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[河南省南阳市150例2019新型冠状病毒感染病例的临床分析]

[Clinical analysis of 150 cases of 2019 novel coronavirus infection in Nanyang City, Henan Province].

作者信息

Sun C, Zhang X B, Dai Y, Xu X Z, Zhao J

机构信息

Department of Respiratory Disease and Intensive Care, Nanyang Central Hospital, Nanyang 473000, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2020 Jun 12;43(6):503-508. doi: 10.3760/cma.j.cn112147-20200224-00168.

DOI:10.3760/cma.j.cn112147-20200224-00168
PMID:32295322
Abstract

To analyze the epidemiological characteristics and clinical features of the patients with 2019-nCoV infection in Nanyang City, so as to provide evidence for clinical diagnosis and treatment. The epidemiology, clinical symptoms, atory and radiologic data of 150 patients with 2019-nCoV infection admitted to the designated hospitals in Nanyang City from January 24,2020 to February 16, 2020 were retrospectively analyzed. The 150 patients with 2019 nCov infection consisted of 67 men and 83 women, and the median age was (45±16) years; 69 of them were the first generation case,60 of them were the second generation case, 6 of them were the third generation case,the median incubation period of the first generation case was (5.4±2.2) days, and the second generation case was (6.7±3.1) days, and the first-generation cases are the majority in severe patients (69%) . The most common basic disease was hypertension (13 cases, 9%), diabetes (9 cases, 6%), and the most common symptom is fever(142 cases, 95%, 63% showed moderate fever) , cough and sputum(108 cases,72%), fatigue(23 cases,15%), anorexia(20 cases, 13%), headache, diarrhea, muscle soreness, sore throat as the first symptoms. The average time from onset of symptoms to consultation was (4.2±2.2) days for all patients. The changes in peripheral blood cells were mainly lymphonpenia (83 cases, 55%) and eosinophilia (95 cases, 63%), The lymphocyte count of the severe and critically ill patients was more significantly reduced, and some patients had increased myocardial enzymes, mainly LDH (47 cases, 31%), and a few patients had liver function damage, mainly manifested in ALT and AST. High, very few patients have renal impairment. Among the inflammation-related indicators, the main manifestations are increased CRP (66 cases, 43%) and ESR (86 cases, 57%), elevated D-Dimer in 29% of patients. 144 cases have different degrees of infective lesions in chest CT examination, with 30 cases (21%) on one side and 144 cases (79%) on both sides. Morphologically, most of the lesions were patchy ground glass lesions, which could be accompanied by air bronchus signs and some consolidation and paving stone signs. Of the cases showing "white lung", 87% were sever ill or critically ill. After active treatment, 45% of patients were discharged according to discharge standards. 33% of sever and critically ill patients were discharged, 49% of them were degraded hospitalization.The average length of hospitalization was (12±4) days. A history of epidemiological exposure, fever, chest CT with signs of pneumonia, normal or decreased WBC, and lymphocytopenia, eosinophilia are the clinical basis for the diagnosis of this disease, and most of the sever patients were the first generation cases. The degree of lymphocytopenia is related to the severity of the disease.

摘要

分析南阳市新型冠状病毒肺炎(COVID-19)患者的流行病学特征和临床特点,为临床诊断和治疗提供依据。回顾性分析2020年1月24日至2月16日南阳市定点医院收治的150例COVID-19患者的流行病学、临床症状、实验室及影像学资料。150例COVID-19患者中,男性67例,女性83例,年龄中位数为(45±16)岁;其中第一代病例69例,第二代病例60例,第三代病例6例,第一代病例的中位潜伏期为(5.4±2.2)天,第二代病例为(6.7±3.1)天,重症患者中第一代病例占多数(69%)。最常见的基础疾病为高血压(13例,9%)、糖尿病(9例,6%),最常见的症状为发热(142例,95%,其中63%为中度发热)、咳嗽咳痰(108例,72%)、乏力(23例,15%)、食欲减退(20例,13%),以头痛、腹泻、肌肉酸痛、咽痛为首发症状。所有患者从症状出现到就诊的平均时间为(4.2±2.2)天。外周血细胞变化主要为淋巴细胞减少(83例,55%)和嗜酸性粒细胞增多(95例,63%),重症和危重症患者淋巴细胞计数降低更明显,部分患者心肌酶升高,主要为乳酸脱氢酶(47例,31%),少数患者肝功能损害,主要表现为谷丙转氨酶和谷草转氨酶升高。肾功能损害者极少。炎症相关指标中,主要表现为C反应蛋白升高(66例,43%)、血沉升高(86例,57%),29%的患者D-二聚体升高。144例胸部CT检查有不同程度的感染性病变,单侧30例(21%),双侧144例(79%)。形态学上,病变多为斑片状磨玻璃影,可伴有空气支气管征及部分实变和铺路石征。出现“白肺”的病例中,87%为重症或危重症。经过积极治疗,45%的患者达到出院标准出院。33%的重症和危重症患者出院,49%降级住院。平均住院时间为(12±4)天。有流行病学暴露史、发热及胸部CT有肺炎征象、白细胞正常或降低、淋巴细胞减少及嗜酸性粒细胞增多是本病的临床诊断依据,重症患者多为第一代病例。淋巴细胞减少程度与疾病严重程度相关。

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