甘肃省SARS-CoV-2 Delta变异株感染的COVID-19流行病学和临床特征分析

Epidemiological and clinical features of COVID-19 infected with SARS-CoV-2 Delta variant in Gansu Province

目的分析新型冠状病毒(SARS-CoV-2)Delta变异株感染的新型冠状病毒肺炎(COVID-19)的流行病学及临床特征。方法回顾性分析2021年10月25日-11月19日兰州市第二人民医院雁滩分院收治的SARS-CoV-2 Delta变异株感染的本土138例COVID-19确诊患者的流行病学和临床特征,采集流行病学及人口学信息、临床症状、实验室检查、胸部CT、治疗和预后数据,最终随访日期为2021年11月27日。结果截至2021年11月19日,甘肃省此次疫情累计报告COVID-19确诊病例144例,其中兰州市第二人民医院雁滩分院集中收治138例,男65例(47.1%),女73例(52.9%),男女比例为1:1.12,年龄2~87(42.7±21.0)岁,临床分型以普通型(48.6%,67/138)为主。SARS-CoV-2 Delta变异株的传播方式以密闭空间为主,具有明显的旅行团聚集性和家庭聚集性;密切接触者筛查和社区排查是发现感染者的主要途径;86.2%(119/138)的确诊患者已接种国产COVID-19灭活疫苗;临床症状最常见的为咳嗽(57.2%,79/138),其次为咽痛(28.3%,39/138)、咽干(24.6%,34/138)、咳痰(21.0%,29/138)等,有发热症状的患者仅占20.3%(28/138),4例(2.9%)出现嗅觉、味觉减退或丧失。实验室检查血清淀粉样蛋白A和高密度脂蛋白胆固醇升高明显,SARS-CoV-2核酸检测ORF1ab基因Ct值为26.31±7.63,N基因为26.35±7.17;71.3%(72/101)的确诊患者胸部CT显示双侧肺叶受累,病灶位置以双肺下叶多见,病灶形态主要为片状、斑片状磨玻璃影。所有确诊患者均采用中西医结合治疗,以俯卧位通气和中医治疗为主,重症患者中医治疗率达100%,在呼吸支持、营养支持、抗凝的基础上配合中和抗体等免疫治疗。结论甘肃省SARS-CoV-2 Delta变异株感染的COVID-19确诊患者主要临床特征为发热比例低、病毒核酸转阴时间长、疫苗接种后重症风险低、治疗效果好,无插管,无体外膜肺氧合(ECMO),无死亡病例。“一人一方案”的中西医结合个性化治疗可有效控制病情进展,治愈疾病。

Objective To analyze the epidemiological and clinical features of coronavirus disease 2019(COVID-19)infected with the Delta variant of SARS-CoV-2.Methods Retrospectively analyze the epidemiological and clinical features of 138 confirmed cases of COVID-19 infected with the Delta variant of SARS-CoV-2 from October 25,2021 to November 19,2021 in Yantan Branch of the Second People's Hospital of Lanzhou City.The epidemiological and demographic information,clinical symptoms,laboratory tests,chest CT,treatment and prognosis data were collected,with a final follow-up date of November 27,2021.Results As of November 19,2021,a total of 144 confirmed cases of COVID-19 were reported in Gansu Province,of which 138 cases[65 males(47.1%)and 73 females(52.9%),aged 2-87(42.7±21.0)years old,with the clinical classification of mainly common type(48.6%,67/138)]were concentrically treated in the Yantan Branch of the Second People's Hospital of Lanzhou City.The transmission mode of the Delta variant of SARS-CoV-2 is mainly in confined spaces,with obvious tour group and family aggregation;screening the close contacts and community investigation are the main approaches of finding the infected persons;86.2%(119/138)of confirmed patients have been vaccinated with the domestic inactivated COVID-19 vaccine.The most common clinical symptoms are cough(57.2%,79/138),followed by sore throat(28.3%,39/138),dry throat(24.6%,34/138),and expectoration(21.0%,29/138).Only 20.3%(28/138)of patients have fever,and 4 patients(2.9%)have decreased or lost sense of smell and taste.Laboratory tests showed that serum amyloid A and high-density lipoprotein cholesterol increased significantly.The Ct value of SARS-CoV-2 ORF1ab gene is 26.31±7.63,and N gene is 26.35±7.17.Chest CT fined that 71.3%(72/101)of confirmed patients showed bilateral lung lobes involvement,and the lesions are mostly located in the lower lobes of both lungs;the lesions are mainly flaky and patchy ground-glass opacities.All confirmed cases are treated with integrated traditional Chinese and Western medicine,mainly prone position ventilation and traditional Chinese medicine(TCM)treatment.The TCM treatment rate is 100%for severe cases.On the basis of respiratory support,nutritional support and anticoagulation,immunotherapy such as neutralizing antibodies are combined.Conclusions The main clinical features of COVID-19 infected by the Delta variant of SARS-CoV-2 in Gansu Province are low rate of fever,long time for viral nucleic acid turned to negative,low risk of severe illness after vaccination,the good therapeutic effect,no intubation,no extracorporeal membrane oxygenation(ECMO),and no deaths."One person,one plan"personalized treatment with integrated Chinese and Western medicine can effectively control the progression of the disease and cure the disease.