新型冠状病毒肺炎患者血清学动态演变与病情的关系分析

The correlation between serological dynamic evolution and the severity of coronavirus disease 2019

目的分析新型冠状病毒肺炎(COVID-19)的临床特点,研究患者外周血中C反应蛋白、淋巴细胞数、嗜酸性粒细胞数、血小板数与病情严重程度的相关性。方法选取在医院隔离病房一区(即重症病区)收治的40例COVID-19患者为研究对象,收集临床资料,分析一般情况、临床症状、胸部CT影像学特点。根据诊断分型标准将患者分为普通型(13例)、重型(16例)和危重型(11例)3组。检测各组患者在入院第1~3天、第5~7天和第10~14天的外周血中C反应蛋白、淋巴细胞数、嗜酸性粒细胞数及血小板数,比较和分析患者不同时间点上述各指标变化的规律及其与病情严重程度的关系。结果(1)40例COVID-19患者中男23例(57.5%),60岁以上老年患者21例(52.5%);主要临床症状为发热(85%),多数患者伴有干咳(80%)、乏力(77.5%)、气促(72.5%),部分患者有纳差(42.5%)、腹泻(25%)、全身酸痛(15%)、头痛(15%)等;26例(65%)患者合并有基础疾病,常见基础疾病包括高血压(32.5%)、糖尿病(17.5%)、心脏疾病(10%)、恶性肿瘤(10%)等。(2)早期患者胸部CT表现主要为单发(12.5%)或多发(80%)的斑片影、磨玻璃影,少数伴有实变影(5%)或单发实变影(2.5%);疾病进展时病灶增多、范围增大,斑片影、磨玻璃影与实变影或条索影共存(47.5%);重症患者多数(30%)表现为双肺弥漫性病变。(3)COVID-19的临床特点与一般病毒性肺炎有所不同,绝大多数(95%)患者伴有非呼吸系统症状;高分辨率CT有助于鉴别诊断,但存在非特异性、滞后性,对病情进展的提示作用欠佳;患者外周血中C反应蛋白、淋巴细胞数、嗜酸性粒细胞数、血小板数与疾病分型存在相关性,有助于对COVID-19的严重程度和预后进行预测。结论COVID-19临床特征及胸部CT表现均具有多样性、多变性的特点;患者外周血中C反应蛋白、淋巴细胞数、嗜酸性粒细胞数、血小板数与COVID-19病情严重程度存在相关性,可考虑作为判断其预后的预警指标。

Objective To analyze the clinical characteristics of coronavirus disease 2019(COVID-19),and to study the correlation between C-reactive protein,lymphocyte count,eosinophil granulocyte count,platelet count and severity of the disease.Methods A total of 40 patients with COVID-19 were selected.Clinical data were collected to analyze the general situation,clinical symptoms and chest CT imaging characteristics.According to the diagnostic classification criteria,patients were divided into 3 groups:normal type(13 cases),severe type(16 cases)and critical type(11 cases).C-reactive protein,lymphocyte count,eosinophilic granulocyte count and platelet count in peripheral blood of patients in each group were assessed 1-3,5-7 and 10-14 days after admission.The changes of the above indicators at different time points and their correlations with the severity of the disease were compared and analyzed.Results Among the 40 COVID-19 patients,23(57.5%)were males and 21(52.5%)were over 60 years old.The main clinical symptoms were fever(85%).Most of the patients were accompanied with dry cough(80%),fatigue(77.5%),shortness of breath(72.5%).Some of the patients had tolerance(42.5%),diarrhea(25%),systemic pain(15%),headache(15%),and etc.Twenty-six patients(65%)were associated with basic diseases.Common basic diseases included hy-pertension(32.5%),diabetes(17.5%),heart disease(10%),and malignant tumor(10%),etc.The chest CT findings of early patients were mainly single(12.5%)or multiple(80%)patches and ground glass shadows,and a few patients were accompanied by consolidation(5%)or single consolidation(2.5%).As the disease progressed,the lesions increased in number and range,and the patch shadow,ground glass shadow,and consolidation shadow or strip shadow coexisted(47.5%).Most of the severe patients(30%)presented with diffuse lesions of both lungs.The clinical characteristics of COVID-19 were different from that of general viral pneumonia.Most of the patients(95%)had non-respiratory symptoms.High resolution CT was helpful for differential diagnosis,but it had non-specificity and hysteresis,which was not good for indicating the progress of the disease.C-reactive protein,lymphocyte count,eosinophilic granulocyte count and platelet count in peripheral blood of patients were correlated with the disease type,which was helpful to predict the severity and prognosis.Conclusion The clinical features and chest CT findings of COVID-19 are characterized by diversity and variability.C-reactive protein,lymphocyte count,eosinophilic granulocyte count and platelet count in peripheral blood of patients are correlated with the severity of COVID-19.