重症和非重症新冠肺炎患者的临床特征对比及危险因素分析

Comparision of clinical characteristics and risk factors analysis between severe and non-severe COVID-patients

目的观察重症及非重症新冠肺炎患者的临床特征及住院期间检验结果的动态改变,并分析发生重症新冠肺炎的相关危险因素。方法在这项回顾性研究中,我们收集了入住通城县人民医院及咸宁市中心医院的59例确诊为新冠肺炎感染的患者。其中重症患者12例,非重症患者47例,比较两组患者的临床特征、住院期间检验结果的动态变化,并采用单变量及多变量分析发生重症新冠肺炎的相关危险因素。结果重症患者的平均年龄大,常伴有基础病史(糖尿病、高血压、冠心病和COPD)。重症患者的症状出现至就诊时间和发热天数较长,且其热峰高于非重症新冠肺炎患者(P<0.05)。重症患者出现气促、骨肌肉疼痛症状的比例更高,常伴有中性粒细胞增高、淋巴细胞减少、血小板减少。重症患者的D-二聚体、CRP、PCT、AST和血肌酐水平均高于非重症患者(P<0.05)。在住院第二周重症和非重症患者淋巴细胞减少的比例上升至83.34%和32.60%,D-二聚体升高的比例上升至66.67%和26.09%,ALT升高(>100 U/L)的比例上升至16.67%和4.35%。在第三周和第四周,大部分非重症患者的淋巴细胞恢复正常,D-二聚体、CRP和PCT下降至正常水平,而部分重症患者的淋巴细胞仍较低,其ALT、D-二聚体、CRP和PCT仍维持在高水平。结论在多变量回归分析中发现D-二聚体升高是发生重症新冠肺炎的危险因素。

Objective To observe the clinical characteristics and dynamic changes of laboratory results in severe and non-severe COVID-19 patients,and to analyze the related risk factors for the occurrence of severeCOVID-19.Methods 59 patients confirmed with COVID-19 infection were included from Tongcheng People's Hospital and Xianning Central Hospital,including 12 severe patients and 47 non-severe patients.The clinical characteristics and the dynamic changes of laboratory test during hospitalization of the two groups were compared,univariate as well as multiple logistic regressions were used to analyze the risk factors of severe COVID-19.Results Severe patients was older on the average age than non-severe patients,and often accompanied by a history of diabetes,hypertension,coronary heart disease and COPD.The time from symptoms onset to treatment and fever days were longer and the peak temperature were higher in severe patients(P<0.05).Severe patients had a higher proportion of shortness of breath and bone-muscle pain,often accompanied by increased neutrophils,lymphopenia,thrombocytopenia.Elevated D-dimer,CRP,procalcitonin,AST and serum creatinine were also found in severe COVID-19 patients(P<0.05).In the second week of hospitalization,the proportion of lymphopenia in severe and non-severe patients increased to 83.34%and 32.60%,the proportion of elevated D-dimer increased to 66.67%and 26.09%,and the proportion of elevated ALT(>100 U/L)increased to 16.67%and 4.35%.In the third and fourth weeks,the lymphocytes of most non-severe patients returned to normal,and D-dimer,CRP and PCT decreased to normal levels.While the lymphocytes of some severe patients were still low,with high levels of ALT,D-dimer,CRP,and PCT.Conclusion In the multivariate regression analysis,it was found that elevated D-dimer was the risk factors of severe COVID-19.