新型冠状病毒肺炎14例临床特征分析

Clinical characteristics of 14 patients with coronavirus disease 2019

目的分析14例新型冠状病毒肺炎患者的临床特征。方法收集2020年1月21日-2月21日渭南市中心医院收治的14例新型冠状病毒肺炎确诊患者的临床资料。回顾性分析患者的一般资料、流行病学史、临床症状、实验室检查、影像学表现及部分预后和转归。结果14例新型冠状病毒肺炎患者中男女比例相同,年龄14~68岁,中位年龄41岁。可推算潜伏期者7例,为7~18 d,有3组家族聚集性发病,共10人。发病至确诊时间最长11 d,最短1 d。临床表现以发热、咽部不适、干咳为主要症状,仅1例患者有明显消化道症状。轻型4例,普通型7例,重型3例,无危重型病例。早期外周血白细胞和淋巴细胞计数多数正常,病程中观察到4例患者外周血淋巴细胞计数呈逐渐下降趋势,伴随持续发热或肺部影像学进展。6例患者血清C反应蛋白升高(包括3例重型新型冠状病毒肺炎)。14例患者降钙素原检查均未见升高。RT-PCR检测新型冠状病毒核酸,1例为第2次检测阳性、2例为第3次检测阳性。4例轻型患者胸部CT无明显改变,10例患者肺部存在多发病灶,均有磨玻璃影,病灶为单侧1例、双侧9例,均位于胸膜下或肺外带,合并有实变4例、结节影1例,无坏死灶出现,未见胸腔积液。目前14例患者中6例连续2次鼻咽拭子新型冠状病毒核酸检测转阴,病程6~27 d,中位时间22.5 d。结论新型冠状病毒肺炎在临床表现、实验室及影像学检查等方面均不具有特异性,确诊需新型冠状病毒核酸检测阳性,但部分患者需多次检测才能得到阳性结果,故新型冠状病毒肺炎的诊断仍需全面结合流行病学史、临床症状、辅助检测及病情进展等方面综合判断。

Objective To analyze the clinical characteristics of the patients with coronavirus disease 2019(COVID-19).Methods The clinical data of 14 patients with COVID-19 treated in Weinan Central Hospital from January 21 to February 21 in 2020 were collected.The demographic data,epidemiological history,clinical manifestations,laboratory tests,the findings of imaging examination,and patient outcome were reviewed retrospectively.Results The 14 COVID-19 patients included 7 males and 7 females,aged 14 to 68 years,with a median age of 41 years.The incubation period was available in 7 patients,ranging from 7 to 18 days.There were 3 clusters of cases,involving 10 individuals.The longest time from onset to diagnosis was 11 days and the shortest one day.The main symptoms were fever,pharynx discomfort,and dry cough.One patient had obvious gastrointestinal symptoms.In terms of disease severity,4 cases were mild type,7 moderate type,and 3 severe type.Peripheral white blood cell and lymphocyte counts remained normal at early stage.Peripheral blood lymphocyte count gradually decreased in 4 patients as disease progressed,associated with persistent fever or progression on lung imaging.Peripheral blood C-reactive protein increased in 6 patients,including 3 cases of severe COVID-19.Serum procalcitonin did not elevate in the 14 patients.Real-time fluorescent RT-PCR detection of SARS-CoV-2 nucleic acid was not positive until second test in 1 case,until third test in 2 cases.Multiple lung lesions including ground glass opacity were found in 10 patients.The lesions were unilateral in 1 case and bilateral in 9 cases,under the pleura or in extrapulmonary zone.Lung consolidation was found in 4 cases and nodular lesion in 1 case.At time of this report,SARS-CoV-2 nucleic acid test with nasopharyngeal swab was negative on 2 consecutive attempts in 6 of the 14 patients.The shortest time to SARS-CoV-2 clearance was 6 days,the longest 27 days.The median time to SARS-CoV-2 clearance was 22.5 days.Conclusions COVID-19 is not specific in clinical manifestations,laboratory tests,or imaging results.The diagnosis requires a positive result of SARS-CoV-2 nucleic acid test.Multiple tests are required to confirm the diagnosis in some patients.The diagnosis of COVID-19 should be based on epidemiological history,clinical manifestations,laboratory tests,the findings of imaging examination,and disease progression.