144例新型冠状病毒感染的肺炎患者的临床特点及转归

Clinical features and outcomes of 144 patients with COVID-19

目的前期研究表明有吸烟史的新型冠状病毒肺炎(COVID-19)患者中重症患者较多,然而,吸烟对新型冠状病毒肺炎的病情严重程度是否有影响目前尚不清楚,故本研究对144例新型冠状病毒肺炎患者的临床特点及转归进行回顾性分析。方法将来自武汉协和东西湖医院144例COVID-19患者按有无吸烟史分为吸烟组(n=89)、非吸烟组(n=55),观察随访直至临床终点。观察的指标包括基本人口学特征,以及入院时的血常规、肝肾功能、电解质、凝血功能以及病情程度及转归等。结果与非吸烟组相比,吸烟组患者的病情程度较为严重,其中危重症比例(80.6%vs 19.4%)增高明显,有基础病的患者比例明显升高,尤其是糖尿病和高血压的人数明显增多,差异具有统计学意义。在吸烟组中嗜酸细胞计数和嗜酸性细胞比明显下降,氧合指数较低,总蛋白、球蛋白较高,白球比较低,血液pH值吸烟组较非吸烟组较高,心肌功能指标CTnl阳性率显著升高(P<0.05)。与非吸烟组相比,吸烟组患者有发热、咳嗽症状人数比例较低。有腹泻症状的患者人数比例较高(P<0.05)。结论与无吸烟史的肺炎患者相比,有吸烟史的肺炎患者有咳嗽、发热等临床表现的人数明显减少,伴有腹泻症状的人数明显增多,吸烟组患者较非吸烟组患者合并基础病患者的比例明显较高,肝功能和心肌功能损伤更加明显,病情程度更为严重。本研究表明吸烟可能是COVID-19病情加重的一个危险因素。

Objective Previous studies have shown that coronavirus disease 2019(COVID-19)patients with a history of smoking were more severe.However,whether smoking has an effect on the severity of COVID-19 patients is not yet known.Therefore,this study retrospectively analyzed the clinical characteristics and outcomes of 144 patients with COVID-19.Methods A total of 144 COVID-19 patients from Union Hospital of Huazhong University of Science and Technology were divided into the smoking group(n=89)and the non-smoking group(n=55)according to their smoking history,and they were tracked until the clinical endpoint.The observed indicators included basic demographic characteristics,biochemical indexes on admission,severity of disease and outcome.Results Compared with the non-smoking group,COVID-19 patients in the smoking group had a more serious illness,in which the proportion of critically ill patients(80.6%vs 19.4%)increased significantly.COVID-19 patients with smoking history had more complications,especially including diabetes and hypertension.The number and percentage of eosinophils were decreased,the oxygenation index was lower,the total protein and globulin were higher,the ratio of aibumin/globulin was lower,and blood PH value was higher in the smoking group than those in the non-smoking group.COVID-19 patients with smoking history had more CTnl-positive rate.Compared with the non-smoking group,COVID-19 patients with smoking history had lower fever and cough,and more diarrhea(P<0.05).Conclusion Compared with COVID-19 patients without smoking history,the number and percentage of eosinophils decrease in COVID-19 patients with smoking history.Hepatic and myocardial function are more worse and the disease severity is more serious in COVID-19 patients with smoking history than those in COVID-19 patients without smoking history.These results provide evidences that smoking aggravates disease severity of COVID-19 patients.