11例新冠肺炎发热门诊临床特征分析  

Analysis of Clinical Feature of 11 COVID-19 Patients from One Fever Clinic

作　　者：孔金丹[1,2] 王鹏[2] 郝艳[1] 徐华[1] 邹迪 石冰玉 宗香萍 仇惠英[2] 吴德沛[2] 付建红[2] KONG Jin-dan;WANG Peng;HAO Yan;XU Hua;ZOU Di;SHI Bing-yu;ZONG Xiang-ping;QIU Hui-ying;WU De-pei;FU Jian-hong(Department of Critical Care Medicine,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China;Department of Hematology,National Clinical Research Center for Hematologic Diseases,Jiangsu Institute of Hematology,The First Affiliated Hospital of Soochow University,Suzhou,Jiangsu,215006,China;Department of Critical Care Medicine,The Affiliated Infectious Diseases Hospital of Soochow University,Suzhou,Jiangsu,215007,China)

机构地区：[1]苏州大学附属第一医院重症医学科,江苏苏州215006 [2]苏州大学附属第一医院血液科,国家血液系统疾病临床医学研究中心,江苏省血液研究所,江苏苏州215006 [3]苏州大学附属传染病医院,苏州市第五人民医院重症医学科,江苏苏州215007

出　　处：《中国血液流变学杂志》2020年第2期194-197,213,共5页Chinese Journal of Hemorheology

摘　　要：目的 分析苏州大学附属第一医院发热门诊筛查确诊的新型冠状病毒肺炎患者的临床特征和辅助检查结果.方法 纳入2020年1月24日—3月1日在苏州大学附属第一医院发热门诊筛查并确诊的新型冠状病毒肺炎患者,分析患者的临床特征、影像学特点和血液学检查指标,收集同期供者健康体检的血液学检查结果作为对照参考.结果 发热门诊确诊11例新冠肺炎患者,以输入性病例为主,大部分临床表现为发热和咳嗽,其中普通型8例,重症型3例.发病到确诊的中位时间为(4.8±3.6)d.所有患者胸部CT均有磨玻璃密度样改变,血清降钙素原阴性,8例C反应蛋白水平升高,白细胞计数、中性粒细胞计数、血小板计数和血红蛋白水平均正常,4例患者有淋巴细胞减少,中性粒细胞淋巴细胞比值(NLR)为(2.67±1.68),血小板淋巴细胞计数比值(PLR)为(164.2±61.2),淋巴细胞单核细胞计数比值(LMR)为(2.37±0.74).根据健康供者资料所确定的参考值范围,11例新冠肺炎患者中NLR升高3例(2例重症),PLR升高3例(2例重症),LMR降低8例(3例重症均降低).其中LMR降低明显.凝血指标方面PT、APTT均正常,6例纤维蛋白原升高,且有2例D-二聚体升高,为重症确诊病例.结论 新冠肺炎患者初诊时CRP升高、LMR降低和纤溶指标异常常见,外周血的血细胞比值(NLR、PLR、LMR)在重症病例中表现明显.NLR、PLR和LMR结合C反应蛋白、凝血指标可能是辅助诊断和判定疾病严重程度的简便指标.Objective To analyze the clinical characteristics and auxiliary examinations of COVID-19 patients diagnosed in the fever clinic of the First Affiliated Hospital of Soochow University.Methods Patients with a confirmed COVID-19 diagnosis in the fever clinic of the hospital from January 24,2020,to March 1,2020,were included.The clinical characteristics,imaging feature and hematological indexes were recorded.The hematological results of healthy donors for pre-transplant health examinations were used as a reference.Results A total of 11 COVID-19 patients were diagnosed in the fever clinic of the hospital.Most of them were imported cases,and the main symptoms were fever and cough.There were 8 mild/moderate cases and 3 severe cases.The median time from onset to diagnosis was(4.8±3.6)days.The main abnonnal findings in chest CT were ground glass density changes.Serum procalcitonin of all patients were negative,and C-reactive protein levels elevated in 8 patients.Leukocyte,neutrophil,platelet,and hemoglobin levels were nonnal,and 4 patients had lymphopenia,neutrophil lymphocyte ratio(NLR)was(2.67±1.68),platelet lymphocyte ratio(PLR)was(164.2±61.2),and lymphocyte monocyte ratio(LMR)was(2.37±0.74).According to the reference range determined by the hematological data of healthy donors,NLR increased in 3 cases(2 severe cases),PLR increased in 3 cases(2 severe cases),LMR decreased in 8 cases(3 severe cases were all decreased).LMR decreased significantly.In terms of coagulation panel,PT and APTT were normal,fibrinogen elevated in 6 cases,and D-dimer elevated in 2 severe cases.Conclusion In newly diagnosed COVID-19 patients,elevated C-reactive protein,decreased LMR and fibrinolysis abnormal were common.Peripheral blood cell ratios(NLR,PLR,LMR)were significantly abnormal in severe cases.NLR,PLR and LMR combined with C-reactive protein and coagulation panel may be used as convenient indicators for assisting diagnosis and determining the severity of the disease.

关 键 词：新型冠状病毒肺炎 发热门诊 血液学指标 

分 类 号：R563.1[医药卫生—呼吸系统]