重症新型冠状病毒肺炎患者预后危险因素的评估  

Risk Factors Affecting Outcomes of the Patients with Severe Coronavirus Disease 2019

作　　者：薛文娟[1] 陈公平[2] 林振吕[3] 林婷[2] 张伟 XUE Wenjuan;CHEN Gongping;LIN Zhenlyu;LIN Ting;ZHANG Wei(Department of Traditional Chinese Medicine,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Emergency Surgery,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Department of Respiratory and Critical Care Medicine,The Third People s Hospital of Yichang,Yichang 443008,China)

机构地区：[1]福建医科大学附属第一医院中医科,福州350005 [2]福建医科大学附属第一医院呼吸科,福州350005 [3]福建医科大学附属第一医院急诊外科,福州350005 [4]宜昌市第三人民医院呼吸与危重症医学科,宜昌443008

出　　处：《福建医科大学学报》2021年第6期525-530,共6页Journal of Fujian Medical University

摘　　要：目的探讨影响重症新型冠状病毒肺炎(COVID-19)患者预后的因素。方法纳入2020年1月17日—2020年2月26日湖北省宜昌市第三人民医院确诊的359例COVID-19患者的临床资料。根据重症患者在随访截止时间的转归,分为存活组(n=51)及死亡组(n=15)。采用χ^(2)检验或Fisher精确检验比较轻/普通型、重型及危重型的计数资料,采用单因素方差分析正态分布的计量资料,采用Kruskal-Wallis H检验分析偏态分布的计量资料。比较两组患者的一般资料及实验室指标。采用Cox回归分析评估影响重症COVID-19患者死亡的危险因素。结果死亡组的高血压病、慢性阻塞性肺病、恶性肿瘤、肝功能损害及急性呼吸窘迫综合征(ARDS)比例显著高于存活组(P<0.05)。两组患者入院时的淋巴细胞数、血红蛋白、最高白细胞数、中性粒细胞数、最低淋巴细胞数、血小板、最长凝血酶原时间(PT)、活化部分凝血活酶时间、D-二聚体、天冬氨酸氨基转移酶峰值、C-反应蛋白、降钙素原比较,差别有统计学意义(P<0.05)。多因素Cox回归分析发现,ARDS(HR=6.316, 95%CI:1.342~29.713)、最长PT(HR=1.200, 95%CI:1.067~1.349)及CRP(HR=1.026, 95%CI:1.012~1.040)是重症COVID-19死亡的危险因素,入院时的淋巴细胞数升高(HR=0.014, 95%CI:0.001~0.322)则是重症COVID-19死亡的保护因素(P<0.05)。结论应密切监测重症COVID-19患者的最长PT、CRP及淋巴细胞数的变化,若发生ARDS,死亡概率显著增加。早期识别及采取有效措施可改善预后。Objective To evaluate the risk factors affecting outcomes of the patients with severe Coronavirus disease 2019(COVID-19). Methods Patients with confirmed COVID-19 from January 17, 2020 to February 26, 2020 were recruited. A total of 359 participants including 195 males and 164 females were analyzed. The severe COVID-19 patients were classified into survival group and death group.There were 51 subjects in survival group and 15 subjects in death group. Categorical variables were compared using the chi-squared test or Fisher’s exact probability test among three groups. Continuous variables were compared using one-way ANOVA when the data were normally distributed for multiple-group;otherwise, the Kruskal-Wallis H test was used. The differences in general data and laboratory indicators were tested. Cox regression analysis was conducted to obtain the independent risk factors from the laboratory indicators. Results Hypertension, COPD, malignant tumor, liver injury and ARDS showed significant difference between two groups. The level of leucocytes, neutrophils, PT, APTT and AST at peak time, CRP and PCT(P<0.05) were higher in death group compared to survival group. Meanwhile, compared with the survival group, level of lymphocyte and hemoglobin on admission, the valley value of platelets and lymphocyte(P<0.05) were lower in death group. ARDS(HR=6.316, 95% CI:1.342-29.713), peak PT(HR:1.200, 95%CI:1.067-1.349), and CRP(HR=1.026, 95% CI:1.012-1.040) were independent risk factors and increased lymphocyte on admission(HR=0.014, 95% CI:0.001-0.322) was protective factor for prognosis of the death of severe COVID-19 patients. Conclusions We should pay close attention to the ARDS, the level of CRP, PT and lymphocyte for severe patients. It will help us to identify the patients with high risk of death in the early stage, and take effective treatment measures as early as possible to improve the prognosis.

关 键 词：新型冠状病毒肺炎 预后 危险因素 

分 类 号：R563.1[医药卫生—呼吸系统]