Wang Rui, He Hong, Liao Cong, Hu Hongtao, Hu Chun, Zhang Juan, Gao Ping, Wu Xiaoyan, Cheng Zhenshun, Liao Meiyan, Shui Hua
Department of Nephrology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Clin Kidney J. 2020 Jun 12;13(3):328-333. doi: 10.1093/ckj/sfaa086. eCollection 2020 Jun.
Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that first manifested in humans in Wuhan, Hubei Province, China, in December 2019, and has subsequently spread worldwide.
We conducted a retrospective, single-center case series of the seven maintenance hemodialysis (HD) patients infected with COVID-19 at Zhongnan Hospital of Wuhan University from 13 January to 7 April 2020 and a proactive search of potential cases by chest computed tomography (CT) scans.
Of 202 HD patients, 7 (3.5%) were diagnosed with COVID-19. Five were diagnosed by reverse transcription polymerase chain reaction (RT-PCR) because of compatible symptoms, while two were diagnosed by RT-PCR as a result of screening 197 HD patients without respiratory symptoms by chest CT. Thirteen of 197 patients had positive chest CT features and, of these, 2 (15%) were confirmed to have COVID-19. In COVID-19 patients, the most common features at admission were fatigue, fever and diarrhea [5/7 (71%) had all these]. Common laboratory features included lymphocytopenia [6/7 (86%)], elevated lactate dehydrogenase [3/4 (75%)], D-dimer [5/6 (83%)], high-sensitivity C-reactive protein [4/4 (100%)] and procalcitonin [5/5 (100%)]. Chest CT showed bilateral patchy shadows or ground-glass opacity in the lungs of all patients. Four of seven (57%) received oxygen therapy, one (14%) received noninvasive and invasive mechanical ventilation, five (71%) received antiviral and antibacterial drugs, three (43%) recieved glucocorticoid therapy and one (14%) received continuous renal replacement therapy. As the last follow-up, four of the seven patients (57%) had been discharged and three patients were dead.
Chest CT may identify COVID-19 patients without clear symptoms, but the specificity is low. The mortality of COVID-19 patients on HD was high.
2019冠状病毒病（COVID-19）是一种新发传染病，于2019年12月在中国湖北省武汉市首次在人类中出现，随后在全球范围内传播。
我们对武汉大学中南医院2020年1月13日至4月7日期间7例感染COVID-19的维持性血液透析（HD）患者进行了回顾性单中心病例系列研究，并通过胸部计算机断层扫描（CT）扫描主动搜索潜在病例。
在202例HD患者中，7例（3.5%）被诊断为COVID-19。5例因症状相符通过逆转录聚合酶链反应（RT-PCR）确诊，而另外2例是通过对197例无呼吸道症状的HD患者进行胸部CT筛查后经RT-PCR确诊的。197例患者中有13例胸部CT特征呈阳性，其中2例（15%）确诊为COVID-19。在COVID-19患者中，入院时最常见的特征是乏力、发热和腹泻[5/7（71%）具备所有这些症状]。常见的实验室特征包括淋巴细胞减少[6/7（86%）]、乳酸脱氢酶升高[3/4（75%）]、D-二聚体[5/6（83%）]、高敏C反应蛋白[4/4（100%）]和降钙素原[5/5（100%）]。胸部CT显示所有患者肺部均有双侧斑片状阴影或磨玻璃样混浊。7例中有4例（57%）接受了氧疗，1例（14%）接受了无创和有创机械通气，5例（71%）接受了抗病毒和抗菌药物治疗，3例（43%）接受了糖皮质激素治疗，1例（14%）接受了连续性肾脏替代治疗。截至最后一次随访，7例患者中有4例（57%）已出院，3例死亡。
胸部CT可能识别出无症状的COVID-19患者，但特异性较低。HD患者中COVID-19的死亡率较高。
