安徽省六安市新型冠状病毒肺炎临床特征及重症患者预警因素

Clinical characteristics analysis and early warning factors of severe patients of COVID-19 in Lu′an,Anhui

目的探讨新型冠状病毒肺炎(COVID-19)的临床特点,分析患者发生重症的预警因素。方法收集2020年1月—2020年3月六安市人民医院69例COVID-19患者的临床资料,将患者分为普通组(60例)和重症组(9例),比较两组的临床表现和实验室检查结果,以Logistic回归分析COVID-19重症患者的影响因素。结果老年、患有基础性疾病及发热持续时间>5 d,是发生重症的危险因素(P<0.05),但发热程度在普通组与重症组差异无统计学意义;与普通组比较,重症组新型冠状病毒(SARS-CoV-2)核酸阴转时间长(P<0.05),出现畏寒、乏力、纳差、全身酸痛等毒血症状比例较高(P<0.05);实验室检查显示,重症组除淋巴细胞、血小板低于普通组(P<0.05);血沉(ESR)、C反应蛋白(CRP)、降钙素原、肌酸激酶、谷草转氨酶、乳酸脱氢酶(LDH)、血糖等指标方面,重症组显著高于普通组(P<0.05);若患者出现ESR≥50 mm/H,CRP≥100 mg/L,提示更容易重症化。Logistic回归结果显示,年龄、发热持续时间、LDH升高是导致疾病由轻症发展为重症的危险因素。结论COVID-19患者在早期病情评估时,临床医生需密切监测重症预警因素,尽早识别可能发生重症的病例。

Objective To explore the clinical features of coronavirus disease 2019(COVID-19),and we analyze the early warning factors for severe patients.Methods The clinical data of 69 COVID-19 patients in Lu′an People′s Hospita from January to March 2020 were retrospectively analyzed,the patients were divided into ordinary group(60 cases)and severe group(9 cases),and the clinical manifestations and laboratory tests of the 2 groups were compared.Logistic regression analysis of the influencing factors of COVID-19 severe patients were conducted.Results Elderly,combined with underlying disease,fever duration>5 days,is a risk factor for severe illness(P<0.05).There was no statistical difference in the degree of fever between the severe group and the ordinary group.The severe group had a longer time for nucleic acid negative conversion than ordinary group(P<0.05);And the incidence of chills,fatigue,anorexia,and systemic soreness in the severe group was higher than that of the ordinary group(P<0.05).Laboratory test results showed that in the severe group,except for lymphocyte and platelet lower than the ordinary group,eosinophils also had a significant decrease(P<0.05).Erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),procalcitonin,creatine kinase,aspartate aminotransferase,lactate dehydrogenase(LDH),and blood glucose levels in severe group were higher than those in the ordinary group(P<0.05).If the patient had ESR≥50 mm/H and CRP≥100 mg/L,it is more likely to be severe.Logistic regression results show that age,duration of fever,and elevated LDH are risk factors that cause the disease to develop from mild to severe.Conclusions In the early assessment of COVID-19 patients,it is necessary to closely monitor the critical early warning factors and identify severe cases as early as possible.