457例新型冠状病毒肺炎轻症患者的临床及CT特征  

Clinical presentations,laboratory examination and CT characteristics in 457 cases with mild of COVID-2019

作　　者：凌学斌 季永能 林初芬 李天发[1] 王军[1] 蔡毅 LING Xuebin;JI Yongneng;LIN Chufen;LI Tianfa;WANG Jun;CAI Yi(Department of Cardiovasology,The First Affiliated Hospital of Hainan Medical University,Haikou 570102,China;Department of Pharmacy,The First Affiliated Hospital of Hainan Medical University,Haikou 570102,China;Secretary of the College Party Committee,The First Affiliated Hospital of Hainan Medical University,Haikou 570102,China;Department of Health Management Physical Examination, Haikou People' Hospital, Haikou 570208, China)

机构地区：[1]海南医学院第一附属医院心血管内科,海南海口570102 [2]海南医学院第一附属医院药学部,海南海口570102 [3]海南医学院第一附属医院医院党办,海南海口570102 [4]海口市人民医院健康管理体检部,海南海口570208

出　　处：《暨南大学学报（自然科学与医学版）》2020年第5期391-397,454,共8页Journal of Jinan University(Natural Science & Medicine Edition)

基　　金：国家自然科学基金项目(81860075);海南医学院科研培育基金项目(201705)。

摘　　要：目的:回顾分析457例新型冠状病毒肺炎(COVID-19)轻症患者临床症状、不同发病阶段的实验室及胸部CT特征性改变,为早期诊治提供参考.方法:纳入武汉江汉方舱医院457例经核酸确诊的COVID-19轻症患者,通过采集流行病学调查资料、临床表现、入院前、住院期间及出院前血常规、超敏C-反应蛋白(hs-CRP)及胸部CT影像学资料,分析患者临床症状及发病早、中、后期3阶段的实验室检查及胸部CT特征.结果:本研究中患者的平均年龄为(47.8±11)岁,男女比为1∶1.52,退休人员发病比例最高,达135例(29.5%),华南海鲜市场暴露史190例(41.6%),与COVID-19确诊患者密切接触史144例(31.5%),合并高血压病史29例(6.3%)、2型糖尿病10例(2.2%).临床表现发热312例(68.3%),高热组发热持续天数大于低热组(P<0.001);干咳373例(81.6%),咳痰138例(30.2%),痰中带血10例(2.2%);气促102例(22.3%);胸闷26例(5.7%);乏力167例(36.5%);肌肉酸痛24例(5.3%);腹泻57例(12.5%);食欲减退31例(6.8%),睡眠差91例(19.9%).发病早期高热组、低热组与体温正常组比较,白细胞(WBC)、淋巴细胞(LYM)、血小板(PLT)水平明显下降(P<0.05),hs-CRP水平明显升高(P<0.001);高热组与低热组相比,WBC、中性粒细胞(NEUT)、LYM水平降低(P<0.05),hs-CRP水平升高(P<0.001).与发病早期相比,发病中期、后期的WBC、NEUT、LYM、单核细胞(MONO)及PLT水平升高(P<0.05),hs-CRP水平下降(P<0.001).胸部CT检查在发病早期无影像学改变11例(2.4%),单侧病变93例(20.4%),双侧病变353例(77.2%),早期病变性质常见磨玻璃影334例(74.9%)、斑片高密度影95例(21.3%);中期主要表现磨玻璃影279例(64.1%)、斑片高密度影71例(16.3%)、实变影74例(17.0%)、网格影77例(17.7%)、纤维条索影50例(11.5%);后期主要表现磨玻璃影182例(41.7%)、斑片高密度影52例(11.9%)、实变影41例(9.4%)、网格影152例(34.9%)、纤维条索影147例(33.7%)、实性结节影12例(2.8%),从发病早期至�Objective:To analyze clinical manifestations,laboratory examination and CT characteristics in the pathogenesis of different stages.Methods:A total of 457cases of non-severe Corona Virus Disease 2019(COVID-19)diagnosed by RT-PCR in Wuhan Jianghan module Hospital from February 6,2020 to February 26,2020 were analyzed retrospectively.Epidemiological and clinical manifestation was summarized,and blood routine,hypersensitivity C-reactive protein(hs-CRP)and the chest CT were examined at pre-hospital,hospitalization and before discharge.For further analysis of laboratory examination and CT characteristics in the pathogenesis of early,middle,late stages,respectively.Results:Among the 457confirmed cases,the average age was(47.8±11)years,male-female ratio was 1∶1.52,retirees of 135 cases(29.5%)had the highest incidence,190 cases(41.6%)had Huanan seafood market exposure history,144 cases(31.5%)had closely contact with COVID-19 patients,29cases(6.3%)had hypertension history,10 cases(2.2%)had diabetes,including 312cases(68.3%)of fever,the fever duration of high fever group was more than low fever group(P<0.001),373 cases(81.6%)of dry cough,138 cases(30.2%)of expectoration,10 case(2.2%)of blood-stained sputum,102 cases(22.3%)of shortness of breath,26 cases(5.7%)of chest tightness,167cases(36.5%)of fatigue,24 cases(5.3%)of muscle soreness,57 cases(12.5%)of diarrhea,31cases(6.8%)of loss of appetite,and 91cases(19.9%)of poor sleep quality.In the early stage,compared with non-fever group,the levels of white blood cell(WBC),lymphocyte(LYM),platelet(PLT)significantly decreased(P<0.05)while the level of hs-CRP significantly elevated significantly(P<0.001)in high/low fever group.Compared with early stage,the level of WBC,NEUT,LYM,MONO and PLT significantly elevated(P<0.05)while the level of hs-CRP significantly decreased obviously(P<0.001)at middle/late stage.There were 11cases(2.4%)without Chest CT radiographic changes at early stage,meanwhile,93 cases(20.4%)of unilateral lesions,353 cases(77.2%)of bilateral lesions,334 cases(74.9

关 键 词：新型冠状病毒肺炎 轻症 临床表现 实验室检查 CT 

分 类 号：R563.1[医药卫生—呼吸系统]