新型冠状病毒肺炎临床特点及筛查流程探讨  

Clinical features of novel coronavirus infection patients and a feasible screening procedure

作　　者：李妍[1] 徐胜勇[1] 杜铁宽[1] 徐军[1] 李毅[1] 于学忠[1] 朱华栋[1] Li Yan;Xu Shengyong;Du Tiekuan;Xu Jun;Li Yi;Yu Xuezhong;Zhu Huadong(Emergency Department,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院急诊科,100730

出　　处：《中华急诊医学杂志》2020年第3期336-340,共5页Chinese Journal of Emergency Medicine

基　　金：中国医学科学院医学与健康科技创新工程(2017-I2M-1-009)。

摘　　要：目的通过收集确诊及排除的新型冠状病毒肺炎(COVID-19)患者病历资料,分析其病例特点并拟定可疑患者急诊发热门诊筛查流程。方法回顾性收集2020年1月19日至1月26日于北京协和医院发热门诊筛查的有流行病学史及呼吸系统症状或有发热症状的患者临床资料,根据鼻咽拭子新型冠状病毒核酸检测(实时逆转录聚合酶链反应方法,real time RT-PCR)结果确诊或除外新型冠状病毒感染,收集并分析患者的流行病学特征、临床表现、实验室检查及影像学特征。结果共筛查46例患者,其中9例为新型冠状病毒感染患者,37例为排除新型冠状病毒感染患者。新型冠状病毒感染患者于发病前2周内有武汉旅居史的比例较高(P<0.05),但两组在年龄、性别、其他流行病学特征及合并症方面差异无统计学意义(P>0.05)。新型冠状病毒感染患者最常见的临床表现是发热(100%),但该症状在两组间差异无统计学意义(P>0.05),其他症状如咳嗽、咳痰、咽痛等两组间差异亦无统计学意义(P>0.05)。新型冠状病毒感染患者白细胞计数低于非新型冠状病毒感染患者(P<0.05),且胸部CT均有肺炎表现。胸部CT正常者中均未检测到新型冠状病毒核酸阳性。结论新型冠状病毒感染无特异性临床症状,但胸部CT阴性对新型冠状病毒感染具有很高的阴性预测价值。推荐急诊与发热门诊采取基于流行病学史、胸部CT阳性再结合新型冠状病毒核酸检测的筛查流程以降低漏诊率并提高筛查效率。Objective To study the clinical characteristics of novel coronavirus pneumonia(COVID-19)patients and make a feasible screening process in fever clinic.Methods Epidemiologic features,clinical presentation,laboratory findings and image features of the screened patients were retrospectively collected and analyzed.Results A total of 46 patients were screened,9 of them were laboratory-confirmed novel coronavirus infection,and others were defined as laboratory-excluded patients.Laboratory-confirmed patients had higher frequency of travelling or residence in Wuhan within two weeks of onset(P<0.05),but there were no differences on age,sex,other epidemiologic features and comorbidities between the two groups(P>0.05).The most common feature of the laboratory-confirmed patients was fever(100%),but the symptoms showed no differences between the two groups(P>0.05).Laboratory-confirmed patients had lower white blood cell count than the laboratory-excluded patients(P<0.05),and all of them had pneumonia in chest CT scan.None of the patients with normal chest CT had positive novel coronavirus nucleic acid test.Conclusions No specific symptom is helpful in the diagnosis of novel coronavirus infection.However,patients without chest CT scan changes have a very low risk of novel coronavirus infection despite of the epidemiologic history and fever.We recommended a screening procedure that might help to reduce the rate of miss diagnosis and improve screening efficiency.

关 键 词：新型冠状病毒 肺炎 发热 胸部CT 

分 类 号：R563.1[医药卫生—呼吸系统]