广州市输入性2019新型冠状病毒奥密克戎与德尔塔变异株感染者的临床特征分析  

Clinical characteristics of imported patients infected with 2019 novel coronavirus Omicron variants and Delta variants in Guangzhou City

作　　者：刘莹[1] 李美瑜 李锋 徐永昊[4] 黎毅敏[4] 唐小平[5] 邓西龙 Liu Ying;Li Meiyu;Li Feng;Xu Yonghao;Li Yimin;Tang Xiaoping;Deng Xilong(Department of Critical Care Medicine,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510060,China;Cardiovascular Medical Department,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510060,China;Infectious Diseases Institute,Guangzhou Eighth People′s Hospital,Guangzhou Medical University,Guangzhou 510060,China;Department of Critical Care Medicine,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属市八医院重症医学科,广州510060 [2]广州医科大学附属市八医院心内科,广州510060 [3]广州医科大学附属市八医院传染病研究所,广州510060 [4]广州医科大学附属第一医院重症医学科,广州510120 [5]广州医科大学,广州510120

出　　处：《中华传染病杂志》2022年第10期584-590,共7页Chinese Journal of Infectious Diseases

基　　金：广东省科学技术厅重点项目(2021A1111110001);广州实验室应急攻关项目(EKPG21-29);广东省钟南山基金(ZNSA-2021004);广州市卫生健康委员会一般项目(20201A011041)。

摘　　要：目的分析比较输入性2019新型冠状病毒奥密克戎与德尔塔变异株感染者的临床特征和预后, 为临床诊治和防控策略提供参考。方法回顾性分析2021年8月1日至2022年1月18日广州医科大学附属市八医院收治的输入性2019新型冠状病毒感染者, 按照鼻/咽拭子2019新型冠状病毒全基因组测序结果分为奥密克戎组和德尔塔组, 分析两组临床特征、实验室检查、抗体水平、病毒核酸[N基因和开放阅读框1ab(open reading frame 1ab, ORF1ab)的循环阈值]、主要治疗措施及临床预后。统计学分析采用秩和检验、χ2检验或Fisher确切概率法。结果共纳入344例2019新型冠状病毒感染者, 德尔塔组152例, 奥密克戎组192例。男240例(69.8%), 中位年龄为33岁, 102例(29.7%)有基础疾病, 271例完成全程或加强疫苗接种。奥密克戎组疫苗全程接种率为70.8%(136/192), 高于德尔塔组的51.3%(78/152);奥密克戎组轻型患者比例高于德尔塔组[57.3%(110/192)比24.3%(37/152)], 普通型和重型比例均低于德尔塔组[33.9%(65/192)比55.3%(84/152)和0(0/192)比10.5%(16/152)], 差异均有统计学意义(χ2=37.64、15.84, Fisher确切概率法;均P<0.001)。奥密克戎组发热时间和热峰值分别为1.5(1.0, 2.0) d和38.1(37.8, 38.5) ℃, 均低于德尔塔组的3.0(1.0, 4.8) d和38.5(38.1, 39.0) ℃, 差异均有统计学意义(Z=-4.14、-3.85, 均P<0.001)。接种疫苗的奥密克戎组患者入院时2019新型冠状病毒抗体IgG、N基因和ORF1ab基因循环阈值均高于德尔塔组, 差异均有统计学意义(Z=-3.25、-2.18、-2.82, 均P<0.050)。奥密克戎组较德尔塔组需要呼吸治疗的患者比例更低, 氧疗时间、入院至2019新型冠状病毒核酸循环阈值≥35的时间和住院时间均更短, 差异均有统计学意义(χ2=47.86, Z=-5.41、-5.60、-4.71;均P<0.001)。两组均无危重症和28 d死亡病例。结论奥密克戎变异株感染者较德尔塔变异株感染者的病情严重程度更轻, 病�Objective To analyze and compare the clinical characteristics and prognosis of imported patients infected with 2019 novel coronavirus(2019-nCoV)Omicron variants and Delta variants,so as to provide references for clinical diagnosis,treatment and epidemic prevention strategies.Methods The patients with imported 2019-nCoV infection from August 1,2021 to January 18,2022 in Guangzhou Eighth People′s Hospital,Guangzhou Medical University were retrospectively analyzed.According to the whole genome sequencing of 2019-nCoV in nasal or throat swabs,they were divided into Omicron group and Delta group.The clinical characteristics,laboratory tests,antibody levels,viral nucleic acid(the cycle threshold(Ct)of N gene and open reading frame(ORF)1ab),main treatment measures and clinical prognosis were analyzed in the two groups.Statistical analysis was performed using the rank sum test,chi-square test or Fisher′s exact test.Results A total of 344 cases were enrolled,including 152 cases in the Delta group and 192 cases in the Omicron group,and there were 240 males(69.8%),with a median age of 33 years old.One hundred and two(29.7%)of those patients had underlying disease.Two hundred and seventy-one had completed full or booster vaccination.The overall full vaccination rate in Omicron group was 70.8%(136/192),which was higher than 51.3%(78/152)in Delta group.The proportion of mild patients in Omicron group was higher than that in Delta group(57.3%(110/192)vs 24.3%(37/152),respectively),and the proportions of common type and severe type were lower than those of the Delta group(33.9%(65/192)vs 55.3%(84/152)and 0(0/192)vs 10.5%(16/152)),the differences were all statistically significant(χ2=37.64 and 15.84,respectively,Fisher′s exact test;all P<0.001).The duration and peak of fever in Omicron group were 1.5(1.0,2.0)d and 38.1(37.8,38.5)℃,respectively,which were lower than those in Delta group(3.0(1.0,4.8)d and 38.5(38.1,39.0)℃,respectively),and the differences were both statistically significant(Z=-4.14 and-3.85,respectively,

关 键 词：冠状病毒感染 2019新型冠状病毒 临床特征 德尔塔变异株 奥密克戎变异株 输入性病例 

分 类 号：R563.1[医药卫生—呼吸系统]