2019冠状病毒病待排患者临床特征分析及鉴别诊断体会  

Clinical characteristics analysis and differential diagnosis of patients with suspicion for COVID-19

作　　者：邹外龙[1] 陈济超[1] 王玉敏 徐哲 ZOU Wai-long;CHEN Ji-chao;WANG Yu-min;XU Zhe(Department of Respiratory Disease,Aero Space Center Hospital,Beijing 100049,China;不详)

机构地区：[1]航天中心医院呼吸科,北京100049 [2]中国人民解放军总医院第五医学中心感染病医学部生物损伤救治科,北京100039

出　　处：《传染病信息》2021年第2期152-155,共4页Infectious Disease Information

基　　金：新冠应急攻关课题(BWS20J006)。

摘　　要：目的总结2019冠状病毒病(coronavirus disease 2019,COVID-19)待排患者的临床特征和鉴别诊断体会,提高COVID-19的诊断技能。方法回顾性分析53例COVID-19待排患者的临床资料,包括流行病学史,以及白细胞计数、淋巴细胞计数、PLT、CRP、LDH、胸部高分辨CT(high resolution CT,HRCT)等检查结果。结果本研究的53例COVID-19待排患者中,男32例,女21例;年龄15~79岁,平均年龄(53.5±8.4)岁。首诊时病程为1~12 d不等,病程中位数4 d。所有患者均否认COVID-19流行病学史。21例患者具有慢性基础病。首发症状主要为发热、乏力、咳嗽、咳痰、咽痛等。实验室检查外周血白细胞计数多为正常或减少;部分患者LDH、ALT、CK升高。胸部HRCT均呈现多发小斑片影、磨玻璃影及间质改变,以肺外带明显。53例患者均经间隔至少24 h的2次新冠病毒核酸检测为阴性,排除COVID-19,诊断为轻症社区获得性肺炎(community acquired pneumonia,CAP),经治疗后患者无发热及呼吸道症状。结论COVID-19待排患者的临床表现以及肺部影像学与COVID-19相似,与CAP鉴别亦缺乏特异性;结合流行病学史以及新型冠状病毒核酸检测可以提高COVID-19诊断准确率。Objective To summarize the clinical characteristics and differential diagnosis of patients with suspicion for COVID-19,in order to provide a reference for the diagnosis of the disease.Methods The clinical data of 53 patients with suspicion for COVID-19 were analyzed retrospectively.The results of epidemiological history,leukocyte,lymphocyte,platelet count,CRP,LDH and chest high-resolution CT(HRCT)were analyzed.Results In this study,53 patients,32 males and 21 females,aged 15-79 years with an average age of(53.5±8.4)years,had a course of 1-12 days with a median of 4 days.All patients denied the epidemiological history of COVID-19.Twenty-one cases had chronic disease basis.The first symptoms were fever,fatigue,cough,expectoration and sore throat and so on.Laboratory examination showed that peripheral blood leukocyte count was normal and decreased.LDH、ALT、AST and CK were increased in some patients.Chest HRCT showed multiple small spots ground-glass opacity and interstitial changes,especially in the extrapulmonary zone.All patients were negative by nucleic acid test of 2019-nCoV at least twice every 24 hours,excluding COVID-19.All patients were diagnosed as mild community acquired pneumonia(CAP).After treatment,the patients had no fever and respiratory symptoms.Conclusions The clinical manifestations and lung imaging of patients with suspicion for COVID-19 were similar to those of patients with COVID-19,compared with CAP.It lacks specificity too.The diagnosis accuracy of COVID-19 can be improved by the combination of epidemiological history and 2019-nCoV nucleic acid detection.

关 键 词：COVID-19待排 临床特征 鉴别诊断 流行病学 

分 类 号：R563.1[医药卫生—呼吸系统]