71例2019冠状病毒病临床特征分析

Clinical characteristics of 71 patients with coronavirus disease 2019

目的:分析71例2019冠状病毒病(coronavirus disease 2019,COVID-19)患者的临床特征。方法:回顾性分析郑州市第六人民医院于2020年1月19日至3月3日收治的71例COVID-19患者的一般资料、流行病学资料、实验室检查指标、影像学表现及治疗情况,总结疾病的临床特征。结果:71例患者年龄为4~84(41.29±15.21)岁,其中男38例(53.5%),女33例(46.5%)。52例(73.2%)属于22起聚集性疫情发病。患者以发热[56例(78.9%)]、咳嗽[46例(64.8%)]、咳痰[27例(38.0%)]为主要临床表现。发热以低、中热为主,37.3~39.0℃共49例(69.0%)。白细胞、中性粒细胞及淋巴细胞数正常者分别有47例(66.2%),51例(71.8%)及51例(71.8%),下降者分别有21例(29.6%),16例(22.5%)及20例(28.2%);38例(53.5%)出现CD4^+T淋巴细胞计数下降,31例(43.7%)出现CD8^+T淋巴细胞计数下降;38例(53.5%)红细胞沉降率升高,41例(57.7%)C反应蛋白、32例(45.1%)降钙素原、26例(36.6%)纤维蛋白原、22例(31.0%)白介素-6、20例(28.2%)乳酸脱氢酶、14例(19.7%)D-二聚体、14例(19.7%)丙氨酸氨基转移酶、9例(12.7%)天门冬氨酸氨基转移酶水平升高。发病早期即可累及肺部,71例中累及肺部的有60例(84.5%),其中累及双肺的47例(66.2%),累及单肺13例(18.3%)。病程较长,从出现症状到第2次严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARS-CoV-2)核酸转阴时间为(17.22±6.34)d。重症组患者与非重症组患者在潜伏期(t=-0.453,P>0.05)、基础疾病合并情况(χ^2=0.042,P>0.05)、出现症状到确诊时间(t=-1.330,P>0.05)上差异无统计学意义,在发病年龄、性别、SARS-CoV-2核酸转阴时间、淋巴细胞计数、D-二聚体、C反应蛋白、总胆红素、直接胆红素、乳酸脱氢酶、钙离子、CD4^+T淋巴细胞计数、CD8^+T淋巴细胞计数、降钙素原、肌红蛋白及肌钙蛋白方面的差异有统计学意义(均P<0.05)。71例患者中轻症4例(5.6%)、普通型59例(83.1%)、重症和危重症8例(11.3%)。结论:COVID-19聚集性发病现象明显,应高度重视并预防;以发热、咳嗽为主要临床表现;在发病早期大部分患者白细胞、中性粒细胞、淋巴细胞数正常;大部分为轻症及普通型的患者,预后良好。

Objective:To analyze the clinical characteristics of 71 patients with coronavirus disease 2019(COVID-19).Methods:The general data,epidemiological data,laboratory tests,imaging examinations,and treatment of 71 patients with COVID-19 admitted to the Sixth People’s Hospital of Zhengzhou from January 19,2020 to March 3,2020 were retrospectively analyzed.Results:Of the 71 COVID-19 patients,the ages were 4-84(41.29±15.21)years,38(53.5%)patients were male,33(46.5%)were female,and 52(73.2%)were in 22 clusters.The main clinical manifestations were fever(78.9%),cough(64.8%),and sputum(38.0%).The fever was mainly low and moderate,with 49 patients(69.0%)at 37.3-39.0℃.Most of the leukocytes,neutrophils,and lymphocytes were normal,accounting for 47(66.2%),51(71.8%),and 51(71.8%)patients,respectively;a few of them were decreased,accounting for 21(29.6%),16(22.5%),and 20(28.2%)patients,respectively.There were 38(53.5%)and 31(43.7%)patients with the decreased CD4^+and CD8^+T cell counts,respectively.There were 41(57.7%),38(53.5%),32(45.1%),26(36.6%),22(31.0%),20(28.2%),14(19.7%),14(19.7%),and 9(12.7%)patients with the increased levels of C-reactive protein,erythrocyte sedimentation rate,procalcitonin,fibrinogen,interleukin 6,lactate dehydrogenase,D-dimer,alanine aminotransferase,and aspartate aminotransferase,respectively.Of the 71 patients,the lung was involved in 60(84.5%)patients,the double lung was involved in 47(66.2%)patients,and the single lung was involved in 13(18.3%)patients.The course of the disease was long,and the time from symptom onset to the second severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)nucleic acid negative transformation was(17.22±6.34)days.There were no significant differences in the incubation period(t=-0.453,P>0.05),the complicates(χ^2=0.042,P>0.05),and the time from symptom onset to diagnosis(t=-1.330,P>0.05)in patients between the non-severe group and the severe group.The onset age,gender,SARS-CoV-2 nucleic acid negative time,lymphocyte count,D-dimer,C-reactive protein,total bilirubin,direct bilirubin,lactate dehydrogenase,calcium ion,CD4^+T cell count,CD8^+T cell count,calcitonin,procalcitonin,and troponin were significantly different between the severe group and the non-severe group(all P<0.05).Among the 71 patients,4(5.6%)patients were mild,59(83.1%)were normal,and 8(11.3%)were severe or critical.Conclusion:The aggregation phenomenon of COVID-19 is obvious.Fever and cough are the main clinical manifestations.White blood cells,neutrophils,and lymphocytes in the most patients in the early onset are normal.Most COVID-19 patients are light and ordinary type,with good prognosis.