新型冠状病毒肺炎疫情期间上海市市区与郊区发热门诊患者临床特征分析

Clinical characteristics of urban and suburban patients in fever clinics during COVID-19 epidemic in Shanghai

目的比较在上海市市区与郊区发热门诊就诊的患者临床特征的差异,并探讨其在新型冠状病毒肺炎(COVID-19)疫情防控工作中的意义。方法纳入2020年1月22日-2月6日至上海交通大学附属第一人民医院北部院区(市区)和南部院区(郊区)发热门诊就诊患者,收集其症状、体征、流行病学史、血液检查和胸部薄层CT检查结果等临床资料。对COVID-19疑似患者进行隔离并行核酸检测。比较市区与郊区发热门诊患者的临床特征和COVID-19确诊情况。结果共1410例市区患者、1103例郊区患者入选。市区患者年龄为(42.8±17.8)岁,郊区患者年龄为(38.3±15.8)岁,市区患者年龄显著大于郊区患者(P<0.01)。两组患者性别构成的差异无统计学意义(P=0.4636)。与市区患者相比,郊区患者发热持续时间更长[(1.5±0.7)d比(1.4±0.6)d,P<0.01],就诊时体温更高[(38.7±0.5)℃比(38.4±0.5)℃,P<0.01],呼吸频率加快者更常见[8.3%(117/1410)比4.3%(47/1103),P<0.01]。郊区患者中伴呼吸系统症状(干咳、脓痰、咽痛、胸痛),以及其他症状(恶心、腹泻和头痛)者比例均显著高于市区患者(P值均<0.01)。郊区患者中急性发热呼吸疾病和流行性感冒(简称流感)样疾病的占比,以及患者外周血中性粒细胞计数和比例均显著高于市区患者(P值均<0.01)。市区患者中共103例(7.3%)诊断为肺炎,郊区患者中共124例(8.8%)诊断为肺炎,两组间肺炎诊断率的差异无统计学意义(P=0.0759)。在市区肺炎患者中,60~79岁年龄段的患者占比最高(45.6%);而在郊区肺炎患者中,20~39岁年龄段占比最高(41.9%)。共65例患者有COVID-19相关流行病学接触史,其中市区9例和郊区56例。经核酸检测,市区3例患者和郊区9例患者被确诊为COVID-19。结论市区和郊区发热门诊患者的临床特征存在差异,可能与人口结构不同有关。

Objective To identify the difference of clinical characteristics between urban and suburban patients in fever clinics,and investigate its implication in the prevention and control of coronavirus disease 2019(COVID-19).Methods Patients who visited urban(northern campus)or suburban(southern campus)fever clinics of Shanghai General Hospital between January 22 and February 6,2020,were enrolled in this study.Symptoms,epidemiological history,signs,blood test results and high-resolution computerized tomography scan presentations were collected.COVID-19 suspects were isolated and received nucleic acid assays.Clinical characteristics and COVID-19 confirmed cases were compared between urban and suburban patients.Results A total of 1410 urban patients and 1103 suburban patients were enrolled in the present study.The urban subjects were significantly older than suburban subjects([42.8±17.8]years old vs.[38.3±15.8]years old,P<0.01).There was no statistical difference in the gender ratio between urban and suburban patients(P=0.4636).Compared with urban patients,suburban patients had longer duration of fever[(1.5±0.7)d vs.(1.4±0.6)d,P<0.01],higher body temperatures[(38.7±0.5)℃vs.(38.4±0.5)℃,P<0.01],higher tachypnea rate[8.3%(117/1410)vs.4.3%(47/1103),P<0.01]and higher frequencies of respiratory symptoms(dry cough,purulent sputum,sore throat and thoracic pain),other symptoms(nausea,diarrhea and headache)and the differences were statistically significant(all P<0.01).Suburban patients had higher incidences of acute febrile respiratory illness and influenza-like illness,and higher levels of absolute and percentage neutrophil counts than urban patients(all P<0.01).Pneumonia was diagnosed in 103(7.3%)urban patients and 124(8.8%)suburban patients.No significant difference was found in pneumonia incidences between two groups(P=0.0759).Age distribution showed that the percentage of pneumonia patients in the urban group was the highest(45.6%)in the age range between 60 and 79 years old,while in suburban group the highest(41.9%)was found in the age range between 20 and 39.A total of 65 patients,including 9 urban patients and 56 suburban patients had COVID-19 related epidemiological contact history.Of them,3 urban patients and 9 suburban patients were confirmed to have COVID-19 by nucleic acid assays.Conclusion Clinical characteristics are significantly different between urban and suburban fever patients.