老年新型冠状病毒肺炎患者的临床特点

Clinical characteristics of elderly patients with coronavirus disease 2019

目的探讨老年新型冠状病毒肺炎患者的临床特点,为新型冠状病毒感染老年患者的诊治提供科学依据。方法纳入并收集2020年2月1—28日武汉同济医院中法新城分院B11东病区与光谷分院E1-3病区收治的102例新型冠状病毒肺炎患者的临床资料(最后随访日期为2020年2月28日),根据年龄分为老年组(≥60岁)和中青年组(<60岁),回顾性分析两组患者的流行病学、人口学、主要临床表现、实验室检测指标、影像学特征的差异。结果102例确诊新型冠状病毒肺炎的患者中,老年组(≥60岁)58例,中位年龄67.0(63.8,71.0)岁;中青年组(<60岁)44例,中位年龄47.5(38.0,51.8)岁;两组性别构成比较差异无统计学意义(χ^(2)=0.033,P=0.855)。在暴露史中,42.0%(21/50)患者回忆曾接触新型冠状病毒感染患者,14.0%(7/50)患者来自群聚发病,18.0%(9/50)患者来自可疑院内感染。发热与咳嗽仍为最常见的首发症状,消化道症状如恶心、纳差、腹泻和肌肉疼痛等非呼吸道症状应警惕,老年男性患者乏力与咳嗽首发居多。双侧斑片状阴影(57.9%、22/38)和磨玻璃影(42.1%、16/38)为主要影像学特点,42.1%(16/38)出现多部位累及。超过50%的患者出现血糖、D-二聚体、纤维蛋白原、C反应蛋白、降钙素原、多项细胞因子水平及中性粒细胞/淋巴细胞比升高,白蛋白、血红蛋白、红细胞压积、淋巴细胞、血钙水平降低。老年组与中青年组比较,D-二聚体、血钙浓度异常比例差异有统计学意义(χ^(2)=7.067、4.166,P=0.008、0.041)。结论老年患者总体以发热与咳嗽为最常见首发症状,老年患者临床实验室化验值多项异常,与中青年患者相比有一定的特殊性。

Objective To investigate the clinical characteristics of elderly patients with coronavirus disease 2019(COVID-19),in order to provide scientific evidence for the diagnosis and treatment of COVID-19 in elderly patients.Methods Clinical data of 102 patients with COVID-19 admitted to the B11 East Ward of the Zhongfaxincheng campus and the E1-3 ward of the Guanggu Campus of Tongji Hospital affiliated to Huazhong University of Science and Technology in Wuhan from 1 February 2020 to 28 February 2020 were retrospectively collected and analyzed.Patients were categorized into 2 groups:the elderly group(≥60 years old)and the young and middle-aged group(<60 years old).Differences in epidemiological features,demographics,clinical symptoms,laboratory results and imaging findings between the two groups were retrospectively analyzed.Results Among 102 patients with COVID-19,58 were in the elderly group(≥60 years old),with a median age of 67.0(63.8,71.0)years old,and 44 in the young and middle-aged group(<60 years old),with a median age of 47.5(38.0,51.8)years old.There was no significant difference in gender ratio between the two groups(χ^(2)=0.033,P=0.855).Of 102 patients,42.0%(21/50)had close contact with an infected person,14.0%(7/50)were from infection clusters,and 18.0%(9/50)had suspected hospital-acquired infections.Fever and cough remained the most common symptoms,but gastrointestinal symptoms such as nausea,poor appetite,diarrhea and muscle cramps were also warning signs.Fatigue and cough were the most common presenting symptoms in elderly male patients.Bilateral patchy infiltrates(57.9%,22/38)and ground-glass opacities(42.1%,16/38)were the main imaging features and 42.1%(16/38)patients had multiple areas of the lungs involved.Over 50%patients had increased levels of blood glucose,D-dimer,fibrinogen,C-reactive protein,procalcitonin,multiple cytokines and neutrophil-to-lymphocyte ratio,as well as decreased levels of albumin,hemoglobin,hematocrit,lymphocytes and serum calcium.Compared with the young and middle-aged group,the elderly group had higher rates of abnormality in levels of D-dimer and serum calcium(χ^(2)=7.067 and 4.166,P=0.008 and 0.041).Conclusions Fever and cough are the most common symptoms in elderly patients with COVID-19.Elderly patients with COVID-19 have multiple abnormalities in clinical laboratory test results,which show a certain level of specificity compared with young and middle-aged patients.