新型冠状病毒肺炎临床表现分析

Clinical Analysis of Corona Virus Disease 2019

目的探讨新型冠状病毒肺炎(COVID-19)的临床特征。方法收集经病毒核酸检测确诊的COVID-19住院患者74例,分析患者的性别、年龄分布、基础疾病、症状、实验室检查及影像学特点。结果74例中,男性34例,女性40例,年龄(58.2±13.0)岁(28~87岁);入院前病程中位数为11.0 d;有基础疾病的30例(40.5%);入院时主要症状为发热(64例,86.5%)、干咳(52例,70.3%)、呼吸困难(42例,56.8%)、乏力(39例,52.7%)、腹泻(5例,6.8%)等。实验室检查:白细胞计数低下(9/71,12.7%)、淋巴细胞减少(32/71,45.1%)、血小板减低(14/71,19.7%)、转氨酶增高(30/71,42.3%)、白蛋白减低(65/71,91.5%)、胆红素增高(8/71,11.3%)、铁蛋白增高(43/51,84.3%)、乳酸脱氢酶增高(32/49,65.3%)、心肌酶增高(6/49,12.2%)、肌红蛋白增高(5/63,7.9%)、肌钙蛋白增高(2/63,3.2%)、C反应蛋白升高(52/70,74.3%)、血沉升高(48/61,78.7%)。呼吸道病原体抗体谱检测阴性39例(39/43,90.7%),咽拭子病毒核酸检测第1次阳性39例(39/74,52.7%),其余为核酸检测≥2次阳性。入院24 h内第1次胸部CT检查39例,均为阳性,平均累及(3.2±1.2)个肺叶;胸膜下病灶37例,沿支气管血管束分布24例;主要表现:磨玻璃影39例,实变影36例,大片实变影30例,结节影5例,条索影13例,网格状影4例,空气支气管征10例,混合表现36例。治疗3~7 d后复查胸部CT 31例,明显改善25例,无进展也无吸收3例,进展3例。经对症及抗病毒治疗后,出院或病情稳定继续治疗72例,因病情加重转ICU 2例。结论COVID-19发病时以发热、干咳、呼吸困难、乏力为主要临床表现,部分伴腹泻;大部分患者白细胞计数正常,淋巴细胞数及白蛋白水平降低,转氨酶、铁蛋白及C反应蛋白升高,降钙素原基本正常;肺部CT表现多样,以磨玻璃影及实变影多见,常双肺受累,影像学表现是否改善可作为评估病情变化的重要指标;咽拭子病毒核酸检测阳性可以确诊,但首次检出率较低,重复多次检测可提高检出率。尽早采取对症及抗病毒治疗,大多预后较好。

Objective To investigate the clinical characteristics of patients with corona virus disease 2019(COVID-19).Methods 74 cases of patients with COVID-19 confirmed by viral nucleic acid detection were collected.The gender,age distribution,basic diseases,symptoms,laboratory examination and imaging characteristics of the patients were analyzed.Results Of 74 patients(34 males)with COVID-19,the average age was(58.2±13.0)years(range 28-87 years).The median duration before patients admitted to hospital after the onset of the disease was 11.0 days.30 cases(40.5%)had underlying diseases.The most common symptoms were fever(64 cases,86.5%),dry cough(52 cases,70.3%),dyspnea(42 cases,56.8%),fatigue(39 cases,52.7%),diarrhea(5 cases,6.8%).Laboratory examination:leukopenia(9/71,12.7%),lymphopenia(32/71,45.1%),thrombocytopenia(14/71,19.7%),elevated level of aminotransferase(30/71,42.3%),decreased albumin(65/71,91.5%),increased bilirubin(8/71,11.3%),increased ferritin(43/51,84.3%),increased lactic dehydrogenase(32/49,65.3%)and increased myocardial enzymes(6/49,12.2%),myoglobin(5/63,7.9%),troponin(2/63,3.2%),C-reactive protein(52/70,74.3%)and ESR(48/61,78.7%).39(90.7%)of patients with negative results among 43 patients who performed the respiratory pathogens tests.The positive rate of the first time of nucleic acid test was 52.7%,and the others had two or more times of the test.Imaging:39 cases of chest CT were performed for the first time in our hospital within 24 hours after admission.In all of the 39 patients,everyone had abnormal chest CT.The average number of lobes involved was(3.2±1.2).37 cases were located under the pleura,and 24 cases were located along the bronchovascular bundle.There were 39 cases of ground glass shadow,36 cases of consolidation shadow,30 cases of large consolidation shadow,5 cases of nodular shadow,13 cases of strip shadow,4 cases of grid shadow,10 cases of air bronchogram,36 cases of mixed type.After 3-7 days of treatment,31 cases of chest CT were reexamined,among them,25 cases were improved,3 cases had no progress or absorption,3 cases had progress.After symptomatic and antiviral treatment,2 cases(2.7%)were transferred to ICU,and 72 cases(97.3%)were discharged from hospital or continued treatment.Conclusion COVID-19 is characterized by fever,dry cough,dyspnea and asthenia,some of which are accompanied with diarrhea.The laboratory tests show most of patients with abnormal white blood cell counts and procalcitonin level,but the numbers of lymphocyte as well as the level of albumin are reduced,and the level of aminotransferase,ferritin as well as C-reactive protein are increased.The CT manifestations of COVID-19 are various,but ground glass shadow and consolidation shadow are common,often involving both lungs.The improvement of CT imaging of lung can be used as an important index to evaluate the change of disease.Throat wasp NPC nucleic acid test is the only method to confirm the diagnoses of NPC but with a lower detection rate at the first time.Multiple tests can increase the detection rate.Performing symptomatic and supportive treatment combine with antiviral therapy as early as possible may be helpful for outcomes.