海南省危重型新型冠状病毒肺炎患者九例的临床分析

Clinical analysis of nine cases with critical corona virus disease 2019 in Hainan Province

目的:了解危重型新型冠状病毒肺炎患者的临床特征。方法:回顾性分析2020年1月21日至2月6日海南省人民医院收治的9例危重型新型冠状病毒肺炎患者的临床资料。9例患者中,男8例,女1例,年龄范围为28~77岁,年龄为(52.9±18.0)岁。采用反转录聚合酶链反应检测患者咽拭子、血液、粪便、尿液标本中的2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)核酸。随访截至2020年3月4日。比较好转组(5例)和恶化或死亡组(4例)患者的白细胞计数、C反应蛋白、降钙素原和乳酸水平,两组间比较采用t检验。结果:9例患者中,好转出院5例,死亡3例,1例仍病情危重。好转组患者在病程2~4周时多部位标本病毒核酸全部阴转。恶化或死亡组患者痰液标本病毒核酸持续阳性(最长达48 d)。恶化或死亡组与好转组患者的白细胞计数分别为(13.52±8.24)×10^9/L和(10.49±4.46)×10^9/L,C反应蛋白分别为(139.71±87.46)mg/L和(78.60±55.40)mg/L,降钙素原分别为(4.03±2.32)μg/L和(0.58±0.28)μg/L,乳酸水平分别为(4.14±3.70)mmol/L和(2.33±0.53)mmol/L,差异均有统计学意义(t=2.908、5.009、4.391和2.942,均P<0.01)。1例患者死亡前3 d内IL-6水平明显升高,达8500 ng/L。结论:危重型新型冠状病毒肺炎死亡患者的炎性因子水平均高于好转出院患者。

Objective To explore the clinical features of critical cases of corona virus disease 2019(COVID-19).Methods The clinical data of nine patients who were diagnosed with critical COVID-19 in Hainan General Hospital from January 21 to February 6,2020 were retrospectively analyzed.There were eight males and one female enrolled.The patients aged 28 to 77 years old,with an age of(52.9±18.0)years.Reverse transcription-polymerase chain reaction testing for 2019 novel coronavirus(2019-nCoV)was performed with multi-sites synchronize specimens including pharyngeal swab,blood,excrement and urine.The deadline of follow-up was March 4,2020.The serum levels of leukocyte,C reactive protein,procalcitonin and lactic acid between the improved group(five cases)and the deteriorated group(four cases)were compared.The t test was used for comparison of normally distributed continuous data between groups.Results Among nine patients,five cases were cured and discharged,three cases died and one case remained in critical condition.All multi-sites specimens of patients in improved group turned negative in 2 to 4 weeks of illness onset,while those of cases in deteriorated group showed sustained viral nucleic acid positive(up to 48th day of illness onset).The white blood cell counts((13.52±8.24)×10^9/L vs(10.49±4.46)×10^9/L),C reactive protein((139.71±87.46)mg/L vs(78.60±55.40)mg/L)and procalcitonin((4.03±2.32)μg/L vs(0.58±0.28)μg/L),lactic acid((4.14±3.70)mmol/L vs(2.33±0.53)mmol/L)in deteriorated group were all significantly higher than those in improved group(t=2.908,5.009,4.391 and 2.942,respectively,all P<0.01).A rapid rise of serum interleukin-6 level up to 8500 ng/L was observed in one patient three days prior to death.Conclusion Among the patients with critical COVID-19,serum levels of inflammatory cytokines of the death cases are higher than those of improved and discharged cases.