重型COVID-19与重型甲型流感患者早期临床特征的比较

Comparison of Early Clinical Features of Patients with Severe COVID-19 and Severe Influenza A

目的比较重型新型冠状病毒肺炎(corona virus disease 2019,COVID-19)与重型甲型流感患者临床特征及实验室指标的差异。方法收集2019年12月~2020年3月江苏省多中心收治的71例重型(包括危重型15例)COVID-19患者的临床资料及2019年1月~2020年12月徐州医科大学附属医院收治的218例重型甲型流感患者的临床资料,比较两组患者在基础疾病、临床症状、化验指标及肺部影像学表现等方面的差异。结果重型COVID-19患者平均年龄较重型甲型流感患者低(50.92岁vs 58.10岁);临床症状方面,重型COVID-19患者在气促、呼吸困难、腹泻较甲型流感患者多见,而甲型流感患者多表现为发热、头痛、咽痛、肌肉酸痛等;实验室指标中,重型甲型流感患者的白细胞计数(white blood cell,WBC)、中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、D-二聚体较重型COVID-19患者升高更明显,二者比较差异有统计学意义(P<0.05);在肺部影像学表现方面,重型COVID-19患者更多表现为磨玻璃样变,差异有统计学意义(P<0.05),两组患者肺部均有明显的实变影改变,差异无统计学意义(P>0.05)。结论临床特征及实验室指标可加强重型COVID-19患者与重型甲型流感患者的早期识别,为疾病的鉴别诊断提供依据。

Objective To compare the clinical characteristics and laboratory indicators of corona virus disease 2019(COVID-19)with patients with severe influenza A.Methods The clinical data of 71 patients with severe(including 15 critical)COVID-19 patients admitted to multiple centers in Jiangsu Province from December 2019 to March 2020 and the clinical data of 218 patients admitted to the Affiliated Hospital of Xuzhou Medical University from January 2019 to December 2020 were collected and the differences in basic diseases,clinical symptoms,laboratory indicators and lung imaging performance were compared.Results The mean age of severe COVID-19 patients was lower than that of severe influenza A patients(50.92years vs 58.10years).In terms of the clinical symptoms,patients with severe COVID-19 were more frequent in shortness of breath,dyspnea and diarrhoea than those with influenza A.In the laboratory indicators,white blood cell(WBC)count,neutrophil to lymphocyte ratio(NLR),hypersensitive C-reactive protein(hs-CRP),D-dimer were more elevated than severe COVID-19 patients.The difference was statistically significant(P<0.05).In terms of the pulmonary imaging findings,patients with heavy COVID-19 presented more with ground glass changes,The difference was significant(P<0.05).There were significant solid contrast changes in the lungs in both groups.There was no statistically significant difference(P>0.05).Conclusion Clinical characteristics and laboratory indicators can strengthen the early identification of severe COVID-19 patients and severe influenza A patients,and provide a basis for the differential diagnosis of disease.