广州市59例新型冠状病毒肺炎病例的临床特征

Clinical characteristics of 59 cases of COVID-19 in Guangzhou

目的探讨并分析广州市部分新型冠状病毒肺炎(COVID-19)患者的临床特征、治疗方法及转归。方法对广州市第八人民医院隔离三区病房收治并治愈出院的59例COVID-19患者进行流行病学史、一般情况、临床症状、血液检验、呼吸道标本核酸及CT影像学的临床特征、治疗方法及转归进行分析。结果(1)38例患者(64.4%)为武汉疫区来源或有武汉旅行史人员,25起家庭聚集性感染;(2)轻型患者4例(6.8%),普通型41例(69.5%),重型14例(23.7%),31例(52.5%)患者合并基础疾病,发热(79.7%)、咳嗽(71.2%)、乏力(44.1%)、纳差(42.4%)为主要临床表现,8例(23.6%)呼吸困难;(3)患者外周血白细胞总数降低17例(28.8%),淋巴细胞计数低下29例(47.5%),38例CRP升高(64.4%),25例SAA升高(42.4%),重型与非重型差异有统计学意义;24例ALT、AST升高(40.7%);4例血肌酐升高(6.8%),5例心肌酶CK-MB升高(8.5%)。(4)咽拭子核酸多于病程第(15.4±7.9)天转阴,最快3 d,最慢35 d;(5)CT典型影像学表现:35例磨玻璃样改变(GGO)(59.3%),28例混合GGO(47.5%),13例实变影(22.0%),8例合并胸腔积液(13.6%),25例遗留纤维条索影(42.4%)。(6)52例(88.1%)进行了抗病毒治疗,11例重型患者使用了小剂量糖皮质激素,16例低流量吸氧,14例经鼻高流量湿化氧疗,3例无创呼吸机辅助通气。结论广州市COVID-19以输入型为主,家庭聚集起病多见。疾病类型以普通型为主。血常规以淋巴细胞计数下降更明显,SAA、CRP对重型有预测价值,肝功能损害多见,咽拭子核酸多于病程第(15.4±7.9)天转阴,痰标本的阳性率高于咽拭子,胸部CT影像学有一定特征性,氧疗等综合治疗有效。

Objective To explore and analyze the clinical characteristics,treatment and outcome of some coronavirus disease 2019(COVID-19)patients in Guangzhou.Methods We extracted data regarding 59 patients with COVID-19,who were admitted and cured in the isolation ward 3 of our hospital,the epidemiological history,general conditions,clinical symptoms,blood tests,respiratory specimens,CT imaging inspections,treatments and outcomes were analyzed.Results(1)38 cases(64.4%)were epidemic area source or people with travel history in Wuhan,and 25 cases were family cluster infection;(2)4 cases(6.8%)were mild patients,41 cases(69.5%)were ordinary type,14 cases(23.7%)were severe type,31 cases(52.5%)were combined basic diseases;fever(79.7%),cough(71.2%),weakness(44.1%),anorexia(42.4%)were the main clinical manifestations,and 8 cases(23.6%)were dyspnea;(3)The decrease in white blood cell counts occurred in 17 patients(28.8%),and the lymphocyte count decreased in 29 patients(47.5%),38 cases(64.4%)of CRP increased,and 25 cases(42.4%)of SAA increased.There were differences between severe and non-severe groups:ALT and AST increased in 24 cases(40.7%);Increased serum creatinine in 4 cases(6.8%),the level of CK-MB increased in 5 cases(8.5%).(4)Most pharyngeal swabs specimens turned negative on day 15.4±7.9 of the patient′s course,the shortest 3 days,the longest 35 days;(5)Typical CT imaging findings:36 cases of ground-glass opacity(59.3%),28 cases of consolidation with ground glass opacity(47.5%),13 cases of consolidation(22.0%),8 cases of combined pleural effusion(13.6%),25 cases of residual fibrous cord shadow(42.4%).(6)52 patients(88.1%)received antiviral therapy;11 patients with severe disease received low-dose glucocorticoids,16 patients received low-flow oxygen inhalation,14 patients received nasal high-flow humidified oxygen therapy,and 3 patients received noninvasive ventilator-assisted ventilation.Conclusions COVID-19 in Guangzhou is mainly of imported type,and it is common in families.The disease type is mainly common type.Blood routines have a more significant decrease in lymphocyte counts,CRP,SSA has predictive value and more common liver damage.More nucleic acids in throat swabs turned negative on day 15.4±7.9 of admission,and the positive rate of sputum samples was higher than that of throat swabs.The CT imaging of COVID-19 has certain characteristics manifestation.Comprehensive treatment including oxygen therapy is effective.