沧州地区47例新型冠状病毒肺炎患者的临床特征分析

Clinical characteristics of 47 cases of corona virus disease 2019 in Cangzhou region

目的总结沧州地区新型冠状病毒肺炎(简称新冠肺炎)患者的流行病学和临床特征,为其他地区新冠肺炎的诊治提供参考。方法回顾性分析2020年1月24日至3月5日沧州市人民医院呼吸与危重症医学科收治的所有新冠肺炎患者的临床资料(随访结果至2020年3月16日),观察其流行病学特征、人口统计学特征、临床特征以及影像学特征和实验室检查结果;评估实验室检查结果测量值是否超过正常参考值范围。结果共纳入47例新冠肺炎患者,其中男性23例,女性24例;平均年龄(43.6±17.7)岁;16例有慢性疾病。患者的临床表现主要为发热、咳嗽、气促、咽痛、腹泻等。10例(21.3%)有武汉暴露史,36例(76.6%)均与新冠肺炎患者有密切接触史,1例(2.1%)未能明确接触史。47例患者中,轻型4例(8.5%),普通型33例(70.2%),重型6例(12.8%),危重型4例(8.5%);平均住院时间(12.68±4.96)d。部分患者实验室指标:白细胞计数(WBC)、中性粒细胞比例(N)、淋巴细胞计数(LYM)、血小板计数(PCT)、血红蛋白(Hb)、白蛋白(Alb)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、尿素氮(BUN)、血肌酐(SCr)、乳酸脱氢酶(LDH)、肌红蛋白(Myo)异常。肺部影像学结果显示,35例(74.5%)患者表现为双侧肺炎,8例(17.0%)患者表现为单侧肺炎,4例(8.5%)患者无异常影像学表现;30例(63.8%)患者表现为多发性斑片样和磨玻璃样改变,其中2例(4.3%)双侧肺炎并出现多发性斑片及磨玻璃样变患者进展为急性呼吸窘迫综合征(ARDS),1例(2.1%)患者出现气胸。47例患者中,25例(53.2%)出现外周血CD3^+、CD4^+、CD8^+、CD4^+/CD8^+T淋巴细胞水平降低。47例患者均给予阿比多尔抗病毒治疗,18例接受抗菌药物治疗,9例给予激素治疗。治疗后45例(95.7%)治愈出院,2例(4.3%)死亡(1例为肺癌,1例为85岁高龄)。结论新冠肺炎感染呈聚集性发作,有基础疾病的患者更容易被感染,并可能导致呼吸衰竭、ARDS、多器官功能障碍综合征(MODS)等。新冠肺炎的临床症状及肺部影像学特征与普通病毒性肺炎相似,LYM、心肌酶谱异常与疾病严重程度及预后相关,可作为患者预后评价的指标。

Objective To summarize the epidemiological and clinical characteristics of corona virus disease 2019(COVID-19)patients in Cangzhou region,so as to provide reference for diagnosis and treatment of COVID-19 in other regions.Methods The clinical data of all COVID-19 patients admitted to the Department of Respiratory Critical Care Medicine of Cangzhou People's Hospital from January 24 to March 5,2020(follow up results to March 16,2020)were retrospectively analyzed,and their epidemiological characteristics,demographic characteristics,clinical characteristics,imaging characteristics and laboratory examination results were analyzed.Whether the measured value of laboratory indexes exceeded the normal reference value range was evaluated.Results The 47 patients with COVID-19 in the study included 23 males and 24 females,with the average age of(43.6±17.7)years old.Sixteen had chronic disease.The clinical manifestations of the patients included fever,cough,shortness of breath,sore throat,diarrhea,etc.Ten cases(21.3%)had a history of exposure to Wuhan,36 patients(76.6%)had close contact history with COVID-19 patients,1 case(2.1%)had no clear exposure history.Among the 47 patients,4 cases(8.5%)were mild type,33 cases(70.2%)were common type,6 cases(12.8%)were severe type,and 4 cases(8.5%)were critical type;the average length of stay was(12.68±4.96)days.The laboratory indexes of some patients including white blood cell count(WBC),neutrophil ratio(N),lymphocyte count(LYM),platelet count(PLT),hemoglobin(Hb),albumin(Alb),aspartate transaminase(AST),alanine transaminase(ALT),blood urea nitrogen(BUN),serum creatinine(SCr),lactate dehydrogenase(LDH),and myoglobin(Myo)were abnormal.In the lung imaging examination,35 patients(74.5%)presented with bilateral pneumonia,8 patients(17.0%)presented with unilateral pneumonia,and 4 patients(8.5%)presented with no abnormal imaging manifestations.Thirty patients(63.8%)presented with multiple patchy and ground glass changes.Two patients(4.3%)with bilateral pneumonia and multiple plaques and ground-glass degeneration developed acute respiratory distress syndrome(ARDS).One patient(2.1%)developed pneumothorax.Among the 47 patients,25 cases(53.2%)showed the decrease of CD3^+,CD4^+,CD8^+and CD4^+/CD8^+T lymphocyte level,the levels in severe and critical type were significantly lower than those in common type(all P<0.05).The 47 patients were given antiviral therapy with abidol,18 with antibacterials and 9 with glucocorticoid.After treatment,45 cases(95.7%)were cured and discharged,and 2 cases(4.3%)died(1 case was lung cancer,1 case was 85 years old)Conclusions COVID-19 infection is a cluster attack,and people with underlying diseases are more likely to be infected,which may lead to respiratory failure,ARDS,multiple organ dysfunction syndrome(MODS)and other serious diseases.The clinical symptoms and lung imaging features of COVID-19 are similar to those of common viral pneumonia.LYM and myocardial enzyme spectrum abnormalities are related to the severity and prognosis of the disease,which can be used as indicators for prognosis evaluation of patients.