168例新型冠状病毒肺炎患者临床特点及重症进展的影响因素分析

Analysis of the clinical characteristics of novel coronavirus pneumonia and the influencing factors of severe disease progress

目的分析新型冠状病毒肺炎患者的临床特点及导致患者发展为重症的影响因素,为临床发现潜在重症病例及防治提供依据。方法回顾性分析2020年1月20日至3月2日因诊断新冠肺炎收治于安徽省两家三级综合医院住院治疗的168例病例资料的临床特点。并根据国家卫生健康委员会颁布的新冠肺炎诊疗方案(试行第六版)中的分型标准,将其中轻型和普通型病例归为轻症组(n=137),重型和危重型病例归为重症组(n=31)。对两组病例的一般资料、流行病学史、临床表现、实验室检查及影像学指标等进行比较;先行单因素分析,再对单因素分析差异有统计学意义的因素进行多因素Logistic回归分析,得出重型新冠肺炎发生的独立影响因素。结果168例新冠肺炎患者中男性95例,女性73例,年龄(42.6±15.8)岁。轻症组年龄小于重症组[(40.5±15.5)岁vs(51.6±14.1)岁,P<0.01]。重症组合并高血压(29.0%vs 10.9%,P=0.045)、糖尿病(25.8%vs 2.2%,P=0.005)以及同时有2种以上基础疾病者比例(29.0%vs 4.4%,P=0.006)均明显高于轻症组。重症组中初诊就诊于二级以下医院的患者比例明显高于轻症组(P<0.01),且出现症状距确诊的时间更长[(8.00±3.27)d vs(6.49±3.90)d,P=0.048]。轻症组和重症组的首发症状比较差异无统计学意义。但重症组就诊时体温更高[(38.80±0.67)℃vs(37.9±0.60)℃,P<0.01]。入院时实验室检查中,重症组的淋巴细胞百分比值[(18.20±9.13)%vs(24.43±10.43)%,P<0.01]明显低于轻症组,而C-反应蛋白、白介素-6、D-二聚体、乳酸脱氢酶和谷草转氨酶等均明显高于轻症组(P<0.01)。CT影像学检查轻症组有11例(8%)病灶局限在肺单叶,重症组全部病例均存在肺多叶病灶,两组差异有统计学意义(P<0.01)。本组168例新冠肺炎患者全部治愈,重症组的住院时间明显长于轻症组[(24.71±7.72)d vs(20.28±7.67)d,P=0.021]。经多元二分类Logistic回归分析,年龄(P=0.042),合并糖尿病(P=0.021),入院时体温(P=0.001),入院时IL-6水平(P=0.008)为患者转为重症新冠肺炎的独立影响因素。结论加强对基层医院的专业知识培训有助于早期诊断新冠肺炎。高龄、合并糖尿病、初始高热以及IL-6明显增高者更易发展为重症,应早期识别并加以防治。

Objective To analyze the clinical characteristics of patients with novel coronavirus pneumonia(COVID-19)and the factors influencing mild cases developing into severe cases,so as to provide a basis for clinical screening,prevention and treatment of potential severe cases.Methods Retrospective analysis was performed on the clinical characteristics of 168 cases who were admitted to two tertiary general hospitals in Anhui province and diagnosed with COVID-19 from January 20 to March 4,2020.According to the classification criteria in the COVID-19 diagnosis and treatment program(trial version 6)issued by the National Health Commission,the mild and common cases were classified as the mild group(n=137),and the severe and critical cases were classified as the severe group(n=31).The general data,epidemiological history,clinical manifestations,laboratory examination and imaging indexes of the two groups were compared.Univariate analysis was performed.Then multivariate Logistic regression analysis was conducted on the factors with statistically significant differences in univariate analysis to obtain independent influencing factors of the occurrence of severe COVID-19.Results Among the 168 COVID-19 patients,95 were male and 73 were female,with an average age of 42.6±15.8 years old.The mean age of the mild group was younger than that of the severe group(40.5±15.5 vs 51.6±14.1,P<0.01).The proportion of patients combined with hypertension(29.0%vs 10.9%),diabetes(25.8%vs 2.2%,P=0.005)and two or more underlying diseases(29.0%vs 4.4%,P=0.006)in the severe group were significantly higher than those in the mild group.In the severe group,the proportion of patients receiving initial treatment in Medical institutions below secondary hospitals was significantly higher than that in the mild group(P<0.01),and the time between symptom onset and diagnosis was longer[(8.00±3.27)d vs(6.49±3.90)d,P=0.048].There was no significant difference in the initial symptoms between the mild group and the severe group.However,the body temperature was higher in the severe group[(38.80±0.67)℃vs(37.9±0.60)℃,P<0.01].At the time of admission,the lymphocyte percentage of the severe group was significantly lower than that of the mild group[(18.20±9.13)%vs(24.43±10.43)%,P<0.01],while C-reactive protein,interleukin-6(IL-6),D-dimer,LDH,aspartate and aminotransferase were significantly higher than that of the mild group(P<0.01).CT imaging showed that 11(8%)patients in the mild group had lesions confined to a single lobe of the lung,while all patients in the severe group had multi-lobe lesions(P<0.01).All the 168 COVID-19 patients in this study were cured,and the length of hospital stay in the severe group was significantly longer than that in the mild group[(24.71±7.72)d vs(20.28±7.67)d,P=0.021].According to multivariate binary Logistic regression analysis,age(P=0.042),diabetes(P=0.021),body temperature at admission(P=0.001),and IL-6 measured at admission(P=0.008)were independent factors affecting COVID-19 to severe progress.Conclusions Strengthening the professional knowledge training of primary hospitals is helpful for early diagnosis of COVID-19.Patients with older age,combined with diabetes,high initial fever and significantly increased IL-6 level are more possibly to develop into severe disease.Early identification and prevention should be carried out.