2019新型冠状病毒奥密克戎变异株感染者的临床特征分析

Clinical characteristics of the 2019 novel coronavirus Omicron variant infected cases

目的探讨2019新型冠状病毒奥密克戎变异株感染患者的临床特征及预后因素。方法纳入2021年7月1日至2022年1月6日上海市(复旦大学附属)公共卫生临床中心收治的987例境外输入新型冠状病毒肺炎(COVID-19)确诊患者, 根据2019新型冠状病毒核酸检测结果分为奥密克戎组(193例)与非奥密克戎组(794例), 收集两组患者的临床资料、影像学检查和实验室检查结果进行比较。统计学方法采用χ^(2)检验和曼-惠特尼U检验, 采用多重线性回归分析进行多因素分析。结果奥密克戎组以18~30岁者居多, 占51.3%(99/193), 高于非奥密克戎组的31.4%(249/794), 差异有统计学意义(χ^(2)=52.75, P<0.001)。奥密克戎组中轻型占88.6%(171/193), 高于非奥密克戎组中的81.6%(648/794),差异有统计学意义(χ^(2)=5.37, P=0.021)。奥密克戎组患者临床表现较非奥密克戎组更多见[60.1%(116/193)比29.1%(231/794)], 差异有统计学意义(χ^(2)=65.49, P<0.001), 以咽痛/咽痒、发热、咳嗽/咳痰为主。入院时奥密克戎组存在肺部计算机断层成像影像学病变者占13.0%(25/193), 低于非奥密克戎组的27.1%(215/794), 差异有统计学意义(χ^(2)=16.83, P<0.001);奥密克戎组入院时2019新型冠状病毒抗体IgG阳性比例为47.7%(92/193), 低于非奥密克戎组的61.1%(485/794), 差异有统计学意义(χ^(2)=11.51, P<0.001)。奥密克戎组的住院时间为20.0(16.0, 23.0) d, 长于非奥密克戎组的14.0(10.0, 22.0) d, 差异有统计学意义(Z=-7.42, P<0.001)。多重线性回归分析结果显示, 入院时2019新型冠状病毒抗体IgG阳性的奥密克戎变异株感染患者住院时间短, 发热的奥密克戎变异株感染患者住院时间长(均P<0.050)。结论奥密克戎变异株感染患者以发热及上呼吸道症状为主要临床表现, 其肺部计算机断层成像存在影像学病变少, 住院时间稍延长;入院时2019新型冠状病毒抗体IgG阳性者和不伴发热者住院时间较短, 病毒清除快。

Objective To investigate the clinical characteristics and prognostic factors of 2019 novel coronavirus(2019-nCoV)Omicron variant infected cases.Methods A total of 987 coronavirus disease 2019(COVID-19)adult imported cases admitted to Shanghai Public Health Clinical Center,Fudan University from July 1,2021 to January 6,2022 were recruited.The cases were divided into Omicron group(193 cases)and non-Omicron group(794 cases)according to the genotype of the virus.The clinical data,imaging examination and laboratory results of two groups were collected and compared.Chi-square test and Mann-Whitney U test were used as statistical methods.Multiple linear regression analysis was used for multiple linear regression analysis.Results The majority of patients in Omicron group were 18 to 30 years old,accounting for 51.3%(99/193),which was higher than 31.4%(249/794)in non-Omicron group.The difference was statistically significant(χ^(2)=52.75,P<0.001).The proportion of mild cases in Omicron group was 88.6%(171/193),which was higher than 81.6%(648/794)in non-Omicron group.The difference was statistically significant(χ^(2)=5.37,P=0.021).Cases with symptoms were more common in Omicron group than those in non-Omicron group(60.1%(116/193)vs 29.1%(231/794)),and the difference was statistically significant(χ^(2)=65.49,P<0.001),with the main clinical manifestations of sore/itchy throat,fever and cough/expectoration.The proportion of cases with pulmonary computed tomography(CT)imaging manifestations at admission in Omicron group was 13.0%(25/193),which was lower than that in non-Omicron group(215/794,27.1%).The difference was statistically significant(χ^(2)=16.83,P<0.001).The proportion of cases with 2019-nCoV IgG positive at admission was 47.7%(92/193)in Omicron group,which was lower than 61.1%(485/794)in non-Omicron group,and the difference was statistically significant(χ^(2)=11.51,P<0.001).The hospitalization time of Omicron group was 20.0(16.0,23.0)d,which was longer than that of non-Omicron group(14.0(10.0,22.0)d),and the difference was statistically significant(Z=-7.42,P<0.001).Multiple linear regression analysis showed that the time of hospitalization of cases with 2019-nCoV IgG positive at admission was shorter,while that of the cases with fever in Omicron group was longer(both P<0.050).Conclusions The main clinical characteristics of cases with Omicron variant are fever and upper respiratory symptoms.Their pulmonary CT imaging manifestations are less,and the time of hospitalization is slightly longer.The time of hospitalization and the virus clearance time in Omicron variant infected cases with 2019-nCoV IgG positive at admission and not presented with fever are both shorter.