新型冠状病毒肺炎患者病情加重可能预警指标的研究  

Analysis of possible warning indicators of exacerbation in COVID-19 patients

作　　者：顾娜[1] 杜晓菲 聂巍 李雪梅 郭颖 李燕冰 路金环 赵艳[1] Gu Na;Du Xiaofei;Nie Wei;Li Xuemei;Guo Ying;Li Yanbing;Lu Jinhuan;Zhao Yan(Blood Purification Center,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血液净化中心,100069 [2]首都医科大学附属北京佑安医院慢病管理中心,100069

出　　处：《北京医学》2020年第10期930-933,共4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新型冠状病毒肺炎应急防控公益项目(BJYAYY-2020GL-04;BJYAYY-2020ZQN-02)。

摘　　要：目的分析新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者病情加重的可能预警指标。方法选取2020年1月21日至2月27日首都医科大学附属北京佑安医院确诊为COVID-19的90例患者,通过复习住院病历,实验室检查及影像学资料,将其中37例患者,包括住院期间肺炎加重30例,合并肝损伤7例,作为病情加重组,其余为病情非加重组。通过分析比较性别、年龄、入院时有无发热,以及入院时的WBC、中性粒细胞百分比、淋巴细胞百分比及绝对数、CRP、降钙素原(procalcitonin,PCT)、乳酸、ALB、SCr、肌酸激酶(creatine kinase,CK)及肺CT累及病变范围等14个因素水平,探讨COVID-19患者病情加重的可能预警指标。结果90例患者平均年龄(47.6±18.4)岁,男37例(41.1%),女53例(58.9%)。有湖北疫区旅居史者42例(46.7%)、聚集性发病患者45例(50.0%),无明确感染原因3例(3.3%)。常见症状包括发热67例(74.4%),干咳26例(28.9%),乏力、胸闷21例(23.3%),头痛、咽痛、四肢疼痛或腹痛19例(21.2%)。多因素分析提示,出现发热、淋巴细胞绝对值降低,乳酸及CK升高,可能是病情严重的预警指标。结论患者入院时有无发热、淋巴细胞绝对数、乳酸以及肌酸激酶水平与COVID-19病情严重程度具有相关性。出现发热、淋巴细胞计数减少、乳酸及肌酸激酶升高,可能是COVID-19患者病情加重的预警指标。Objective To explore possible warning indicators of aggravation of coronavirus disease 2019(COVID-19 patients.Methods A retrospective,single-center case series analysis included 90 general ward patients with confirmed COVID-19 at Beijing Youan Hospital from January 21 to February 27,2020.By reviewing the inpatient medical records,laboratory examinations and imaging data,there were 37 patients,including 30 patients with pneumonia aggravation and seven patients with liver injury,were observed as aggravating patients,and the rest 53 cases were observed as non-aggravating patients.By comparing the 14 factors level,such as gender,age,with or without fever at admission,leukocyte number,percentage of neutrophils,lymphocytes percentage and absolute number,CRP,calcitonin,lactic acid,albumin,serum creatinine,creatine kinase and lung CT involvement in the range of lesions,the possible early warning indicators of exacerbation in COVID-19 patients were explored.Results The mean age of 90 hospitalized COVID-19 patients was(47.6±18.4)years.There were 37 males(41.1%)and 53 females(58.9%).There were 42 cases(46.7%)of people living in Hubei epidemic areas,45 cases(50.0%)of clustered patients,and three cases(3.3%)without clear cause of infection.Common symptoms included fever in 67 cases(74.4%),dry cough in 26 cases(28.9%),fatigue and chest tightness in 21 cases(23.3%),headache,sore throat,limb pain or abdominal pain in 19 cases(21.2%).Multiple-factor analysis showed that fever,reduced lymphocyte count,elevated lactic acid and creatine kinase might be early warning indicators of exacerbation in COVID-19 patients.Conclusions The presence or absence of fever at admission,absolute number of lymphocytes,levels of lactic acid and creatine kinase are correlated with patients with severe COVID-19.Fever,reduced lymphocyte count,elevated lactic acid and creatine kinase may be early warning indicators of exacerbation in COVID-19 patients.

关 键 词：新型冠状病毒肺炎 病情加重 预警指标 

分 类 号：R563.1[医药卫生—呼吸系统]