武汉某院早期COVID-19患者临床特征与诊疗数据的回顾性研究

Analysis on clinical characteristics, diagnose and treatment of COVID-19 at early phage in a hospital in Wuhan

目的:明确及分析某院收治COVID-19肺炎患者的临床资料、特征及诊疗数据。方法:回顾性收集某院自2019年12月31日收治案例,均依指南确诊,分析患者流行病资料、检验及影像学资料、治疗方案等。患者最迟出院于2020年2月8日。结果:54名患者性别比为1∶1,平均年龄56.5岁,男性平均年龄63.4岁,女性平均年龄49.8岁。女性年龄分布整体低于男性。全部患者基础疾病前3位为高血压(13例, 24.1%)、冠心病(4例, 7.4%)、糖尿病(4例, 7.4%)。常见症状包括咳嗽(41例, 75.9%)、乏力(29例, 52.7%)、胸闷(16例, 29.1%)、腹泻(9例, 16.4%),体温高于38℃有19人(35.2%)。入院患者当日淋巴细胞为0.7×10^(9)/L(IQR 0.6~1.3),SAA为373.5 mg/L(IQR 57.1~961.7),白细胞和中性粒细胞在第10日达到峰值,分别为10.4×109/L和9.4×10^(9)/L;淋巴细胞在第12日达到峰值,为1.8×10^(9)/L。收治患者多给与甲泼尼龙琥珀酸钠(46例, 85.2%)、奥司他韦胶囊(39例, 72.2%)、连花清瘟颗粒(31例, 57.4%)、洛匹那韦利托那韦片(29例, 53.7%)、阿比朵尔片(28例, 51.8%)、莫西沙星(54例,100.0%)治疗。在非重症治愈患者中,连花清瘟颗粒使用率达72.4%,高于转院患者(23.1%),差异有统计学意义(χ^(2)=8.922,P=0.023);人免疫丙种球蛋白和碳青霉烯类抗菌药物在转院患者中使用率分别为61.5%和84.6%,高于非重症治愈组(27.6%, 13.8%),差异有统计学意义(χ^(2)=4.328,P=0.047;χ^(2)=19.143,P<0.001)。结论:年老体弱及多基础疾病人群为疫情易感人群,密切接触患者的医护人员是高风险人群。疾病治疗应考虑中西医结合模式并予以个体化药物联合治疗。

OBJECTIVE To explore the general features, diagnoses and treatments of COVID-19 pneumonia in hospitalized patients in Wuhan.METHODS A total of 54 COVID-19 inpatients were recruited from January 31, 2020. Epidemiological profiles, demographic details, clinical data, laboratory tests, imaging studies and treatment protocols were retrospectively reviewed. And their outcomes were followed up until February 8, 2020.RESULTS There were 27 males and 27 females with an average age of 56.5 years. The average age was 63.4 years for males and 49.8 years for females. And 49.1% of them had chronic diseases, including hypertension(n=13, 24.1%), coronary heart disease(n=4, 7.4%) and diabetes mellitus(n=4, 7.4%). Clinical manifestations included cough(n=41, 75.9%), fatigue(n=29, 52.7%), dyspnea(n=16, 29.1%), diarrhea(n=9, 16.4%) and fever >38 ℃(n=19, 35.2%). At admission Day 1, lymphocyte count was 0.7×10^(9)/L(interquartile range)[IQR](0.6-1.3) and SAA level at 373.5 mg/L(IQR57.1-961.7). The levels of leucocyte and neutrophil peaked at 10.4×10^(9)/L and 9.4×10^(9)/L at Day 10 while lymphocyte reached its highest level at 1.8×10^(9)/L at Day 12. Imaging examinations revealed bilateral pneumonia(n=37, 67.3%), patchy shadow(n=22, 40.0%), multiple patchy shadows(n=15, 27.3%), interstitial disease(n=11, 20.0%), ground-glass opacity(n=4, 7.3%), bilateral/unilateral distribution of massive ground-glass opacity(n=3, 5.5%) and hydrothorax(n=6, 10.9%). According to current guidelines, both chemicals and traditional Chinese medicine were prescribed, including methylprednisolone(n=46, 85.2%), oseltamivir(n=39, 72.2%), Lianhuaqingwen Granule(n=31, 57.4%), lopinavir & ritonavir tablets(n=29, 53.7%) and arbidol(n=28, 51.8%). In discharged non-severe patients, 72.4% patients received Lianhuaqingwen Granule. As compared with transferred non-severe patients(23.1%), there was significant difference(χ^(2)=8.922, P=0.023). And immune globulin γ and carbapenems were preferred for non-severe patients(61.5% vs. 84.6%)(χ^(2)=4.328, P=0.047;χ^(2)=19.143, P<0.001).CONCLUSION Elders with pre-existing chronic diseases and frontline medical staff are more prone to SARS-CoV-2. Individualized treatments with integrative Chinese and western medicine should be further promoted.