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2019 年新型冠状病毒感染分析及门急诊临床特征:一项来自中国武汉发热门诊的流行病学研究。

Analysis of 2019 novel coronavirus infection and clinical characteristics of outpatients: An epidemiological study from a fever clinic in Wuhan, China.

机构信息

Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Respiratory Diseases, Tongji Hospital, Wuhan, China.

Department of Laboratory Medicine, Tongji Hospital, Wuhan, China.

出版信息

J Med Virol. 2020 Nov;92(11):2758-2767. doi: 10.1002/jmv.26175. Epub 2020 Jul 14.

Abstract

BACKGROUND

Since the outbreak of 2019 novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) pneumonia, thousands of patients with fever or cough were flocked into fever clinic of designated hospitals in Wuhan, China. To date, no data have ever been reported to reflect the prevalence of coronavirus disease 2019 (COVID-19) among these outpatients. Moreover, it is almost unknown to discriminate COVID-19 and nucleic acid negative patients based on clinical features in the fever clinics.

METHODS

The infectious status of SARS-CoV-2 was estimated among the outpatients. The epidemiological and clinical characteristics were compared between COVID-19 and nucleic acid negative patients.

RESULTS

The nucleic acid positive rate for SARS-CoV-2 in the outpatients from our fever clinic was 67·1%, while the majority of patients with COVID-19 were mild cases. The predominant initial symptom in those patients with COVID-19 was fever (78.2%), followed by cough (15.6%). Very significantly lower number of eosinophils was characterized in patients with COVID-19 as compared with that of nucleic acid negative patients. More importantly, the proportion of subjects with eosinophil counts lower than normal levels in patients with COVID-19 was much higher than that of nucleic acid negative patients. Fever combined with bilateral ground-glass opacities in computed tomography imaging and eosinophil count below the normal level are probably a valuable indicator of COVID-19 infection in those outpatients.

CONCLUSIONS

Those findings may provide critical information for the regions, such as Europe and United States that are facing the same situation as Wuhan experienced, and could be valuable to prevent those nucleic acid negative patients from misdiagnosis before antibody testing.

摘要

背景

自 2019 年新型冠状病毒(严重急性呼吸综合征冠状病毒 2 [SARS-CoV-2])肺炎爆发以来,数以千计的发热或咳嗽患者涌入中国武汉的指定医院发热门诊。迄今为止,尚无数据反映这些门诊患者中 2019 年冠状病毒病(COVID-19)的流行情况。此外,在发热门诊根据临床特征区分 COVID-19 和核酸阴性患者几乎是未知的。

方法

估计 SARS-CoV-2 在门诊患者中的感染状况。比较 COVID-19 患者和核酸阴性患者的流行病学和临床特征。

结果

我们发热门诊门诊患者 SARS-CoV-2 的核酸阳性率为 67.1%,而大多数 COVID-19 患者为轻症病例。COVID-19 患者的主要首发症状是发热(78.2%),其次是咳嗽(15.6%)。与核酸阴性患者相比,COVID-19 患者的嗜酸性粒细胞明显减少。更重要的是,COVID-19 患者中嗜酸性粒细胞计数低于正常水平的患者比例远高于核酸阴性患者。发热伴有计算机断层扫描成像中的双侧磨玻璃影和嗜酸性粒细胞计数低于正常水平可能是 COVID-19 感染门诊患者的一个有价值的指标。

结论

这些发现可能为欧洲和美国等面临与武汉相同情况的地区提供重要信息,并有助于在抗体检测之前防止这些核酸阴性患者误诊。

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