襄阳市新型冠状病毒肺炎住院患者特征的横断面研究

The cross-sectional study of hospitalized COVID-19 patients in Xiangyang,Hubei province

目的研究我院新型冠状病毒肺炎(Corona virus disease 2019,COVID-19)住院患者的临床流行病学特点和临床特征,为COVID-19的防控、诊断、治疗提供参考。方法提取、评估并分析截止2020年2月9日0时我院确诊的COVID-19患者资料,总结其流行病学特点和临床特征。结果我院共收治核酸检测确诊COVID-19患者102例,男52例,女50例;平均年龄50.38±16.86岁。输入性患者7例,37例有武汉旅行史。病毒潜伏期1-20天,平均8.09±4.99天。主要症状包括发热(84%)、咳嗽(57%)、咳痰(12%)、乏力(27%)、呼吸不畅(23%)、腹泻(15%)、食欲下降(10%)等。21例白细胞计数降低,56例淋巴细胞计数降低,66例(66/97)C反应蛋白升高,49例(49/85)血沉增快,19例(19/72)降钙素原升高,12例(12/13)铁蛋白升高。均行抗病毒、抗炎、对症治疗。8例入住ICU,6例出现呼吸衰竭,3例出现多器官功能衰竭,3例死亡。首次胸部CT检查90例、两次检查共有100例出现比较典型影像学表现,与核酸检测符合率98%。核酸检测首检阳性率66%,累计两次检测阳性率86%,累计3次96%。结论襄阳市COVID-19以二代传播为主,部分潜伏期长,性别易感性无明显差异。中老年为易感人群,重症及死亡病例集中分布在70岁以上年龄段,需采取针对性防控和诊断治疗措施。铁蛋白有可能反映该病炎症等变化情况。本地区重症及病死率低,可能与采取了积极有效的防治措施有关。3次核酸检测、2次CT检查,核酸、CT结合症状可大幅提高其诊断阳性率,有利于疾病防控和诊断治疗。

Objective To study the epidemiological and clinical characteristics of the Corona Virus Disease 2019(COVID-19)hospitalized patients in Xiangyang No.1 people’s hospital,to offer suggestions to the urgent needs of COVID-19 prevention,diagnosis and treatment.Methods In this study,all the confirmed cases in Xiangyang No.1 people’s hospital were included until Feb 9,2020.After all data were extracted and analyzed,we summarized the COVID-19 patients epidemiological and clinical features.Results 102 cases were confirmed by real-time RT-PCR,including 52 males and 50 females with an average age of 50.38 years(SD 16.86).We found 7 imported cases and 37 patients with travel history to Wuhan while rest are secondary cases such as family clustered infections.Incubation time of COVID-19 ranges from 1 day up to 20 days,average period was 8.09 days(SD 4.99).Fever(84%),cough(57%),fatigue(27%),shortness of breath(23%),diarrhea(15%),expectoration(12%),inappetence(10%)were the most common clinical manifestations.According to the laboratory findings,21 patients showed decreased blood leukocyte count and lymphopenia was observed in 56 patients.66(66/97)patients showed elevated C-reactive protein level,49(49/85)patients had increased erythrocytes sedimentation rate.Higher level of procalcitonin and ferritin were observed in 19(19/72)and 12(12/13)patients,respectively.Anti-viral and anti-inflammatory treatments were taken on all patients according to their symptoms.Among all hospitalized patients,8 were admitted to intensive care unit(ICU),6 developed respiratory failure and 3 had multiple organ failure.3 death were recorded by Feb 10,2020.90 patients were found with typical radiological findings of pneumonia on chest computed tomography(CT)for first examination and this number increased to 100 in second CT scan as a consistency of 98%with rea-time RT-PCR diagnosis.When retrospected to the first real-time RT-PCR examination,which showed 66%positive rate while the following second and third test showed 86%and 96%cumulative positive rate among all included patients,respectively.Conclusions Most COVID-19 patients in Xiangyang were identified as secondary cases,some cases had long incubation period,no significant difference of susceptibility was found between genders,middleto-old-age population were sensitive to SARS-CoV-2 infection,severe and fatal cases mainly came from patients over 70 years old.For the mentioned phenomenon,special interventions need to be taken.Some parameters like ferritin could be used as possible clinical markers of COVID-19 associated inflammation.The low rate of severe cases and low mortality could be due to active prevention after the outbreak and relative adequate access to medical resources.Repeated real-time RT-PCR for 3 times together with 2 times of CT scans and symptoms could give significantly higher positive rate than single examination,benefits the COVID-19 prevention,diagnosis and treatment.