江苏省新型冠状病毒Delta突变株患者的临床特征

The clinical characteristics of novel coronavirus Delta mutant in Jiangsu province

目的回顾性分析江苏省新冠Delta病毒突变株患者的临床特征,为疫情防控提供依据。方法以江苏省2021年7月20日至2021年8月5日于南京市第二医院收治的392名Delta病毒突变株的COVID-19患者资料为研究对象,根据年龄(<60岁和≥60岁)分为A、B组,总结分析2组的临床特征。结果共纳入392名Delta病毒突变株患者,男性207例,女性185例,平均年龄为52.13±15.80(14~84)岁。359名(91.58%)患者有明确的流行病学接触史,患者的平均潜伏期为(4.56±2.23)d,疾病分型的人数及百分比分别为:轻型119例(30.36%)、普通型261例(66.58%)、重型10例(2.55%)和危重型2例(0.05%)。A组轻型所占比例明显高于B组(37.92%vs 13.82%,P=0.0001),而B组普通型和重型比例均高于A组(78.05%vs 61.34%,6.50%vs 0.74%,P<0.001)。最常见的临床表现是发热(82.40%)、干咳(66.58%)。<60岁269例,≥60岁123例。疫苗总接种率为61.99%,其中A组接种率为81.78%,B组为18.70%。2组患者入院时外周血淋巴细胞计数均在正常范围内,但B组外周血淋巴细胞计数在治疗7 d后低于A组(P=0.00)。影像学表现中,B组在疾病进展期和恢复期肺炎病灶/总肺体积均高于A组(P<0.05)。患者的总体核酸检测转阴天数为:(21.25±5.32)d,而B组核酸检测转阴后天数明显高于A组,分别是(20.00±5.00)和(24.00±4.98)d(P<0.001)。目前,390患者经治疗后痊愈出院隔离并随访,2例危重患者病情趋于好转已转为普通型,继续住院接受治疗。结论Delta突变株病毒传播速度快,老年患者病灶范围更广、病情更重、免疫功能恢复更慢、病毒核酸持续时间更长,对疫情的防控提出更大的挑战,在缺乏确切有效的治疗药物出现之前,我国疫苗及中药可能是有效的预防及治疗措施。

Objective To retrospectively analyze the clinical characteristics of patients with COVID-19 Delta virus mutation in Jiangsu Province,and to provide evidence for epidemic prevention and control.Methods Data of 392 COVID-19 patients with Delta virus mutation treated in Nanjing Second Hospital from 20 July 2021 to 5 August 2021 in Jiangsu Province were selected as research objects.According to age(<60 years and≥60 years),they were divided into group A and group B,and the clinical characteristics of the two groups were summarized and analyzed.Results A total of 392 patients with Delta virus mutant strains were included,including 207 males and 185 females,with an average age of 52.13±15.80(14~84)years.359(91.58%)patients had a clear epidemiological history of exposure,the median incubation period was 4.56±2.23 days.The number and percentage of disease types were:119 cases of mild type(30.36%),261 cases of common type(66.58%),10 cases of severe type(2.55%),and 2 cases of critical type(0.05%).The proportion of light type in group A was significantly higher than that in group B(37.92%vs 13.82%,P=0.0001),while the proportion of common type and severe type in group B was higher than that in group A(78.05%vs 61.34%,6.50%vs 0.74%,P<0.001).The most common clinical manifestations were fever(82.40%)and cough without sputum(66.58%).There were 269 patients<60 years old,and 123 patients≥60 years old.The total vaccination rate was 61.99%,of which the vaccination rate of group A was 81.78%and that of group B was 18.70%.The peripheral blood lymphocyte counts of patients in both groups were within the normal range on admission,but the peripheral blood lymphocyte counts in group B were lower than those in group A after 7 days of treatment(P<0.001).In imaging manifestations,the pneumonia lesions/total lung volume in group B were higher than those in group A at disease progression and recovery stages(P<0.05).The overall number of days when the patient's nucleic acid test turned negative was 21.25±5.32 days,and the days after the nucleic acid test turned negative in group B were significantly higher than that in group A,20.00±5.00 and 24.00±4.98 days,respectively(P<0.001).At present,390 patients had been discharged from the hospital and followed up in isolation,the condition of 2 critically ill patients tended to improve and had been converted to a common type,and they continued to be hospitalized for treatment.Conclusion The Delta mutant spreads quickly,elderly patients have a wider range of lesions,more severe disease,slower recovery of immune function,and longer duration of viral nucleic acid,posing greater challenges to the prevention and control of the epidemic.Before there is a lack of definite and effective therapeutic drugs,vaccines and traditional Chinese medicines in my country may be effective prevention and therapeutic measures.