后疫情阶段重症新型冠状病毒感染患者的临床特征和危险因素分析  

Analysis of clinical characteristics and risk factors of severe COVID-19 patients in the post-epidemic stage

作　　者：张玲玲[1] 王穆群 郭锋[1] ZHANG Lingling;WANG Muqun;GUO Feng(Department of Respiratory and Critical Care Medicine,Suzhou Hospital of Anhui Medical University(Suzhou Municipal Hospital of Anhui Province),Suzhou,Anhui 234000,China;不详)

机构地区：[1]安徽医科大学附属宿州医院呼吸与危重症医学科,安徽宿州234000 [2]蚌埠医科大学第一附属医院呼吸与危重症医学科,安徽蚌埠233004

出　　处：《中华全科医学》2025年第2期215-218,共4页Chinese Journal of General Practice

基　　金：安徽省科技厅2023年安徽省临床医学研究转化专项项目(202304295107020074);安徽省宿州市卫生健康科研项目(SZWJ2023a035)。

摘　　要：目的 分析新型冠状病毒感染(COVID-19)患者的临床特征,探索可靠的临床指标来预测易进展为重症的高危人群。方法 回顾性分析安徽医科大学附属宿州医院呼吸与危重症医学科2022年12月—2024年2月收治的85例COVID-19患者,根据临床症状分为非重症组(47例)和重症组(38例),比较2组患者的临床特征、血常规、C反应蛋白(CRP)、T淋巴细胞亚群之间的差异,采用logistic回归分析并构建模型,筛选出重症的危险因素,并绘制ROC曲线,比较各危险因素及联合应用对预测重症的价值。结果 与非重症组比较,重症组糖尿病患病率、BMI更高,嗜酸性粒细胞、CD4^(+)T淋巴细胞、CD8^(+)T淋巴细胞更低,差异均有统计学意义(P<0.05)。逐步logistic回归分析显示CD4^(+)T淋巴细胞、糖尿病和BMI是重症的影响因素。CD4^(+)T淋巴细胞、BMI和糖尿病预测重症的ROC曲线下面积(AUC)分别为0.877、0.748和0.663;灵敏度分别为81.6%、60.5%和36.8%;特异度分别为85.1%、93.6%和95.7%。而三者联合构建模型的AUC为0.928,灵敏度和特异度分别为97.4%和76.6%。结论 CD4^(+)T淋巴细胞降低单独或联合BMI值高和患糖尿病可以良好地预测COVID-19患者的病情严重性。Objective To analyze the clinical features of patients infected with Coronavirus disease 2019(COVID-19),and to explore reliable clinical indicators for predicting high-risk populations that are likely to progress to severe cases.Methods A retrospective analysis was conducted on 85 patients with confirmed diagnosis of SARS-CoV-2 infection treated at the Department of Respiratory and Critical Care Medicine at the Suzhou Hospital of Anhui Medical University from December 2022 to February 2024.Patients were categorized according to the severity of their clinical symptoms,resulting in the formation of two distinct groups:the non-severe group(n=47)and the severe group(n=38).The differences in clinical characteristics,blood routine,C-reactive protein(CRP)and T lymphocyte subsets between the two groups were compared.Logistic regression analysis was applied to identify the risk factors of the severe group and a predictive model was constructed.The receiver operating characteristic(ROC)curve was used to compare the predictive value of each risk factor and their combined application in predicting severity.Results A comparison of the non-severe group with the severe group revealed a higher incidence of comorbidities in the latter,including diabetes.Additionally,the severe group exhibited significantly lower levels of eosinophils,CD4^(+)T lymphocytes and CD8^(+)T lymphocytes(P<0.05).Furthermore,a notable difference was observed in the mean BMI between the two groups.The results of the stepwise logistic regression analysis indicated that CD4^(+)T lymphocytes,diabetes,and BMI were significant risk factors for the severe group.The area under the receiver operating characteristic curve(AUC)for CD4^(+)T lymphocytes,BMI and diabetes were 0.877,0.748 and 0.663,respectively.The sensitivity of CD4^(+)T lymphocytes,BMI and diabetes were 81.6%,60.5%and 36.8%,respectively;and the specificity were 85.1%,93.6%and 95.7%,respectively.The AUC for the model constructed by combining the three factors was 0.928,the sensitivity was 97.4%and the s

关 键 词：新型冠状病毒感染 重症 危险因素 

分 类 号：R373.19[医药卫生—病原生物学] R563.14[医药卫生—基础医学]