老年新型冠状病毒肺炎患者的实验室指标与临床分型的关系

Relationship between Laboratory Indexes and Clinical Classification in Elderly Patients with COVID-19

目的了解老年新型冠状病毒肺炎(COVID-19)的临床特征,并研究其与病情严重程度的相关性。方法回顾性分析2020年1月27日-2月24日福建援鄂医疗队在武汉市工作期间收治的55例老年(≥60岁)COVID-19患者,据诊断标准分为3组:普通型组(23例)、重型组(16例)及危重型组(16例)。比较3组患者的临床表现以及外周血实验室指标的差异,并分析其与疾病临床分型的关系。结果(1)55例中,男性31例,女性24例,其中危重型组男性的比例高于另外两组(P<0.05)。常见临床症状有发热、咳嗽、呼吸困难、胸闷、咳痰,部分伴有呼吸道以外的症状,如头晕、头痛、恶心、腹泻、盗汗、乏力等。大部分患者伴有基础疾病,如高血压病、2型糖尿病等。3组患者在临床症状和并发基础疾病方面差别无统计学意义(P>0.05)。(2)随着疾病的进展,外周血中白细胞计数(WBC)、中性粒细胞计数(NEU)、α-羟丁酸脱氢酶(α-HBDH)、超敏肌钙蛋白(hsTnI)、尿素氮(BUN)和乳酸脱氢酶(LDH)水平呈升高趋势,淋巴细胞计数(LYM)水平则呈下降趋势;超敏C反应蛋白(Hs-CRP)及D-二聚体(D-Di)的表达水平,重型组及危重型组高于普通型组;肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌酐(CREA)、血清铁蛋白(SF)、降钙素原(PCT)的表达水平,危重型组高于普通型组及重型组;白蛋白(ALB)的表达水平,重型组及危重型组低于普通型组(P<0.05);单核细胞计数(MON)、血沉(ESR)、白细胞介素-6(IL-6)、天冬氨酸转氨酶(AST)及丙氨酸转氨酶(ALT),3组间差别均无统计学意义(P>0.05)。(3)肺部CT表现为双肺、多叶受累,以肺外带、胸膜下为主,可见斑片影、磨玻璃影,伴有小叶间隔增厚、实变、支气管充气相、胸膜下线影等。结论老年COVID-19患者外周血中的部分炎症指标、心肌损伤标志物、肾功能损伤指标及D-Di等有助于判断病情的严重程度,可能有助于预测患者的预后。

Objective To understand the clinical characteristics of elderly patients with COVID-19 and the correlations between them and the severity of COVID-19.Methods A retrospective analysis was conducted on 55 elderly(≥60 years old)patients with COVID-19 observed by the Fujian first Medical Team during their work in the city of Wuhan from 2020-01-27 to 2020-02-24.According to the diagnostic criteria,the patients were divided to three groups:common type(23 cases),severe type(16 cases),critical type(16 cases).The differences in clinical manifestations and laboratory indexes of peripheral blood among the three groups were compared,and their relationships with clinical classification of the disease were analyzed.Results(1)There were 31 males and 24 females in the three groups,and the proportion of males in the critical group was higher than that in the severe/common groups(P<0.05).In this study,the common clinical symptoms of elderly patients were fever,cough,dyspnea,chest tightness,expectorant and some patients were accompanied by other symptoms such as dizziness,headache,nausea,diarrhea,night sweats,and fatigue.Most patients had underlying diseases such as hypertension and type 2 diabetes.There were no statistically significant differences in clinical symptoms and combined underlying diseases among the three groups(P>0.05).(2)With the progression of the disease,the levels of white blood cell count,neutrophil count,ɑ-hydroxybutyrate dehydrogenase,hypersensitive troponin I,urea nitrogen,and lactic dehydrogenase increased,while the level of lymphocyte count decreased;the levels of hypersensitive c-reactive protein and D-Dimer were higher in the severe/critical groups than in the common group;the levels of creatine kinase,creatine kinase isoenzyme,creatinine,serum ferritin,and procalcitonin were higher in the critical group than in the common/severe groups;the albumin level is lower in the severe/critical groups than in the common group(P<0.05).There were no significant differences in monocyte cell count,erythrocyte sedimentation,interleukin-6,alanine aminotransferase,and aspartate aminotransferase among the groups(P>0.05).(3)Pulmonary CT of 55 patients showed bilateral and multilobar involvement,mainly in the extrapulmonary zone and subpleural distribution,with patches or ground glass opacities,accompanied by thickened lobular septum、consolidation,bronchopneumatic phase and subpleural line.Conclusions Among elderly patients with COVID-19,some inflammation indicators,myocardial injury markers,kidney function indicators,and D-Di in the peripheral blood can help determine the severity of the patient's condition and may help predict severity and prognosis of COVID-19 in the elderly.