13例中老年重症新型冠状病毒肺炎患者临床资料分析

Clinical Data of 13 Middle-aged and Old Patients with Severe 2019 Novel Coronavirus Pneumonia

目的 通过观察及分析新型冠状病毒肺炎中老年重症患者的临床资料,总结该疾病的部分特点,为下一步工作提供借鉴.方法 回顾性分析13例于2020年1月18日至2020年1月27日在华中科技大学同济医学院附属同济医院发热隔离病房住院的重症新型冠状病毒肺炎患者的临床资料,并依据目前病情转归,将患者分为死亡+加重组、无变化组及好转组进行对比分析.结果 纳入的13例患者从发病到病重住院平均(7.9±4.2)d,平均年龄(60.2±7.2)岁.3例患者死亡,2例加重,4例无变化,4例好转.9例患者除呼吸道症状,还表现有腹泻.13例患者外周血淋巴细胞总数及比例均有不同程度下降.通过流式细胞学分析,死亡+加重组患者外周血总B淋巴细胞均明显减少,而其他两组多数患者基本正常(P<0.05).所有患者血清铁蛋白和超敏C反应蛋白均升高,部分患者红细胞沉降率升高.所有患者白细胞介素-2受体、白细胞介素-6、白细胞介素-10以及肿瘤坏死因子-α均有不同程度增高,但组间比较差异无统计学意义(P>0.05).结论 血清铁蛋白、超敏C反应蛋白、白细胞介素-2受体、白细胞介素-6、白细胞介素-10以及肿瘤坏死因子-α水平能敏感反映患者炎症程度;外周血T淋巴细胞(CD4+和CD8+)、NK细胞以及B淋巴细胞水平下降的患者预后多不佳;及时足量使用糖皮质激素可帮助部分患者度过炎症期.

Objective By analyzing the clinical data of the middle-aged and old patients with severe 2019 novel coronavirus(2019-nCoV)infection,to summarize some characteristics of the disease,and to provide reference for the following work.Methods The clinical data of 13 patients with severe 2019-nCoV pneumonia who were hospitalized in Tongji Hospital from January 18,2020 to January 27,2020 were analyzed retrospectively.According to the current outcome,the patients were divided into 3 groups:death+exacerbation group,no change group and improvement group.The data of the three groups were analyzed.Results The average time length from onset to hospitalization was(7.9±4.2)days.The average age of the patients was(60.2±7.2)years old.Three patients died in the hospital,2 patients were aggravated,4 patients were unchanged and 4 patients were improved.In addition to respiratory symptoms,9 patients had diarrhea.The number of peripheral blood lymphocytes in 13 patients decreased.Flow cytometry revealed that B lymphocytes in the death+exacerbation group were significantly reduced as compared with those in the rest two groups(P<0.05).Serum ferritin and high-sensitivity C-reactive protein(hsCRP)were increased in all the patients,while erythrocyte sedimentation rate(ESR)was increased in some patients.The levels of interleukin-2 receptor(IL-2 R),IL-6,IL-10 and TNF-αincreased in all patients,but there were no significant differences among the three groups(P>0.05).Conclusion Ferritin,hsCRP,IL-2 R,IL-6,IL-10 and TNF-αcan sensitively reflect the inflammation degree of patients.The prognosis of patients with the decrease of T-lymphocytes(CD4^+and CD8^+),NK cells and B-lymphocytes is poor.Timely and sufficient use of glucocorticoids might help some patients get through inflammatory period.