重庆市某院新型冠状病毒肺炎临床特点分析

Clinical characteristics of corona virus disease of a hospital in Chongqing city

目的分析该院2019新型冠状病毒肺炎(COVID-19)确诊患者及疑似排除患者的一般情况及临床特点,以提高发热门诊临床诊断及鉴别水平。方法纳入2020年1月24日至2月20日该院发热门诊/隔离病房收治的COVID-19确诊患者(含市内会诊确诊病例)10例,疑似排除患者14例。所有患者采集流行病学及收治第1天的胸部CT、实验室检查等临床资料进行比较分析。结果10例COVID-19确诊患者平均年龄53.6岁(SD 14.00),9例(90%)发热,以干咳(50%)为主要症状,淋巴细胞绝对计数低于1.0×10^9/L 5例(50%)。疑似排除患者14例,平均年龄42.1岁(SD22.87),发热12例(86%),干咳7例(50%),淋巴细胞绝对计数低于1.0×10^9/L为3例(21%)。疑似排除患者最后诊断乙型流感伴细菌性肺炎5例,支原体肺炎5例,细菌性肺炎3例,肺血栓栓塞1例。两组患者在临床症状、白细胞总数和淋巴细胞绝对计数方面差异无统计学意义(P>0.05),中性粒细胞计数疑似排除组显著高于确诊组(P=0.008)。从影像学看胸膜下病变,血管增粗与疑似排除组相比差异有统计学意义(P均<0.05)。结论COVID-19呈聚集性发病趋势,传播性强,在发热门诊需高度重视COVID-19的筛查,对核酸阴性但高度疑似患者需及时隔离,多次、多部位取材核酸检查及肺CT动态随访具有重要价值,同时也需要充分考虑呼吸系统其他疾病的诊断筛查,减少医疗资源的浪费。

Objective We aimed to further clarify the epidemiological and clinical characteristics of corona virus disease(COVID-19)confirmed cases and suspected cases but excluded by screening in Chongqing.Methods In this study,we included 10 patients with confirmed and 14 patients with suspected but excluded by screening of COVID-19 in Chongqing General Hospital(including confirmed cases through our consultation)from Jan 24 to Feb 20,2020.Cases were analyzed for epidemiological,clinical,and radiological features and laboratory data on the first day of visiting to the hospital.Results Of the 10 patients with COVID-19,the average age of the patients was 53.6years(SD 14.00).Patients had clinical manifestations of fever(9[90%]patients),cough(5[50%]patients),lymphocyte count less than 1.0×10^9/L of 5 cases(50%).14 suspected patients were excluded,with an average age of 42.1 years(SD22.87),12 cases of fever(86%),7 cases of cough(50%),and 3 cases(21%)of lymphocyte count below 1.0×10^9/L.5 cases in the suspected exclusion group were finally diagnosed with influenza B and bacterial pneumonia,5 cases with mycoplasma pneumonia,3 cases with bacterial pneumonia,and 1 case with pulmonary thromboembolism.There were no significant differences in clinical symptoms,total white blood cells,and lymphocyte counts between the two groups.The neutrophil count in the suspected exclusion group was significantly higher than that in the confirmed group(P=0.008).According to imaging examination,subpleural lesions and vascular thickening were statistically different from those suspected exclusion group(P<0.05).Conclusion The COVID-19 has a tendency of clustering and strong spread.It is necessary to pay high attention to the screening of COVID-19 in the fever clinics.Negative nucleic acid detected by RT-PCR but highly suspected patients need timely and effective isolation.It has great value to collect and test samples of COVID-19 nucleic acids from multiple sites for multiple times and lung CT follow-up.At the same time,it is necessary to consider the screening of other diseases in the respiratory system to reduce the waste of medical resources.