新型冠状病毒肺炎患者重症转化不同阶段的实验室检查特征分析  

Laboratory characteristics of patients with severely transformed coronavirus pneumonia in different stages

作　　者：陈鸣[1] 钱雅君 李静[1] 许莹 唐健[1] 尤勇[1] 陈显成[1] 虞文魁 CHEN Ming;QIAN Ya-jun;LI Jing;XU Ying;TANG Jian;YOU Yong;CHEN Xian-cheng;YU Wen-kui(Department of Critical Care Medicine,the Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院重症医学科,南京210008

出　　处：《医学研究生学报》2021年第1期53-57,共5页Journal of Medical Postgraduates

基　　金：南京大学“新型冠状病毒肺炎(NCP)应急科研专项”项目(XJ2020005101)。

摘　　要：目的新型冠状病毒肺炎患者的实验室检查特征可随病程的进展而改变。文中分析发生重症转化的新型冠状病毒肺炎患者发病后不同时间阶段的实验室检查特征,为早期甄别和防治重症转化患者提供参考。方法回顾性分析武汉同济医院光谷院区和南京公共卫生医疗中心收治的确诊新型冠状病毒肺炎患者125例,记录患者一般临床资料和入院后6 h内的外周血细胞分类计数,谷草转氨酶、乳酸脱氢酶、肌酸激酶、D-二聚体、C反应蛋白和降钙素原等指标。根据患者发病至入院时间分为发病≤7 d和发病>7 d等2个阶段,每个阶段以最终的临床分型分为轻症组(轻型和普通型)和重症组(重型和危重型),分析早期预测患者重症转化的实验室指标。结果125例患者从发病至收入院的中位时间为9 d。其中发病≤7 d阶段59例(轻症组48例、重症组11例),发病>7 d阶段66例(轻症组36例、重症组30例)。发病≤7 d患者中,重症组患者血淋巴细胞比例下降,D二聚体、C反应蛋白和乳酸脱氢酶升高的发生率显著高于轻症组(分别为81.8%vs 18.8%、81.8%vs 9.5%、、100%vs 39.6%、85.7%vs 17.4%,P<0.05);发病>7 d患者中,重症组的血淋巴细胞比例下降,白细胞计数、谷草转氨酶升高的比例显著高于轻症组(分别为53.3%vs 19.4%、20%vs 0、30.0%vs 5.6%,P<0.05)。多因素Logistc回归分析提示发病≤7d患者的C反应蛋白升高(OR=1.070,P=0.01)是重症转化的独立危险因素;而发病>7 d患者的血淋巴细胞计数(OR=0.095,P=0.003)和谷草转氨酶升高(OR=1.056,P=0.031)是重症转化的独立危险因素。结论新型冠状病毒肺炎患者在发病7 d内的C反应蛋白升高,发病7 d后的淋巴细胞计数下降或谷草转氨酶升高均可能预警其重症转化。临床应用以上指标初筛及防治可能重症转化患者时,必需考虑病程的时间阶段。Objective The characteristics of laboratory tests of patients with COVID-19 can change with the progression of the disease.This article aims to study the laboratory examination characteristics of patients with the severe transformation of new coronavirus pneumonia at different time stages after the onset of the disease and to provide a reference for the early identification and prevention of severe transformation patients.Methods We conducted a retrospective analysis of 125 patients confirmed COVID-19 patients admitted to Wuhan and Nanjing.The general clinical data of the patients and the peripheral blood cells within 6 hours after admission were recorded Classified count,aspartate aminotransferase,lactate dehydrogenase,creatine kinase,D-dimer,C-reactive protein,procalcitonin,and other indicators.According to the time from onset to admission,the patients were divided into two stages:onset≤7 d and onset>7 d.Each stage was divided into mild group(light and normal)and the severe group(severe and critical)according to the final clinical classification.We analyzed the laboratory indicators for the early prediction of the severe transformation of patients.Results The median time from illness onset to an admission of all 125 patients was 9(4,15)days,59 patients in the onset≤7 days stage(48 in the mild group and 11 in the severe group)and 66 patients in the onset>7 days stage(36 in the mild group and 30 in the severe group).Among patients of the onset≤7 days stage,the incidence of decrease in lymphocyte proportion and increases in C-reactive protein,d-dimer,lactate dehydrogenase in the severe group was significantly higher than that in the mild group(53.3%vs 19.4%,81.8%vs 9.5%,100%vs 39.6%,85.7%vs 17.4% respectively,all P<0.05).Among the onset>7 days stage patients,the incidence of decrease in lymphocyte proportion and increases in white blood cell count,aminotransferase in the severe group was significantly higher than that in the mild group(53.3%vs 19.4%,20%vs 0%,30.0%vs 5.6% respectively,all P<0.05).Multivariate

关 键 词：新型冠状病毒肺炎 实验室检查 重症转化 淋巴细胞计数 C反应蛋白 

分 类 号：R511[医药卫生—内科学]