新型冠状病毒肺炎49例临床特征分析

Analysis of clinical characteristics of 49 cases of COVID-19

目的分析新型冠状病毒肺炎(COVID-19)患者的流行病学特点、临床表现、实验室检查及影像学特征。方法收集2020年1月23日至2月22日我院感染科收治的49例COVID-19确诊患者临床资料,对其流行病学特征、临床症状、血常规、感染指标、炎症因子、影像学表现及治疗情况进行分析。所采集数据应用SPSS 22.0进行统计学分析。结果49例COVID-19患者中普通型28例,重症16例,危重症5例,3组患者的平均年龄分别为(46±19)、(60±16)和(68±20)岁,危重症患者的年龄最大。发病时常见症状为发热(41例)、干咳(35例)和乏力(21例)。49例中31例(63%)患者曾直接或间接与确诊患者接触,其中14例为家庭聚集性病例。3组患者的淋巴细胞进行性减少,分别为0.85(0.5~1.6)、0.51(0.4~0.9)和0.43(0.47~0.61)×10^9/L,乳酸脱氢酶分别为162(145~204)、265(195~288)和387(312~416)U/L,D-二聚体分别为0.15(0.1~0.4)、0.4(0.2~0.6)和0.91(0.5~1.4)mg/L;IL-6分别为(43.2±15.4)、(78.5±31.2)和(132.4±47.9)μg/L;IL-10分别为(3.5±3.2)、(7.6±6.4)和(9.4±7.2)μg/L。普通型患者肺部影像学主要表现为单侧或双侧多发磨玻璃样渗出影,重症及危重症患者表现为双肺弥漫性渗出和实变,少数呈"白肺"。结论COVID-19患者临床症状以发热和干咳为主。淋巴细胞计数、乳酸脱氢酶、D-二聚体、IL-6和IL-10水平与病情严重程度有明显相关性,可作为判断患者病情发展趋势和预后的依据。肺部影像学表现为单侧或双侧磨玻璃样渗出影,重症及危重症患者呈弥漫性渗出并实变影,甚至呈"白肺"表现。

Objective To analyze the epidemiological and clinical characteristics,and imaging features of patients with COVID-19 in Henan Province People′s Hospital.Methods The epidemiology,clinical symptoms,laboratory and radiologic data of 49 patients with COVID-19 infection admitted to the department of infectious disease in our hospital from January 23,2020 to February 22,2020 were retrospectively analyzed.All analyses were performed with SPSS software,version 22.0.Results A total of 49 patients with COVID-19 were enrolled,of which 28 were ordinary,16 were severe,and 5 were critical in disease severity.The average ages of the 3 groups were(46±19),(60±16)and(68±20)years,with statistical differences(P=0.015).Common symptoms at the onset were fever(41 patients),dry cough(35 patients),and fatigue(21 patients).Epidemiological investigations found that 31(63%)patients had direct or indirect contact with confirmed cases,and 14 cases were family clustered.Laboratory test results showed that the lymphocyte counts progressively decreased[0.85(0.5-1.6)×10^9/L,0.51(0.4-0.9)×109/L and 0.43(0.47-0.61)×109/L,respectively],while LDH[162(145.1-203.5)U/L,265(195.3-288.4)U/L and 387(312.3-415.5)U/L,respectively]and D-dimer[0.15(0.09-0.40)mg/L,0.4(0.2-0.6)mg/L and 0.9(0.5-1.4)mg/L,respectively]were significantly increased(P<0.05),in all the 3 groups.The levels of IL-6[(43.2±15.4)μg/L,(78.5±31.2)μg/L and(132.4±47.9)μg/L,respectively]and IL-10[(3.5±3.2)μg/L,(7.6±6.4)μg/L and(9.4±7.2)μg/L respectively]increased significantly with disease severity.Pulmonary imaging of ordinary patients mainly showed unilateral or bilateral multiple infiltrates,while severe and critically ill patients showed diffuse exudation and consolidation of both lungs,and a few patients showed signs of"white lungs".Conclusions Patients with COVID-19 has a definite history of contact with diagnosed patients,and has family aggregation.The clinical symptoms were mainly fever and dry cough.Laboratory results showed that lymphocyte count,LDH,D-dimer,interleukin-6 and interleukin-10 levels had a significant correlation with the severity of the disease,which could be used as markers for disease progression and prognosis.Pulmonary imaging showed unilateral or bilateral ground glass infiltration.In severe and critically ill patients,diffuse infiltration and consolidation or even"white lung"were present.