H=-1.051,P=0.879;H=-1.484,P=0.414).For leukocyte count,neutrophil count,ALT,AST,γ-GT,TBIL,DBIL,BUM,Cr expression levels,there existed no statistical difference after pairwise comparisons(P>0.05).Conclusion①Most of the COVID-19 patients are not severe at the initial stage of onset;the main symptoms are fever and cough,accompanied by gastrointestinal system or other systemic symptoms.②The levels of lymphocyte count,CRP and LDH are abnormal in severe patients,which may help to judge the severity of the disease.