新型冠状病毒肺炎危重型患者临床特征与血常规分析

Clinical Features and Complete Blood Count of Patients with Critical Coronavirus Disease 2019

目的探讨新型冠状病毒肺炎(COVID-19)危重型患者的临床特征、血常规变化特点及其在疾病发生、发展、转归中的临床意义。方法以医院2019年12月至2020年3月收治的31例危重型COVID-19患者作为危重型组(按死亡与否分为死亡组和治愈组),同期住院的41例普通型COVID-19患者作为普通型组,分析危重型组与普通型组,以及死亡组与治愈组的临床资料及血常规检查结果。结果与普通型组比较,危重型组患者的发病年龄更大,伴有基础疾病的患者更多;危重型组患者的白细胞计数(WBC)、中性粒细胞(NEU)计数及百分比均显著高于普通型组,淋巴细胞(LYM)计数及百分比均显著低于普通型组;住院首次血常规,死亡组与治愈组各指标无显著差异(P>0.05);住院3~10 d血常规,死亡组NEU百分比显著高于治愈组,LYM百分比显著低于治愈组(P<0.05);住院末次血常规,死亡组WBC和NEU计数及百分比均显著高于治愈组,LYM计数及百分比、单核细胞及嗜碱性粒细胞百分比均显著低于治愈组(P<0.05)。结论危重型患者血常规变化与预后相关,特别是LYM,其降低程度与病情严重程度呈正相关。伴有基础疾病的老年人是COVID-19危重型的高危人群,外周血常规变化特别是LYM减少,结合临床表现,可作为COVID-19实验室诊断预警指标之一,在疾病早期识别和危重病例监测中发挥一定作用。

To investigate the clinical features and the change of complete blood count(CBC)in critical patients with coronavirus disease 2019(COVID-19),and to investigate its clinical significance in the occurrence,development and prognosis of the disease.Methods Totally 31 patients with critical COVID-19 admitted to our hospital from December 2019 to March 2020 were selected as the critical group,and they were divided into the death group and the cured group according to whether they died or not.Totally 41 patients with common COVID-19 who were hospitalized in the same period were taken as the common group.The clinical data and CBC result of patients between the critical group and common group,death group and cure group were analyzed.Results Compared with the common group,the onset age of patients was older and the patients with underlying diseases were more in the critical group.The white blood cell count(WBC),neutrophil(NEU)count and percentage in the critical group were significantly higher than those in the common group,while the lymphocyte(LYM)count and percentage in the critical group were significantly lower than those in the common group.There was no significant difference in the indexes of CBC between the death group and the cured group(P>0.05).After 3-10 d of hospitalization,the percentage of NEU in the death group was significantly higher than that in the cured group,while the percentage of LYM in the death group was significantly lower than that in the cured group(P<0.05).The final CBC result showed that WBC and NEU count and percentage in the death group were significantly higher than those in the cured group,while the LYM count and percentage,monocyte and basophil percentage in the death group were significantly lower than those in the cured group(P<0.05).Conclusion The change of CBC(especially LYM)is related to the prognosis of critical patients,and its reduction degree is positively correlated with the severity of the disease.The elderly patients with underlying diseases are at high risk of critical COVID-19,and the change of peripheral CBC,especially the decrease of LYM,combined with clinical manifestations can be used as one of the early warning indicators for COVID-19 laboratory diagnosis,which can play a certain role in disease early identification and critical case monitoring.