重症新型冠状病毒肺炎危险因素分析  

Study on the risk factors for severe COVID-19

作　　者：李爱新 陈枫[2] 黄晓婕 李侗曾[3] 侯维[4] 张维[4] 张佳莹[3] 汪晓军 梁连春[3] Li Aixin;Chen Feng;Huang Xiaojie;Li Tongzeng;Hou Wei;Zhang Wei;Zhang Jiaying;Wang Xiaojun;Liang Lianchun(Department of Infection Diseases,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院感染中心,100069 [2]首都医科大学附属北京佑安医院放射科,100069 [3]首都医科大学附属北京佑安医院感染综合科,100069 [4]首都医科大学附属北京佑安医院肝病重症医学科,100069 [5]首都医科大学附属北京佑安医院中西医结合中心,100069

出　　处：《北京医学》2020年第10期925-929,共5页Beijing Medical Journal

基　　金：中国初级卫生保健基金会佑安医学发展基金(BJYAYY-2020ZQN-06)。

摘　　要：目的探讨重症新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)的相关危险因素。方法选取2020年1月21日至2月19日首都医科大学附属北京佑安医院感染科收治的95例COVID-19患者,分为非重症组(轻型、普通型,66例)和重症组(重型、危重型,29例),收集两组患者的一般临床资料、实验室检测结果及影像学特征,采用多因素logistic回归分析,探讨重症COVID-19的相关危险因素。结果单因素分析显示,与非重症组比较,重症组年龄,合并高血压、冠心病、脑血管疾病、慢性阻塞性肺疾病,出现呼吸困难、食欲减退,体温、MAP,WBC、中性粒细胞计数、中性粒细胞/淋巴细胞比值等显著增高(P<0.05),SpO2、淋巴细胞计数、血清ALB等则显著降低(P<0.05);影像学显示肺内出现双侧病变、中央及边缘同时受累、多肺叶受累以及出现胸腔积液、胸膜增厚表现均显著高于非重症组(P<0.05),多因素logistic回归分析显示,CRP、年龄是重症COVID-19发生的独立危险因素。根据重症发生的独立危险因素,将患者分为低风险(年龄<50岁且CRP<27 mg/L)、中风险(年龄≥50岁且CRP<27 mg/L或年龄<50岁且CRP≥27 mg/L)和高风险(年龄≥50岁且CRP≥27 mg/L)3个等级,高风险患者的重症发生率为79.2%(OR=74.100,95%CI:13.149~417.586,P<0.001),显著高于中风险(26.7%,OR=7.091,95%CI:1.382~36.381,P<0.05)和低风险(4.9%)患者。结论CRP、年龄是重症COVID-19发生的独立危险因素,根据独立危险因素制定的风险等级有助于重症患者的早期识别。Objective To investigate the related risk factors of severe coronavirus disease 2019(COVID-19).Methods Ninty-five patients with COVID-19 treated in Department of Infectious Diseases,Beijing You’an Hospital,from January 21,2020 to February 19,2020 were divided into non-severe group(mild type and common type,66 cases)and severe group(severe type and critical type,29 cases).Clinical data,laboratory test results and imaging characteristics of the two groups of patients were collected,and multivariate logistic regression analysis was used to explore the relevant risk factors of severe cases.Results The univariate analysis showed that age,combined hypertension,coronary heart disease,cerebrovascular disease,chronic obstructive pulmonary disease,dyspnea,anorexia,temperature,MAP,WBC,neutrophil,neutrophil/lymphocyte ratio,ect,were significantly higher in the severe group than those in the non-severe group(P<0.05).SpO2,lymphocyte,serum ALB,ect,were significantly lower in the severe group than those in the non-severe group(P<0.05).The proportion of bilateral lesions in the lung,central and marginal involvement,multiple lobe involvement,and pleural effusion and pleural thickening were significantly higher in the severe group than those in the non-severe group(P<0.05).Multivariate logistic regression analysis showed that CRP and age were independent risk factors for the occurrence of severe COVID-19.Patients were divided into three levels based on independent risk factors for the occurrence of severe COVID-19:low risk group(age<50 years and CRP<27 mg/L),medium risk group(age≥50 years and CRP<27 mg/L or age<50 years and CRP≥27 mg/L)and high risk group(age≥50 years and CRP≥27 mg/L),79.2%(OR=74.100,95%CI:13.149~417.586,P<0.001)of patients in the high risk group had severe COVID-19,which was significantly higher than the medium risk group(26.7%,OR=7.091,95%CI:1.382~36.381,P<0.05)and low risk(4.9%)patients.Conclusions CRP and age are independent risk factors for the occurrence of severe COVID-19.The risk level based on in

关 键 词：新型冠状病毒肺炎 重型 危重型 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]