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[29例2019新型冠状病毒肺炎患者临床特征分析]

[Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia].

作者信息

Chen L, Liu H G, Liu W, Liu J, Liu K, Shang J, Deng Y, Wei S

机构信息

Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan 430030, China.

Department of Respiratory and Critical Care Medicine, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):203-208. doi: 10.3760/cma.j.issn.1001-0939.2020.03.013.

DOI:10.3760/cma.j.issn.1001-0939.2020.03.013
PMID:32164089
Abstract

To analyze the clinical characteristics of 2019 novel coronavirus (2019-nCoV) pneumonia and to investigate the correlation between serum inflammatory cytokines and severity of the disease. 29 patients with 2019-ncov admitted to the isolation ward of Tongji hospital affiliated to Tongji medical college of Huazhong University of Science and Technology in January 2020 were selected as the study subjects. Clinical data were collected and the general information, clinical symptoms, blood test and CT imaging characteristics were analyzed. According to the relevant diagnostic criteria, the patients were divided into three groups: mild (15 cases), severe (9 cases) and critical (5 cases). The expression levels of inflammatory cytokines and other markers in the serum of each group were detected, and the changes of these indicators of the three groups were compared and analyzed, as well as their relationship with the clinical classification of the disease. (1) The main symptoms of 2019-nCoV pneumonia was fever (28/29) with or without respiratory and other systemic symptoms. Two patients died with underlying disease and co-bacterial infection, respectively. (2) The blood test of the patients showed normal or decreased white blood cell count (23/29), decreased lymphocyte count (20/29), increased hypersensitive C reactive protein (hs-CRP) (27/29), and normal procalcitonin. In most patients, serum lactate dehydrogenase (LDH) was significantly increased (20/29), while albumin was decreased (15/29). Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (Tbil), serum creatinine (Scr) and other items showed no significant changes. (3) CT findings of typical cases were single or multiple patchy ground glass shadows accompanied by septal thickening. When the disease progresses, the lesion increases and the scope expands, and the ground glass shadow coexists with the solid shadow or the stripe shadow. (4) There were statistically significant differences in the expression levels of interleukin-2 receptor (IL-2R) and IL-6 in the serum of the three groups (0.05), among which the critical group was higher than the severe group and the severe group was higher than the mild group. However, there were no statistically significant differences in serum levels of tumor necrosis factor-alpha (TNF-α), IL-1, IL-8, IL-10, hs-CRP, lymphocyte count and LDH among the three groups (0.05). The clinical characteristics of 2019-nCoV pneumonia are similar to those of common viral pneumonia. High resolution CT is of great value in the differential diagnosis of this disease. The increased expression of IL-2R and IL-6 in serum is expected to predict the severity of the 2019-nCoV pneumonia and the prognosis of patients.

摘要

分析2019新型冠状病毒(2019-nCoV)肺炎的临床特征,并探讨血清炎症细胞因子与疾病严重程度之间的相关性。选取2020年1月入住华中科技大学同济医学院附属同济医院隔离病房的29例2019-nCoV患者作为研究对象。收集临床资料,分析一般信息、临床症状、血液检查及CT影像特征。根据相关诊断标准,将患者分为三组:轻症(15例)、重症(9例)和危重症(5例)。检测每组患者血清中炎症细胞因子及其他标志物的表达水平,比较分析三组这些指标的变化情况及其与疾病临床分型的关系。(1)2019-nCoV肺炎的主要症状为发热(28/29),伴有或不伴有呼吸道及其他全身症状。两名患者分别因基础疾病和合并细菌感染死亡。(2)患者血液检查显示白细胞计数正常或降低(23/29),淋巴细胞计数降低(20/29),超敏C反应蛋白(hs-CRP)升高(27/29),降钙素原正常。大多数患者血清乳酸脱氢酶(LDH)显著升高(20/29),而白蛋白降低(15/29)。丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(Tbil)、血清肌酐(Scr)等项目无明显变化。(3)典型病例的CT表现为单发或多发斑片状磨玻璃影伴小叶间隔增厚。疾病进展时,病灶增多、范围扩大,磨玻璃影与实变影或条索影并存。(4)三组患者血清中白细胞介素-2受体(IL-2R)和IL-6的表达水平差异有统计学意义(P<0.05),其中危重症组高于重症组,重症组高于轻症组。然而,三组患者血清肿瘤坏死因子-α(TNF-α)、IL-1、IL-8、IL-10、hs-CRP、淋巴细胞计数及LDH水平差异无统计学意义(P>0.05)。2019-nCoV肺炎的临床特征与常见病毒性肺炎相似。高分辨率CT对该病的鉴别诊断具有重要价值。血清中IL-2R和IL-6表达升高有望预测2019-nCoV肺炎的严重程度及患者预后。

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