44例不同严重程度新型冠状病毒肺炎患者临床检测指标分析

Clinical indicators of 44 patients with different types of coronavirus disease 2019

目的分析不同严重程度新型冠状病毒肺炎(COVID-19)患者在入院初期临床检测指标特点,寻找可预警轻型/普通型发展为重型/危重型的实验室检测指标。方法回顾性研究武汉大学中南医院感染科于2020年2月收治的44例COVID-19患者病历资料,依据病情严重程度,将患者分为轻型/普通型组28例,重型/危重型组16例。分析患者入院3天内血常规[白细胞(WBC)、中性粒细胞(NEU)、淋巴细胞(LYM)、单核细胞百分比(MON)、血小板(PLT)]、生化指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)、白蛋白(ALB)、肌酐(CREA)]、炎症因子[C反应蛋白(CRP)、白细胞介素6(IL-6)]、新型冠状病毒核酸检测以及外周血淋巴细胞亚群等指标,采用t检验、秩和检验或卡方检验进行分析。采用二元Logistics回归分析病情重症化的风险因素。结果重型/危重型组患者外周血WBC、NEU、MON、PLT、LYM、CD3^(+)T细胞、CD3^(+)CD4^(+)T细胞、CD3^(+)CD8^(+)T细胞、CD4^(+)/CD8^(+)、CD19^(+)、CD16^(+)CD56^(+)细胞计数均低于轻型/普通型组,其中CD3^(+)T细胞(t=2.24、P=0.03)、CD3^(+)CD4^(+)T细胞(t=2.148、P=0.037)和外周血淋巴细胞(t=2.039、P=0.047)差异有统计学意义。重型/危重型组患者血清IL-6为21.06(11.02,36.43)pg/ml,轻型/普通型组患者为6.13(3.14,12.54)pg/ml,差异有统计学意义(Z=2.952、P=0.003)。重型/危重型组患者咽拭子样本和粪便样本新型冠病毒核酸Ct值分别为(30.03±1.196)和(33.12±1.48),均低于轻型/普通型组患者新型冠病毒核酸Ct值[(33.56±0.75)和(35.76±0.98)],差异均有统计学意义(t=2.634、P=0.012,t=1.545、P=0.130)。重型/危重型组患者住院天数[(25.06±3.01)d]显著长于轻型/普通型组患者[(11.79±1.06)d],差异有统计学意义(t=4.986、P<0.001)。二元Logistics回归分析发现IL-6(OR=1.059、P=0.039)和住院天数(OR=1.173、P=0.005)均为COVID-19患者病情严重程度的影响因素。结论不同严重程度COVID-19患者入院初期淋巴细胞及亚群、IL-6及病毒核酸水平存在差异,其中住院天数和IL-6异常升高是重症化的危险因素,对COVID-19患者病情严重程度和临床分型的早期预判有重要意义。

Objective To analyze the characteristics of clinical and laboratory data of coronavirus disease 2019(COVID-19)patients with different severity on admission,and to find a laboratory indexes for early warning mild/moderate development into severe/critical type.Methods Total of 44 patients confirmed with COVID-19 were included in the Department of Infectious Diseases,Zhongnan Hospital of Wuhan University in February 2020,retrospectively.Patients with COVID-19 were divided into mild/moderate group(28 patients)and severe/critical group(16 patients).Blood routine tests[white bloodcell(WBC),neutrophil(NEU),lymphocyte(LYM),monocytes(MON),platelet(PLT)],biochemical examinations[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),albumin(ALB),creatinine(CREA)],inflammatory factors tests[C-reactive protein(CRP),interleukin-6(IL-6)],new coronavirus nucleic acid tests and peripheral blood lymphocyte subsets tests performed within 3 days on admission were collected and analyzed by t test,rank sum test or chi-square test,respectively.The risk factors of severe disease were analyzed by Binary Logistic regression analysis.Results Levels of peripheral blood WBC,NEU,MON,PLT,LYM,and absolute count of CD3^(+)T lymphocytes,CD3^(+)CD4^(+)T lymphocyte,CD3^(+)CD8^(+)T lymphocytes,CD4^(+)/CD8^(+)T,CD19^(+)B lymphocytes,CD16^(+)CD56^(+)NK cells of patients in severe/critical group were all lower than those of mild/moderate group,among which,the absolute count of CD3^(+)T lymphocytes(t=2.24,P=0.03),CD3^(+)CD4^(+)T lymphocytes(t=2.148,P=0.037)and peripheral blood lymphocytes(t=2.039,P=0.047)were decreased with significant difference.Serum IL-6 level was 21.06(11.02,36.43)pg/ml of patients in severe/critical group and 6.13(3.14,12.54)pg/ml in mild/moderate group,with significant difference(Z=2.952,P=0.003).Novel coronavirus nucleic acid Ct values of respiratory tract specimens and fecal specimens of patients in severe/critical group were(30.03±1.196)and(33.12±1.48),which were significantly lower than those of mild/moderate group:(33.56±0.75)of respiratory tract specimens(t=2.634,P=0.012)and(35.76±0.98)of fecal specimens(t=1.545,P=0.130)with significant differences.The length of hospital stay of patients in severe/critical group was(25.06±3.01)days,which was significantly higher than that of mild/moderate group[(11.79±1.06)days],with significant difference(t=4.986,P<0.001).Binary Logistic regression analysis found that IL-6(OR=1.059,0.039)and the length of hospital stay(OR=1.173,0.005)were both the influencing factors of the severity of patients with COVID-19.Conclusions There were significant differences in lymphocyte subsets,serum IL-6 level and viral nucleic acid levels between COVID-19 patients with varying severity,and the length of hospital stay and abnormally increased IL-6 were risk factors for severe disease,and both were of great significance in predicting the severity and clinical classification of COVID-19 patients at early stage.