河南省南阳市150例新型冠状病毒感染患者临床特征分析

Clinical analysis of 150 cases of 2019 novel coronavirus infection in Nanyang City,Henan Province

目的分析河南省南阳市新型冠状病毒(2019-nCoV)感染患者的流行病学和临床特点,为临床诊治提供依据。方法对2020年1月24日至2月16日在南阳市各定点医院收治的150例2019-nCoV感染患者的流行病学、临床症状、实验室和影像学资料进行回顾性分析,其中男67例,女83例,年龄3~98岁,平均(45±16)岁。结果150例2019-nCoV感染患者中,一代病例69例(69/150,45%),二代病例60例(60/150,40%),三代病例6例(6/150,4%);一代病例平均潜伏期为(5.4±2.2)d,二代病例平均潜伏期为(6.7±3.1)d,重症患者中一代病例占多数(69%)。患者最常见的基础疾病为高血压(13/150,8%),其次为糖尿病(9/150,6%);最常见的症状为发热(142/150,95%),多表现为中等发热(38.1~39.0℃,90/150,63%),较常见的临床症状为咳嗽咳痰(108/150,72%)、乏力(23/150,15%)、纳差(20/150,13%),少数患者以头痛、腹泻、肌肉酸痛、咽痛为首发症状。所有患者从出现首发症状到就诊平均时间为(4.2±2.2)d。外周血细胞学改变主要为淋巴细胞(83/150,55%)及嗜酸粒细胞减低(95/150,63%),重症及危重症患者淋巴细胞计数降低更显著,部分患者出现心肌酶升高,主要为LDH升高(47/150,31%),少数患者出现肝功能损伤,主要表现为丙氨酸氨基转移酶、天冬氨酸基转移酶升高,极少数患者出现肾功能损伤。炎症相关指标中,主要表现为C反应蛋白(66/150,43%)及ESR(86/150,57%)升高,29%患者D-二聚体升高。所有患者均行胸部CT检查,其中144例存在不同程度的感染性改变,30例累及单肺,114例累及双肺,形态学以斑片状磨玻璃病灶居多,可伴空气支气管征及部分实变及铺路石征;7例影像学呈"白肺"表现,多为重症或危重症患者。经积极治疗,67例患者符合出院标准出院,39例危重症患者中13例出院,19例降级住院,出院患者平均住院时间为(12±4)d。结论有流行病学接触史、发热、胸部CT有肺炎征象及白细胞正常或减少、淋巴细胞减少是诊断本病的临床依据,重症患者多为一代病例,淋巴细胞降低程度与疾病的严重程度呈相关性。

Objective To analyze the epidemiological characteristics and clinical features of the patients with 2019-nCoV infection in Nanyang City,so as to provide evidence for clinical diagnosis and treatment.Methods The epidemiology,clinical symptoms,atory and radiologic data of 150 patients with 2019-nCoV infection admitted to the designated hospitals in Nanyang City from January 24,2020 to February 16,2020 were retrospectively analyzed.Results The 150 patients with 2019 nCov infection consisted of 67 men and 83 women,and the median age was(45±16)years;69 of them were the first generation case,60 of them were the second generation case,6 of them were the third generation case,the median incubation period of the first generation case was(5.4±2.2)days,and the second generation case was(6.7±3.1)days,and the first-generation cases are the majority in severe patients(69%).The most common basic disease was hypertension(13 cases,9%),diabetes(9 cases,6%),and the most common symptom is fever(142 cases,95%,63%showed moderate fever),cough and sputum(108 cases,72%),fatigue(23 cases,15%),anorexia(20 cases,13%),headache,diarrhea,muscle soreness,sore throat as the first symptoms.The average time from onset of symptoms to consultation was(4.2±2.2)days for all patients.The changes in peripheral blood cells were mainly lymphonpenia(83 cases,55%)and eosinophilia(95 cases,63%),The lymphocyte count of the severe and critically ill patients was more significantly reduced,and some patients had increased myocardial enzymes,mainly LDH(47 cases,31%),and a few patients had liver function damage,mainly manifested in ALT and AST.High,very few patients have renal impairment.Among the inflammation-related indicators,the main manifestations are increased CRP(66 cases,43%)and ESR(86 cases,57%),elevated D-Dimer in 29%of patients.144 cases have different degrees of infective lesions in chest CT examination,with 30 cases(21%)on one side and 144 cases(79%)on both sides.Morphologically,most of the lesions were patchy ground glass lesions,which could be accompanied by air bronchus signs and some consolidation and paving stone signs.Of the cases showing"white lung",87%were sever ill or critically ill.After active treatment,45%of patients were discharged according to discharge standards.33%of sever and critically ill patients were discharged,49%of them were degraded hospitalization.The average length of hospitalization was(12±4)days.Conclusion A history of epidemiological exposure,fever,chest CT with signs of pneumonia,normal or decreased WBC,and lymphocytopenia,eosinophilia are the clinical basis for the diagnosis of this disease,and most of the sever patients were the first generation cases.The degree of lymphocytopenia is related to the severity of the disease.