新型冠状病毒肺炎出院患者203例的临床特点分析

Clinical characteristics of 203 discharged patients with corona virus disease 2019

目的通过分析203例新型冠状病毒肺炎(COVID-19)出院患者的临床资料,探索重症患者的预测因素。方法纳入2020年1月1日至2月1日于武汉大学中南医院连续住院诊治并出院的COVID-19患者,分成重症组和非重症组。收集纳入患者的病历资料,分析两组的临床表现、实验室检查、影像学检查、治疗和预后等。统计学方法采用Mann-Whitney U秩和检验和χ2检验。结果共纳入203例COVID-19出院患者,常见的临床表现为发热(89.2%,181/203)、干咳(60.1%,122/203)、胸闷(35.5%,72/203)、气促(29.1%,59/203)和肌肉/关节疼痛(26.6%,54/203)。从开始出现症状至入院的时间为5.8 d(1.0~20.0 d)。203例COVID-19患者中,重症组107例(52.7%),非重症组96例(47.3%)。重症组年龄为60岁(23~91岁),大于非重症组的47岁(20~86岁),差异有统计学意义(Z=-6.12,P<0.01);重症组有至少1种基础疾病者占63.6%(68/107),大于非重症组的20.8%(20/96),差异有统计学意义(χ2=37.60,P<0.01)。重症组白细胞计数升高比例,淋巴细胞计数、白蛋白的下降比例,丙氨酸转氨酶、天冬氨酸转氨酶、肌酐、乳酸脱氢酶、肌酸激酶、空腹血糖、D-二聚体、红细胞沉降率、C反应蛋白、白细胞介素6、降钙素原的升高患者比例均增加。203例患者中,172例(84.7%)入院时影像学检查已显示双肺斑片影、磨玻璃影;20例(9.9%)合并胸腔积液;平均间隔5 d复查影像学发现,55例(27.1%)显示肺部病变进展。203例患者中,123例(60.6%)入院即给予氧疗,107例(52.7%)给予糖皮质激素短期治疗,131例(64.5%)给予抗病毒治疗;26例(12.8%)死亡。住院时间为11.0 d(1.0~45.0 d)。结论COVID-19患者的症状中发热占的比例最高,老年、合并基础疾病患者易进展为重症。对于老年患者,应加强早期监测,重视基础疾病的控制,减少危重症的发生。

Objective To analyze the clinical data of 203 discharged patients with corona virus disease 2019(COVID-19),and to investigate the predictors for the severe cases.Methods Confirmed COVID-19 cases hospitalized at Zhongnan Hospital of Wuhan University from January 1 to February 1,2020 were consecutively enrolled,who were divided into severe group and non-severe group.The clinical data of enrolled patients were collected and the clinical manifestations,laboratory results,imaging,treatments and prognosis of patients in the two groups were analyzed.Mann-Whitney U rank sum test and chi-square test were used for statistical analysis.Results A total of 203 discharged patients with COVID-19 were enrolled.The common clinical manifestations included fever(89.2%,181/203),dry cough(60.1%,122/203),chest distress(35.5%,72/203),shortness of breath(29.1%,59/203)and myalgia or arthralgia(26.6%,54/203).The time from disease onset to hospital admission was 5.8 days(1.0 to 20.0 days).Among 203 enrolled patients,107(52.7%)were divided into severe group and 96(47.3%)were non-severe group.The age in severe group was 60 years(23 to 91 years),which was significantly older than non-severe group(47 years(20 to 86 years)),the difference was statistically significant(Z=-6.12,P<0.01).There were 63.6%(68/107)patients in severe group with at least one underlying disease,which was significantly more than non-severe group(20.8%(20/96)),the difference was statistically significant(χ2=37.60,P<0.01).The proportions of patients with increased white blood cells,decreased lymphocytes and albumin,elevated alanine aminotransferase,aspartate aminotransferase,creatinine,lactic acid dehydrogenase,creatine kinase,fasting blood glucose,D-dimer,erythrocyte sedimentation rate,C-reactive protein,interleukin-6,and procalcitonin in severe group were all higher.On admission,172 patients(84.7%)had bilateral patchy shadows or ground glass opacity in the lungs on chest imaging study,20(9.9%)presented pleural effusion.Fifty-five cases(27.1%)showed progressions of lung lesions on computed tomography(CT)rescan at an average interval of five days.Among 203 patients,123(60.6%)were given oxygen therapy upon admission,107(52.7%)were given short-term glucocorticoid therapy,and 131(64.5%)received antiviral therapy;and 26(12.8%)died.The hospital stay was 11.0 days(1.0 to 45.0 days).Conclusions Fever is the most common symptoms in COVID-19 patients.Elderly and patients with underlying diseases are risk factors for progression to severe cases.The elderly patients should be strengthened early monitoring,paid attention to the control of underlying diseases,and reduce the occurrence of critical diseases.