Department of Respiratory and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, 442000, China.
State Key Laboratory of Quality Research in Chinese Medicine/Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau (SAR), China.
Pharmacol Res. 2020 Jul;157:104821. doi: 10.1016/j.phrs.2020.104821. Epub 2020 Apr 30.
Since December 2019, new COVID-19 outbreaks have occurred and spread around the world. However, the clinical characteristics of patients in other areas around Wuhan, Hubei Province are still unclear. In this study, we performed epidemiological and clinical characteristics analysis on these regional cases.
We retrospectively investigated COVID-19 patients positively confirmed by nucleic acid Q-PCR at Taihe Hospital from January 16 to February 4, 2020. Their epidemiological, clinical manifestations, and imaging characteristics were analysed.
Among the 73 patients studied, 12.3 % developed symptoms after returning to Shiyan from Wuhan, and 71.2 % had a history of close contact with Wuhan personnel or confirmed cases. Among these patients, 9 cases were associated with family clustering. The first main symptoms presented by these patients were fever (84.9 %) and cough (21.9 %). The longest incubation period was 26 days, and the median interval from the first symptoms to admission was 5 days. Of the patients, 67.1 % were originally healthy people with no underlying diseases, others mostly had common comorbidities including hypertension (12.3 %) and diabetes (5.5 %), 10.9 % were current smokers, 30.1 % had low white blood cell counts and 45.2 % showed decreased lymphocytes at the first time of diagnosis. CT scans showed that multiple patchy ground glass shadows outside of the patient lungs were commonly observed, and a single sub-pleural sheet of ground glass shadow with enhanced vascular bundles was also found located under the pleura. Patient follow-up to February 14 presented 38.4 % severe cases and 2.7 % critical cases. After follow-up, the parameter of lymphocyte counts below 0.8 × 10/L cannot be used to predict severe and critical groups from the ordinary group, and a lower proportion of smokers and higher proportion of diabetes patients occur in the poor outcome group. Other co-morbidities are observed but did not lead to poor outcomes.
The epidemiological characteristics of patients in the area around Wuhan, such as Shiyan, at first diagnosis are described as follows: Patients had histories of Wuhan residences in the early stage and family clustering in the later period. The incubation period was relatively long, and the incidence was relatively hidden, but the virulence was relatively low. The initial diagnosis of the patients was mostly ordinary, and the percentage of critical patients who evolved into the ICU during follow-up is 2.7 %, which is lower than the 26.1 % reported by Wuhan city. According to the Shiyan experience, early diagnosis with multiple swaps of the Q-PCR test and timely treatment can reduce the death rate. Diabetes could be one of the risk factors for progression to severe/critical outcomes. No evidence exists that smoking protects COVID-19 patients from developing to severe/critical cases, and the absolute number of lymphocytes at initial diagnosis could not predict the progression risk from severe to critical condition. Multivariate regression analysis should be used to further guide the allocation of clinical resources.
自 2019 年 12 月以来，新型冠状病毒病（COVID-19）疫情在全球范围内不断发生和蔓延。然而，湖北省武汉市以外地区患者的临床特征尚不清楚。在本研究中，我们对这些地区的病例进行了流行病学和临床特征分析。
我们回顾性调查了 2020 年 1 月 16 日至 2 月 4 日在泰和医院经核酸 Q-PCR 阳性确诊的 COVID-19 患者。分析了他们的流行病学、临床表现和影像学特征。
在 73 例研究患者中，12.3%的患者在从武汉返回十堰后出现症状，71.2%的患者有与武汉人员或确诊病例密切接触的病史。这些患者中有 9 例与家庭聚集有关。这些患者的主要首发症状为发热（84.9%）和咳嗽（21.9%）。最长潜伏期为 26 天，从首发症状到入院的中位间隔为 5 天。这些患者中，67.1%为无基础疾病的健康人，其他多数有常见合并症，包括高血压（12.3%）和糖尿病（5.5%），10.9%为现吸烟者，30.1%首次就诊时白细胞计数较低，45.2%淋巴细胞首次就诊时减少。CT 扫描显示，患者肺部以外的多个斑片状磨玻璃影常见，胸膜下还可见单个胸膜下磨玻璃影伴增强血管束。截至 2 月 14 日患者随访，38.4%为重症病例，2.7%为危重症病例。随访后发现，淋巴细胞计数低于 0.8×10/L 不能用于预测普通组向重症和危重症组的转变，且预后不良组中吸烟者比例较低，糖尿病患者比例较高。其他合并症也有观察到，但并未导致不良结局。
首先描述了武汉周边地区（如十堰）患者的流行病学特征：早期有武汉居住史，后期有家庭聚集史。潜伏期相对较长，发病隐匿，但毒力相对较低。患者的初始诊断多为普通型，随访期间发展为重症监护病房（ICU）的危重症患者比例为 2.7%，低于武汉市报告的 26.1%。根据十堰的经验，早期进行多次 Q-PCR 检测和及时治疗可以降低死亡率。糖尿病可能是向重症/危重症进展的危险因素之一。没有证据表明吸烟可以保护 COVID-19 患者免于发展为重症/危重症病例，且首次就诊时的绝对淋巴细胞计数不能预测从重症到危重症的进展风险。应使用多变量回归分析进一步指导临床资源的分配。
