发热门诊筛查的新型冠状病毒肺炎确诊病例和疑似病例特征分析

Clinical and laboratory findings of confirmed versus suspected COVID-19 cases at fever clinic

目的回顾性分析发热门诊筛查的新型冠状病毒肺炎确诊患者和疑似患者临床特点,旨在为发热门诊早期诊断和正确分流患者提供参考.方法收集2020年1月20日-2月18日中国医科大学附属第一医院发热门诊筛查的8例新型冠状病毒肺炎确诊患者和74例疑似患者的临床资料,分析两组患者的流行病学特点、临床症状、实验室检查及影像学资料.结果8例确诊患者平均年龄(37.2±8.9)岁(21~50岁),男5例;74例疑似患者平均年龄(39.8±16.2)岁(8~85岁),男36例.两组患者在年龄、性别比例方面差异无统计学意义.8例确诊患者均有流行病学史,疑似患者中有流行病学史45例(45/74,60.8%),两组间差异有统计学意义(P=0.046).两组患者的主要临床症状为发热、咳嗽,咯痰、腹泻较少见,两组间差异不明显.与疑似患者相比,确诊患者白细胞总数偏低[(4.45±1.23)×10^9/L,P=0.002],粒细胞计数偏低[(2.30±0.87)×10^9/L,P=0.002].8例确诊患者肺部CT影像学改变以双肺病变为主,多数集中在胸膜下.结论发热门诊筛查的新型冠状病毒肺炎确诊患者和疑似患者临床表现差异不明显,区分很困难,确诊患者有流行病学史,结合早期实验室指标(血常规白细胞总数及粒细胞计数降低)及肺部CT典型的影像学改变(双肺多发、胸膜下病变)可以为临床早期诊断、及时分流患者提供参考依据.

Objective To compare the clinical characteristics of confirmed and suspected COVID-19 cases at fever clinic.Methods This hospital-based retrospective study compared 8 confirmed COVID-19 cases and 74 suspected COVID-19 cases in the First Hospital of China Medical University from January 20 to February 18,2020.Results The mean age of patients was(37.2±8.9)years for the 8 confirmed COVID-19 cases and(39.8±16.2)years for the 74 suspected COVID-19 cases.Age and sex did not show significant difference between these two patient groups.All COVID-19 cases had a history of exposure,while 60.8%of the suspected cases had a history of exposure(P=0.046).The clinical manifestations included fever and cough.COVID-19 patients were more likely to have a low WBC count[(4.45±1.23)×10^9/L,P=0.002]and neutrophils[(2.30±0.87)×10^9/L,P=0.002].Chest CT images showed bilateral patchy opacity(8/8 vs 35/74,P<0.05)and subpleural lesion(5/8 vs 9/74,P<0.05)more often in COVID-19 patients than in suspected cases.Conclusions The clinical manifestations do not show remarkable difference between confirmed COVID-19 patients and suspected fever cases.However,a history of exposure,early stage laboratory results(low WBC count and neutrophils)and characteristic chest CT images(bilateral patchy opacity and subpleural lesion)may help identify COVID-19 patients before laboratory confirmation of the virus.