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新型冠状病毒肺炎恶化的早期危险因素。

Early risk factors of the exacerbation of coronavirus disease 2019 pneumonia.

机构信息

Department of Gastroenterology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China.

Department of General Surgery, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei, China.

出版信息

J Med Virol. 2020 Nov;92(11):2593-2599. doi: 10.1002/jmv.26071. Epub 2020 Aug 21.

Abstract

The purpose of this study was to investigate the early risk factors for the exacerbation of coronavirus disease 2019 (COVID-19) pneumonia. Restrospective analysis of clinical data of 85 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including gender, age, comorbidities, symptoms, blood routine, clotting profile, biochemical examination, albumin, myocardial enzyme profile, inflammatory markers, and chest computed tomography (CT). All laboratory examinations were measured within first 24 hours after admission, and chest CT was performed before admission. A total of 56 (65.9%) patients had a history of exposure to the Huanan seafood market in Wuhan. Fever and dry cough accounted for the highest percentage of all symptoms. Male COVID-2019 patients were more likely to develop severe pneumonia. Patients with severe and critical conditions are older and have higher rates of hypertension (P = .003) and coronary heart disease (P = .017). All severe and critical patients infected with SARS-CoV-2 showed bilateral lung involvement and have more multiple lobes involvement than common patients (P < .001). Severe and critical patients showed higher white blood cell count (P = .006), neutrophil (NEU) count (P = .001), NEU% (P = .002), procalcitonin (P = .011), C-reactive protein (P = .003), prothrombin time (P = .035), D-dimer (P = .025), aspartate aminotransferase (P = .006), and lower lymphocyte (LYM) count (P = .019), LYM% (P = .001), albumin (P < .001). Logistic regression analysis showed that NEU count is an independent risk factor for deterioration, with the threshold of 6.5 × 10 ·L . We concluded that the laboratory independent risk factor for the progression of COVID-19 pneumonia is NEU count. In addition, COVID-19 patients with bilateral lung involvement or multiple lobes involvement should be taken seriously and actively treated to prevent deterioration of the disease.

摘要

本研究旨在探讨 2019 年冠状病毒病(COVID-19)肺炎恶化的早期危险因素。回顾性分析 85 例严重急性呼吸综合征冠状病毒 2(SARS-CoV-2)感染患者的临床资料,包括性别、年龄、合并症、症状、血常规、凝血谱、生化检查、白蛋白、心肌酶谱、炎症标志物和胸部计算机断层扫描(CT)。所有实验室检查均在入院后 24 小时内测量,入院前进行胸部 CT 检查。共有 56 例(65.9%)患者有武汉华南海鲜市场暴露史。发热和干咳占所有症状的比例最高。男性 COVID-2019 患者更易发生重症肺炎。重症和危重症患者年龄较大,高血压(P=.003)和冠心病(P=.017)的发生率较高。所有感染 SARS-CoV-2 的重症和危重症患者均表现为双肺受累,且多发病灶受累多于普通患者(P<.001)。重症和危重症患者的白细胞计数(P=.006)、中性粒细胞(NEU)计数(P=.001)、NEU%(P=.002)、降钙素原(P=.011)、C 反应蛋白(P=.003)、凝血酶原时间(P=.035)、D-二聚体(P=.025)、天冬氨酸转氨酶(P=.006)较高,淋巴细胞(LYM)计数(P=.019)、LYM%(P=.001)、白蛋白(P<.001)较低。Logistic 回归分析显示,NEU 计数是病情恶化的独立危险因素,其阈值为 6.5×10·L-1。我们得出结论,COVID-19 肺炎进展的实验室独立危险因素是 NEU 计数。此外,应重视 COVID-19 患者双肺受累或多发病灶受累,并积极治疗,防止病情恶化。

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Convalescent plasma as a potential therapy for COVID-19.康复期血浆作为治疗新冠肺炎的一种潜在疗法。
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Clinical Characteristics of Coronavirus Disease 2019 in China.《中国 2019 年冠状病毒病临床特征》
N Engl J Med. 2020 Apr 30;382(18):1708-1720. doi: 10.1056/NEJMoa2002032. Epub 2020 Feb 28.
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