重症和危重症新型冠状病毒感染患者的临床特征和风险因素分析  

Clinical characteristics and risk factors of severe and critical COVID-19 patients

作　　者：邹容容[1] 王君 袁静[1] 陈凤 Zou Rongrong;Wang Jun;Yuan Jing;Chen Feng(Department of Infectious Disease,Shenzhen Third People's Hospital,Shenzhen 518112,China;Digestive Medicine Center,the Seventh Affiliated Hospital,SUN Yat-sen University,Shenzhen 518107,China)

机构地区：[1]深圳市第三人民医院感染科,深圳518112 [2]中山大学附属第七医院消化医学中心,深圳518107

出　　处：《国际流行病学传染病学杂志》2025年第1期32-40,共9页International Journal of Epidemiology and Infectious Disease

基　　金：国家重点研发计划(2021YFC2301803);广东省高水平临床重点专科(SZGSP011)

摘　　要：目的:了解新型冠状病毒感染(COVID-19)不同临床分型患者的临床特征,筛选有助于重症化预测的风险因素,为临床分层管理干预提供参考依据。方法:采用回顾性分析方法,收集2020年1月至2020年3月在深圳市第三人民医院确诊的430例COVID-19患者的临床资料,根据临床分型结果分成轻症组(344例)、重型组(70例)和危重型组(16例)。另外根据患者入院后是否由非重型进展为重型分为无进展组(203例)和重型进展组(53例)。比较分析不同组患者的临床资料,使用Logistic回归分析重症化进展的风险因素和预测模型,通过受试者工作特征(ROC)曲线评价其鉴别诊断性能。结果:发热(70.5%,303/430)和咳嗽(51.9%,223/430)是所有组别最常见的临床症状。重型组和危重型组中男性、发热、咳嗽、乏力、气促、合并疾病史和影像学检查异常的比例均高于轻症组(χ2=16.48、21.24、8.19、23.54、19.50、13.95和8.35,P值分别为<0.001、<0.001、0.017、<0.001、<0.001、<0.001和0.015)。轻症组中性粒细胞与淋巴细胞比值、IL-6、C反应蛋白、降钙素原、乳酸脱氢酶、AST、肌酸激酶(CK)、肌酐(Cr)和D-二聚体的中位数水平分别为1.83 pg/mL、8.99 pg/mL、6.59 mg/L、0.034 ng/mL、207.0 U/L、25.0 U/L、65.0 U/L、60.0μmol/L和0.33μg/mL,均低于重症组和危重症组(H=36.44、57.06、75.40、69.23、20.50、32.38、14.01、25.84和39.81,P均<0.001)。另外,危重型组的中性粒细胞绝对数为4.15×109/L,明显高于重型组和轻症组;重型组的ALT中位数水平为28.5 U/L,也高于轻症组(H=11.57和23.95,P值分别为0.003和<0.001)。轻症组从发病至抗病毒的时间[(4.1±3.7)d]和病毒核酸阳性时间[(13.2±8.2)d]均低于重型组和危重型组(F=9.20和23.50,P均<0.001)。COVID-19最常见的并发症为急性呼吸窘迫综合征(5.4%,23/430)和急性肝损伤(4.4%,19/430),其次是急性肾损伤(2.3%,10/430)、感染性休克(0.9%,4/430)和心肌炎(0.9%,4/430)。危重Objective:To understand the clinical characteristics of patients with different clinical subtypes of COVID-19,and identify risk factors that contribute to the prediction of severe progression,so as to provide reference for clinical stratified management and intervention.Methods:A retrospective analysis was used to collect the clinical data of 430 patients with COVID-19 diagnosed at Shenzhen Third People's Hospital from January to March 2020.Patients were classified into mild group(344 cases),severe group(70 cases),and critical group(16 cases)according to the clinical classification.In addition,patients were further categorized into the no-progression group(203 cases)and the severe-progression group(53 cases)according to whether they progressed from mild to severe after admission.The clinical data of patients in different groups were compared and analyzed.Logistic regression was used to identify risk factors for disease progression and to establish a prediction model.The differential diagnostic performance was evaluated by the receiver operator characteristic(ROC)curve.Results:Fever(70.5%,303/430)and cough(51.9%,223/430)were the most common clinical symptoms in all groups.The proportions of males,fever,cough,fatigue,dyspnea,comorbidities,and abnormalities on imaging were higher in the severe and critical groups compared to the mild group(χ2=16.48,21.24,8.19,23.54,19.50,13.95 and 8.35,P<0.001,<0.001,0.017,<0.001,<0.001,<0.001 and 0.015,respectively).The median levels of neutrophil-lymphocyte ratio,IL-6,C-reactive protein,procalcitonin,lactate dehydrogenase,AST,creatine kinase(CK),creatinine(Cr)and D-dimer in the mild group were 1.83 pg/mL,8.99 pg/mL,6.59 mg/L,0.034 ng/mL,207.0 U/L,25.0 U/L,65.0 U/L,60.0μmol/L and 0.33μg/mL,respectively,which were lower than those in the severe and critical groups(H=36.44,57.06,75.40,69.23,20.50,32.38,14.01,25.84 and 39.81,all P<0.001).Moreover,the level of neutrophil in the critical group was 4.15×109/L,which was significantly higher than those in the severe and mild groups,and

关 键 词：冠状病毒感染 临床特征 重症 风险因素 预测 实验室检查 并发症 

分 类 号：R563.1[医药卫生—呼吸系统]