江西省215例新型冠状病毒肺炎病例的实验室检查特征

Analysis of laboratory characteristics of 215 patients with COVID-19 in Jiangxi Province

目的:回顾性分析江西省215例新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)病例的临床资料及实验室检查特征,为病例管理提供科学依据。方法:收集南昌大学第一附属医院象湖院区2020年1月26日至2月24日收治的215例COVID-19患者。入院后采集患者临床资料,完善血常规;C反应蛋白(C-reactive protein,CRP);肝功能,包括丙氨酸转氨酶(alanine aminotransferase,ALT)、天冬氨酸转氨酶(aspartate transaminase,AST)、总胆红素(total bilirubin,TBil)、直接胆红素(direct bilirubin,Dbil)、总蛋白(total Protein,TP)、白蛋白(albumin,ALB);肾功能,包括肌酐(creatinine,Cr)、尿素(urea)、尿酸(uric acid,UA);碱性磷酸酶(alkaline phosphatase,AKP);γ-谷氨酰转肽酶(γ-glutamy transpeptidase,γ-GT);心肌酶谱,包括乳酸脱氢酶(lactate dehydrogenase,LDH)、肌酸激酶(creatine kinase,CK)等实验室检查。根据《新型冠状病毒感染的肺炎诊疗方案(试行第六版)》的临床分型方法,对比分析普通型与重型/危重型患者的实验室检查特征。结果:普通型患者165例(男性95例,女性70例),重型/危重型患者50例(男性36例,女性14例);普通型患者的发病年龄中位数为43岁且21.21%有合并症;重型/危重型患者的发病年龄中位数为52岁且66%有合并症。重型/危重型患者在白细胞总数、中性粒细胞百分数及CRP均值均高于普通型患者;在淋巴细胞百分比、红细胞及血红蛋白的均值均低于普通型患者。重型/危重型与普通型相比较,其肝功能无显著性差异;重型/危重型的蛋白检测值(TP 65.23 g/L;ALB 32.1 g/L)均值较普通型患者显著下降(TP 71.53 g/L;ALB 45.3 g/L);重型/危重型的肾功能检测指标(Cr 126.5μmol/L;Urea 6.38 mmol/L;UA 302.5μmol/L)及γ-GT(79.6 U/L)均较普通型患者的相应指标(Cr 55.75μmol/L;Urea 4.46 mmol/L;UA 260.2μmol/L;γ-GT 58.5 U/L)明显增加。COVID-19患者的心肌酶谱检测无明显异常。结论:江西省重型/危重型COVID-19合并症更多、全身炎症反应更为剧烈,机体携氧能力、营养状态及肾功能等指标较普通患者显著恶化。

Objective:To analyze the clinical manifestationsand laboratory detection characteristics of 215 patients with coronavirus disease 2019(COVID-19)treated in Jiangxi Province and to provide evidence for the management of COVID-19 cases in these types.Methods:This study enrolled 215 patients with COVID-19 who were treated in The First Affiliated Hospital of Nanchang University from January 26 to February 24,2020.The clinical data of patients after admission were collected and laboratory tests such as blood routine,C-reactive protein(CRP),liver function profile(alanine aminotransferase-ALT,aspartate transaminase-AST,total bilirubinTbil,direct bilirubin-Dbil,total protein-TP,albumin-ALB),kidney function profile(creatinine-Cr,Urea,uric acid-UA),alkaline phosphatase(AKP),γ-glutamy transpeptidase(γ-GT)and myocardial enzymes(lactate dehydrogenase-LDH,creatine kinase-CK)were reviewed.The data of common and severe/critical patients were compared.Results:There were 165 cases of common patients(95 males and 70 females);50 cases of severe/critical patients(36 males and 14 females).The median age of common patients was 43 years old and 21.21%had comorbidities.The median age of severe/critical patients was 52 years old and 66%had comorbidities.The total number of white blood cells,the percentage of neutrophils,and the mean CRP in severe/critical patients were higher than those of common patients;the average values of lymphocyte percentage,red blood cells and hemoglobin in severe/critical patients were lower than those of common patients.There was no significant difference in liver function profile between severe/critical patients and common patients.The mean value of protein detection(TP 65.23 g/L;ALB 32.1 g/L)in severe/critical patients was significantly lower than thatin common patients(TP 71.53 g/L;ALB 45.3 g/L);renal function profile test indicators(Cr 126.5μmol/L;Urea6.38 mmol/L;UA 302.5μmol/L)andγ-GT(79.6 U/L)in severe/critical patients were higher than the corresponding index in common patients(Cr 55.75μmol/L;Urea 4.46 mmol/L;UA 260.2μmol/L;γ-GT 58.5 U/L).Myocardial enzymes were not abnormal in COVID-19 patients.Conclusions:Severe/critical patients with COVID-19 in Jiangxi province had more medical comorbidities and more severe systemic inflammatory response than common patients.In addition,oxygen carrying capacity,nutritional status,and renal function of the severe/critical patients were significantly worse than those of common patients.