新冠肺炎患者实验室诊断与临床分型初探

A preliminary study on laboratory diagnosis and clinical classification of COVID-19 patients

目的 通过分析武汉市第一医院53例新型冠状病毒肺炎患者的临床实验室特征,探讨新冠肺炎患者基础情况、肝功能、肾功能、心肌功能指标、血液指标与临床分型之间的相关性。方法 回顾性纳入2020年2月11日—2020年3月24日武汉市第一医院收治的53新冠肺炎轻型(8例)、普通型(35例)和重型及危重型患者(10例),收集患者的临床资料和实验室结果包括姓名、年龄、性别、血常规、急性时相C反应蛋白(CRP)、肝肾功能、心肌标志物、心肌酶谱、凝血功能中的D-二聚体(D-D)等指标进行比较。结果三组患者年龄差异有统计学意义(P<0.05),呈明显增高趋势,且患病男性比例略高于女性。三组患者随着病情的加重,D-D、CRP、乳酸脱氢酶(LDH)、肌钙蛋白I(TNI)、谷草转氨酶(AST)指标升高明显;其他指标如谷丙转氨酶(ALT)、尿素氮(UREA)、肌酐(CREA)、肌酸激酶(CK)、肌酸激酶同工酶(CKMB)、肌红蛋白(MYO)等指标,除重型和危重型患者明显升高外,轻型和普通型患者变化趋势不太明显;另外,淋巴细胞(LYM)数量下降趋势明显。结论 年龄是新冠肺炎病毒感染患者的危险因素,随着病情发展,除了肺部病变外,会出现不同程度的炎症反应、肝肾损伤和心肌损伤,且损伤的严重程度与临床分型相关,轻型和普通型患者只是部分指标开始出现损伤趋势,而重症危重型患者大部分指标升高且直接造成脏器实质性损伤,因此在治疗新冠肺炎时,应尽早监测主要脏器,及时发现高危患者,给予最优化治疗方案。

Objective By analyzing the clinical laboratory characteristics of 53 COVID-19 patients in Wuhan No. 1 Hospital,the correlation among the basic condition,liver function,renal function,myocardial function and blood index of COVID-19 patients and clinical types was discussed. Methods COVID-19 mild(8 cases),ordinary(35 cases)and severe or critical patients(10 cases)were collected in Wuhan No.1 Hospital from February 11,2020 to March 24,2020. The clinical data and laboratory results including name,age,gender,blood routine,C-reaction protein(CRP),liver and kidney function,myocardial markers,myocardial enzymes and D-Dimer(D-D)were collected and compared among the 53 patients. Results There were statistically significant age differences among the three groups( <0.05),showing a significant increase trend,and the proportion of male patients was higher than female patients. With the aggravation of the disease,the indexes of D-D,CRP,lactate dehydrogenase(LDH),troponin I(TNI)and aspartate aminotransferase(AST)increased significantly with the severity of the disease;other indexes such as alanine aminotransferase(ALT),urea nitrogen(urea),creatinine(crea),creatine kinase(CK),creatine kinase isoenzyme(CKMB)and myoglobin(MYO)were significantly higher in severe and critical patients,while for those of mild and ordinary patients the change was not obvious. In addition,the number of lymphocyte(LYM)decreased significantly. Conclusion Age is a risk factor for patients with COVID-19. As the disease progresses,in addition to lung lesions,different degrees of inflammation,liver and kidney damage,and myocardial damage will occur. Moreover,the severity of the injury is related to the clinical classification. Mild and ordinary patients only begin to show damage trends in some indicators while most of the indicators in severe and critical patients rise and directly cause substantial organ damage. Therefore,when treating COVID-19 patients,it is necessary to monitor all organs as soon as possible to find high-risk patients in time and give the optimal treatment plan.