155例新型冠状病毒肺炎患者的临床表现与血清免疫学特点  

Clinical manifestations and sero-immunological characteristics of 155 patients with COVID-19

作　　者：许靖[1] 韩明锋[1] 赵凤德[1] 张婷[1] 马蕾 XU Jing;HAN Ming-feng;ZHAO Feng-de;ZHANG Ting;MA Lei(The Second People’s Hospital of Fuyang,Fuyang,Anhui 236000,China)

机构地区：[1]阜阳市第二人民医院呼吸与危重症医学科感染病区,安徽阜阳236000

出　　处：《中华医院感染学杂志》2020年第15期2261-2265,共5页Chinese Journal of Nosocomiology

基　　金：安徽省阜阳市应急科技攻关基金资助项目(阜科[2020]10号)。

摘　　要：目的分析新型冠状病毒肺炎(Coronavirus disease 2019,COVID-19)患者的临床表现和血清免疫学特点。方法选取2020年1月12日-2020年2月18日安徽省阜阳市第二人民医院收治的COVID-19患者155例为研究对象,收集患者临床资料及血液检验结果,包括T淋巴细胞、CD4^+T淋巴细胞、CD8^+T淋巴细胞、CD4/CD8、白细胞介素-6(Interleukin-6,IL-6)、C-反应蛋白(C-Reactive Protein,CRP)和血清淀粉样蛋白A(Serum amyloid a,SAA)。根据病情严重程度分为普通组和重症组,比较两组患者间免疫学指标的差异。采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)的统计方法,统计各项指标的曲线下面积(Area under the curve,AUC)和截断值(Cut-off value)。结果武汉返乡人员70例,本地户籍150例,农村户口128例,发病时间在1月下旬者87例,临床表现以发热、咳嗽和胸闷为主,所有患者均治愈出院。重症组患者T淋巴细胞、CD4^+T淋巴细胞、CD8^+T淋巴细胞低于普通组,而IL-6、CRP和SAA高于普通组(P<0.05)。ROC分析结果显示,CD8^+T淋巴细胞、T淋巴细胞、IL-6和SAA筛查危重症患者的AUC>0.700。CD8^+T淋巴细胞和T淋巴细胞降低的截断值分别为200.41个/μl和931.56个/μl,IL-6和SAA升高的截断值分别为18.92 pg/ml和129.70 mg/L。四项指标联合检测时预警危重症患者的灵敏度和特异度达81.224%和83.893%。结论普通型和危重型新型冠状病毒肺炎患者早期机体免疫炎症反应程度存在差异,早期联合检测CD8^+T淋巴细胞、T淋巴细胞水平降低以及IL-6、SAA水平升高对于危重症感染者的预警有一定参考价值。OBJECTIVE To analyze the clinical manifestations and sero-immunological features of coronavirus disease 2019(COVID-19)patients.METHODS A total of 155 patients with COVID-19 treated in the second people’s hospital of Fuyang city from January 12,2020 to February 18,2020 were enrolled in the study.Clinical data and serological test results including T lymphocytes,CD4^+T cells,CD8^+T lymphocytes,CD4/CD8,interleukin 6(IL-6),C-reactive protein(CRP)and serum amyloid a Protein(SAA)in patients were collected.The patients were divided into the general group(125 cases)and the severe group(30 cases)according to the severity of the disease.The differences of immunological indexes between the two groups were compared.Receiver operating characteristic curves(ROC curve)of the indexes were plotted,and the area under the curve(AUC)and cut-off value were calculated.RESULTS Subjects included 70 cases(45.16%)of returnees from Wuhan city,150 cases(96.77%)with local household registration and 128 cases(82.58%)with rural household registration.The onset time of the disease in 87 cases(56.12%)of patients was in the last ten days of January.The clinical symptoms were fever,cough and chest tightness.All patients were cured and discharged.T lymphocytes,CD4^+T lymphocytes and CD8^+T lymphocytes in the severe group were significantly lower than that in the general group whereas IL-6,CRP and SAA in the severe group were significantly higher than that in the general group(P<0.05).ROC analysis showed that the AUCs of CD8^+T lymphocytes,T lymphocytes,IL-6 and SAA were>0.700.The reduced cut-off values of CD8^+T lymphocytes and T lymphocytes were 200.41/μl and 931.56/μl,respectively,whereas the increased cut-off values of IL-6 and SAA were 18.92 pg/ml and 129.70 mg/L,respectively.The sensitivity and specificity of the combination detection of four indicators were 81.224%and 83.893%.CONCLUSION Differences of immune inflammatory response in the early stage between the general group and the severe group were significant.Reduced levels of CD8^+T ly

关 键 词：新型冠状病毒肺炎 临床表现 T淋巴细胞 白细胞介素-6 血清淀粉样蛋白 

分 类 号：R563.1[医药卫生—呼吸系统]