发热门诊312例新型冠状病毒肺炎患者临床特征分析

Analysis of Clinical Characteristics of 312 Cases of Patients with Coronavirus Disease 2019 in Fever Clinic

目的明确新型冠状病毒肺炎(COVID-19)临床特征及短期胸部影像学发生病灶进展的危险因素,早期识别可能发展为重型COVID-19患者。方法纳入2020年1月10日-2月8日在武汉市肺科医院发热门诊治疗COVID-19患者312例,将首次复查胸部CT提示病灶进展者180例和非进展者132例进行对比研究。回顾性分析患者一般情况、临床症状、实验室检查、影像学资料、治疗及转归。结果 312例患者中位年龄52岁,男:女为0.9:1,进展组和非进展组患者平均年龄均>50岁,在年龄、性别构成比方面差异无统计学意义(P>0.05)。进展组患者合并糖尿病18例(10.0%),显著高于非进展组3例(2.3%)(P<0.01)。进展组患者因症就诊时间(3.5 d,IQR 1~6)、从出现症状到首次胸部CT检查时间(5 d,IQR 2~7)、从出现症状到首次复查胸部CT检查时间(9 d,IQR 6~11)及首次复查胸部CT与前次检查间隔时间(4 d,IQR 3~5)均明显短于非进展组(P<0.01)。症状表现为发热(84.6%),畏寒(53.2%)、咳嗽(48.4%)、乏力(37.5%),咽喉痛(16.0%)、腹泻(8.0%)、气促(4.2%)。进展组有发热症状患者比例(91.7%)显著高于非进展组(P<0.01)。白细胞正常或减低300例(96.2%),外周血淋巴细胞计数<1.1×109·L-1 163例(52.2%),其中进展组外周血淋巴细胞计数明显低于非进展组(P<0.01);进展组超敏C反应蛋白为19.0 mg·L-1(IQR 4.5~48.1),显著高于非进展组(P<0.01)。胸部CT病灶分布范围>2个肺叶者,进展组和非进展组分别为106例(58.9%)和95例(72.0%)(P<0.05)。两组胸部CT病灶部位、影像学形态特点比较均差异无统计学意义(P>0.05)。结论 COVID-19的常见症状为发热,其次是畏寒、咳嗽和乏力。所有发热患者应及时行胸部CT筛查。有发热症状,合并糖尿病,外周血淋巴细胞计数降低、超敏C反应蛋白升高是患者肺部病灶进展的危险因素或征象,建议短期(3~5 d)复查胸部CT,早期识别可能发展为重型COVID-19患者。

Objective To investigate clinical characteristics and short-term risk factors for chest imaging lesions progression of COVID-19,and to early identify patients who may develop into severe COVID-19.Methods A total of 312 patients with COVID-19 from the fever clinic of Wuhan Pulmonary Hospital from January 10,2020 to February 8,2020 were included in the present study.A comparative study was carried out in 180 patients with advanced lesions and 132 patients with non-advanced lesions.The general situation,clinical symptoms,laboratory examination,imaging data,treatment and outcome of these patients were analyzed retrospectively.Results The median age of 312 patients was 52 years old with a male to female ratio of 0.9:1.The average age in both advanced group and non-advanced group was more than 50 years old,and there was no significant difference in age and sex composition ratio(P>0.05).In the advanced group,18 cases(10.0%)were complicated with diabetes,which was significantly higher than that in non-advanced group[3 cases(2.3%)](P<0.01).The treatment time(3.5 days,IQR 1-6),the time from symptoms onset to the first chest CT examination(5 days,IQR 2-7),the time from symptoms onset to the second chest CT examination(9 days,IQR 6-11),and the interval between the first chest CT examination and the second CT examination(4 days,IQR 3-5)in the advanced group were significantly lower than those in the non-advanced group(P<0.01).The symptoms of COVID-19 were fever(84.6%),chills(53.2%),cough(48.4%),fatigue(37.5%),sore throats(16.0%),diarrhea(8.0%),and polypnea(4.2%).The proportion of patients with fever in the advanced group(91.7%)was significantly higher than that in the non-advanced group(P<0.01).WBC count was normal or below in 300 cases(96.2%).Peripheral blood lymphocyte count was less than 1.1×109·L-1 in 163 cases(52.2%),and the peripheral blood lymphocyte count in the advanced group was significantly lower than that in the non-advanced group(P<0.01).C-reactive protein in the advanced group was 19.0 mg·L-1(IQR 4.5-48.1),which was significantly higher than that in the non-advanced group(P<0.01).Two hundred and one patients with more than two lobes detected in chest CT.Among them,106(58.9%)cases were in the advanced group and 95(72.0%)cases were in the non-advanced group,respectively.There was no significant difference between the two groups in the involved location and imaging features of chest CT lesions(P<0.05).Conclusion The common symptoms of COVID-19 were fever,followed by chills,cough and fatigue.All patients with fever should be screened by chest CT in the early time.It is suggested that chest CT should be reexamined in a short period(3-5 days)to identify the patients who may develop into severe COVID-19.