高龄老人新型冠状病毒感染患者临床特征及检验结果

Clinical characteristics and laboratory test results of elderly patients with coronavirus disease 2019

目的分析高龄老人新型冠状病毒感染患者的临床特征及实验室检验结果,为高龄老人新型冠状病毒感染(COVID-19)的诊治提供参考。方法回顾性分析海军军医大学第一附属医院干部病房2022年12月7日至12月31日收治的73例80岁及以上COVID-19住院患者的临床资料。根据《新型冠状病毒肺炎诊疗方案(试行第九版)》将患者分为轻中型组(34例)与重危型组(39例),比较2组患者入院时及入院48 h内检验结果。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ^(2)检验进行组间比较。采用多因素logistic回归分析高龄COVID-19患者出现重症、危重症的影响因素。结果重危型组在院前居家治疗时间、合并慢性基础疾病数量及临床症状数量方面明显高于轻中型组;未吸氧经皮指脉氧饱和度(SpO_(2))低于轻中型组,差异均有统计学意义(P<0.05)。重危型组淋巴细胞计数、淋巴细胞百分比、白蛋白、肾小球滤过率(GFR)、SpO_(2)、氧分压(PO_(2))低于轻中型组;纤维蛋白原、D-二聚体,肌酐、尿素氮、乳酸脱氢酶高于轻中型组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,院前居家治疗时间(OR=0.265,95%CI 0.085~0.830)与未吸氧SpO_(2)(OR=1.717,95%CI 1.016~2.901)是高龄老人发生重症、危重症COVID-19感染的独立危险因素。结论院前居家治疗时间长、未吸氧SpO_(2)降低的高龄老人是重型或危重型COVID-19的高危人群,应关注其淋巴细胞计数及百分比、凝血功能、肝肾功能、心肌酶谱、动脉血气分析等相关指标等的变化情况,尽早干预,改善预后。

Objective To investigate the clinical characteristics and test results of the elderly patients with coronavirus disease 2019 so as to provide reference for their diagnosis and treatment.Methods A retrospective analysis was conducted of the clinical data of 73 COVID-19 inpatients over 80 years old treated in the Cadre′s Ward of First Affiliated Hospital of Naval Medical University from December 7 to December 31,2022.According to COVID-19 Diagnosis and Treatment Protocol(9th Trial Version),the patients were divided into the light and medium group(n=34)and the severe and critical group(n=39).The test results on admission and 48 h later were compared.SPSS statistics 26.0 was used for data analysis.Data comparison between two groups was performed using t test,Mann-Whitney U test orχ^(2) test depending on the data type.Multivariate logistic regression was employed to analyze the independent risk factors for the severe and critical COVID-19 in the elderly.Results The severe and critical group had longer pre-hospital home treatment and larger number of underlying comorbid chronic diseases but lower saturation of blood oxygen(SpO_(2))without oxygen inhalation than the light and medium group,the differences being statistally significant(P<0.05).Lymphocyte count,lymphocyte percentage,albumin,glomeruar filtration rate(GFR),SpO_(2) and partial pressure of oxygen(PO_(2))in the severe and critical group were lower than those in the light and medium group,and fibrinogen,D-dimer,creatinine,urea nitrogen and lactate dehydrogenase in the former were higher than those in the latter,and the differences were statistically significant.Logistic regression analysis showed that the pre-hospital home treatment time(OR=0.265,95%CI 0.085-0.830)and SpO_(2) without oxygen inhalation(OR=1.717,95%CI 1.016-2.901)were the independent risk factors of the severe and critical COVID-19 infection in the elderly.Conclusion The elderly with long pre-hospital treatment and low SpO_(2) without oxygen inhalation are the high-risk groups for severe or critical COVID-19 infection.Attention should be paid to the changes in lymphocyte count and percentage,coagulation,liver and kidney function,myocardial zymogram,arterial blood gas analysis and other indicators,and intervetion should be taken as soon as possible to improve the prognosis.