新型冠状病毒肺炎30例的临床特征分析  

Clinical characteristics of 30 cases with corona virus disease 2019

作　　者：李丹 刘洪艳[1] 王妍[1] 郭虹利 王岩[1] 王凯[1] 赵蕊[1] 吴云海[1] 李兴海[1] Li Dan;Liu Hongyan;Wang Yan;Guo Hongli;Wang Yan;Wang Kai;Zhao Rui;Wu Yunhai;Li Xinghai(Infection Clinic,Shenyang Sixth People′s Hospital,Shenyang 110006,China)

机构地区：[1]沈阳市第六人民医院感染门诊,110006

出　　处：《中华传染病杂志》2020年第4期204-210,共7页Chinese Journal of Infectious Diseases

基　　金：沈阳市防治新型冠状病毒肺炎科研攻关应急专项(YJ2020-9-009)。

摘　　要：目的分析沈阳市新型冠状病毒肺炎患者的流行病学和临床特征。方法回顾性分析2020年1月22日至2月8日沈阳市第六人民医院收治的30例确诊新型冠状病毒感染患者的流行病学及临床特征。统计学分析采用独立t检验、Mann-Whitney检验或Fisher确切概率法。结果30例患者中输入性病例21例,其中湖北省输入病例17例,其他省份输入4例;本地感染病例9例。男18例,女12例,年龄范围为21~72岁,中位年龄为43岁,其中8例有高血压、糖尿病、冠状动脉粥样硬化性心脏病、支气管炎等基础疾病。入院临床分型中,轻型2例(7%),普通型19例(63%),重型8例(27%),危重型1例(3%)。临床表现主要为发热、伴或不伴上呼吸道症状,白细胞计数为正常、降低或轻度升高,淋巴细胞计数以下降为主,C反应蛋白正常或升高,降钙素原均为正常水平。肺部计算机断层成像检查早期以多发的斑片状磨玻璃影为主,部分伴有实变,病变常累及双肺,或者累及一侧肺的多个肺叶。目前,临床治疗以呼吸支持、对症治疗、抗病毒治疗、抗细菌治疗为主。截至2月15日共治愈出院9例,其中1例为轻型,6例为普通型,2例为重型。在轻型/普通型患者与重型/危重型患者比较中,重型/危重型患者发热时间(中位时间为11.5 d)长于轻型/普通型患者(中位时间为2.0 d),差异有统计学意义(Z=-2.292,P=0.022);重型/危重型患者D-二聚体水平升高(Z=-2.669,P=0.008),中性粒细胞/淋巴细胞比值>3.0的患者较多(Z=-4.071,P<0.01)。结论沈阳市新型冠状病毒感染患者早期以输入型为主,逐渐出现扩张性本地感染。临床表现主要为发热和咳嗽。肺部计算机断层成像表现为多发的磨玻璃影、部分病灶伴有实变。治疗中需严密监测肺部计算机断层成像改变,其变化可早于临床表现。发热时间过长、D-二聚体水平升高、中性粒细胞/淋巴细胞比值>3.0可作为重症病例的早期预警�Objective To analyze the epidemiological and clinical characteristics of patients with corona virus disease 2019(COVID-2019)in Shenyang City.Methods The epidemiological and clinical characteristics of 30 patients diagnosed with COVID-2019 admitted to Shenyang Sixth People′s Hospital from January 22 to February 8,2020 were retrospectively analyzed.The independent t test,Mann-Whitney test and Fisher′s exact test were used for statistical analysis.Results Among the 30 cases,21 were imported,including 17 from Hubei Province and four from other provinces.Nine cases were local infections.There were 18 men and 12 women,aging from 21 to 72 years with the median of 43 years.Eight cases had underlying diseases including hypertension,diabetes,coronary heart disease and bronchitis.On admission,two(7%)cases were mild,19(63%)cases were ordinary,eight(27%)cases were severe,and one(3%)case was critical.Clinical manifestations mainly included fever,with or without upper respiratory tract symptoms,normal,decreased or slightly increased white blood cell counts,mainly decreased lymphocyte counts,normal or increased C reactive protein,and normal procalcitonin.The computed tomography(CT)of the early stage of the lungs showed that multiple patchy ground glass shadows were mainly accompanied by consolidation,which often involved both lungs or multiple lobes of one lung.At the moment,the clinical treatment mainly included respiratory support,symptomatic treatment,antiviral treatment and anti-bacterial treatment.By February 15,a total of nine cases were cured and discharged,including one mild case,six ordinary cases,and two severe cases.In the comparisons between mild/ordinary patients and severe/critical patients,the fever duration in the severe/critical group(median 11.5 d)was significantly longer than that in the mild/ordinary group(median 2.0 d)(Z=-2.292,P=0.022),and the laboratory tests indicated more cases with elevated D-dimer levels(Z=-2.669,P=0.008)and neutrophilic/lymphocyte ratio>3.0(Z=-4.071,P<0.01).Conclusions In Shenyang

关 键 词：冠状病毒感染 肺炎 新型冠状病毒 流行病学 临床特征 肺部计算机断层成像 重症预警 

分 类 号：R512.99[医药卫生—内科学]