合并慢性基础疾病的新型冠状病毒肺炎患者的临床特征及转归

Clinical characteristics and outcomes of COVID-19 patients with chronic underlying diseases

目的:对合并慢性基础疾病的新型冠状病毒肺炎患者的临床特征及转归进行分析。方法:收集武汉大学人民医院2020年1月31日-2月10日收治的确诊且截至3月18日存在明确转归(出院或死亡)的新型冠状病毒肺炎患者的临床资料,并将患者分为合并及未合并慢性基础疾病组,分析比较两组临床表现及转归的差异。结果:共纳入确诊患者171例,其中合并慢性基础疾病组46例,未合并慢性基础疾病组125例。合并组前3位的慢性基础疾病分别为高血压病、糖尿病及慢性心血管疾病。两组患者起病初发热、咳嗽、咳痰、乏力、肌肉酸痛、头痛、胸闷、呼吸困难、腹泻等症状差异无统计学意义,合并组患者纳差症状较未合并组高,咽痛症状较未合并组低。入院时合并慢性基础疾病组重症及危重症患者的比例分别32.6%、21.7%,明显高于未合并组。合并慢性基础疾病组患者基础白细胞计数、中性粒细胞计数、天冬氨酸氨基转移酶、N-末端脑钠肽前体、乳酸脱氢酶、C反应蛋白、降钙素原水平较未合并组升高,白蛋白水平较未合并组下降;淋巴细胞计数、单核细胞计数、血红蛋白、血小板、谷丙转氨酶、总胆红素、肌酐、血清淀粉样蛋白A及CD4淋巴细胞计数两组间无明显差异。合并慢性基础疾病组胸部CT病变累及双肺的比例更高。合并慢性基础疾病组患者死亡率为21.7%,出院患者起病至核酸转阴的中位天数为25 d,未合并组死亡率为6.4%,出院患者起病至核酸转阴的中位天数为17 d,差异有统计学意义。结论:高血压病、糖尿病及慢性心血管疾病等慢性基础疾病可能为新型冠状病毒肺炎的易感因素,合并慢性基础疾病的新型冠状病毒肺炎患者重症及危重症患者比例更高,炎症反应更重,更易出现肝功能异常及心肌受损,病毒排毒时间更长。

Objective:To analyze the clinical characteristics and outcome of COVID-19 patients with chronic underlying diseases.Methods:The clinical data of COVID-19 patients admitted to Renmin Hospital of Wuhan University from January 31 to February 10,2020,with definite outcome(discharge or death) before March 18,were collected,and the patients were divided into the groups with and without chronic underlying diseases,and the differences in clinical manifestations and outcome were analyzed and compared.Results:A total of 171 patients were included,including 46 patients in the group with chronic underlying diseases and 125 patients in the group without chronic underlying diseases.The top three chronic diseases in the underlying diseases group were hypertension,diabetes,and chronic cardiovascular disease.There was no statistically significant difference in the symptoms of fever,cough,sputum,fatigue,muscle ache,headache,chest tightness,dyspnea,and diarrhea between the two groups at the beginning of the disease.The patients in underlying diseases group had higher anorexia symptoms than those without underlying diseases,while the symptoms of sore throat were lower.The proportion of severe and critical patients in the group with chronic underlying diseases at admission was 32.6% and 21.7% respectively,which was also higher.In terms of laboratory examination,the white blood cell count,neutrophils count,aspartate aminotransferase,N-terminal brain natriuretic peptide precursor,lactate dehydrogenase,C-reactive protein and calcitonin levels of patients in the group with chronic underlying diseases were increased and the albumin level was decreased compared with that respectively in the uncombined group.The proportion of chest CT lesions involving both lungs was higher in the group with chronic underlying diseases.The mortality rate of patients with chronic underlying diseases was 21.7%,the median duration of viral shedding from illness onset was 25 days in patients discharged from hospital,and the mortality rate of patients without chronic underlying diseases was 6.4%,and the median duration of viral shedding from illness onset was 17 days,with statistically significant differences.Conclusion:Chronic underlying diseases such as hypertension,diabetes and chronic cardiovascular diseases may be susceptibility factors of COVID-19.There is a higher proportion of severe and critical types,more severe inflammatory reactions,higher rate of liver dysfunction and myocardial damage,and longer viral detoxification time in COVID-19 patients with chronic underlying diseases.