基于流行病学和临床的 COVID-19 患者四阶段研究：无症状期干预有助于早期康复。
Epidemiological and clinical based study on four passages of COVID-19 patients: intervention at asymptomatic period contributes to early recovery.
机构信息
Department of Emergency Critical Care Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, SC, China.
Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, 610072, SC, China.
出版信息
BMC Infect Dis. 2020 Nov 17;20(1):855. doi: 10.1186/s12879-020-05570-x.
BACKGROUND
With the worldwide spread of the 2019 novel coronavirus, scarce knowledge is available on the clinical features of more than two passages of patients. Further, in China, early intervention policy has been enacted since February. Whether early intervention contributes to swift recovery is still unknown. Hence, in this study, we focused on the patients from an isolated area, investigated the epidemiological and clinical characteristics of four serial passages of the virus.
METHODS
From January 25 to February 29, 2020, all patient data on the SARS-CoV-2 passages in this isolated area were traced, and the patients were grouped according to the passaging of SARS-CoV-2. Clinical characteristics of patients, including laboratory, radiology, treatment and outcomes, were collected and analyzed.
RESULTS
A total of 78 patients with four passages of virus transmission were included in this study. One patient transmitted SARS-CoV-2 to 8 patients (passage 2, P2), who next infected 23 patients (passage 3, P3), and then 46 patients (passage 4, P4). P2 received antiviral treatment when they had symptom, whereas P4 received antiviral treatment during their asymptomatic period. The incubation periods for P2, P3 and P4 patients were 7 days (IQR:2-12), 8 days (IQR:4-13) and 10 days (IQR:7-15), respectively. P2 patients showed lymphocytopenia (0.79 × 10/L), decreased lymphocyte percentages (12.15%), increased white blood cell count (6.51 × 10/L), increased total bilirubin levels (25% of P2 patients), increased C-reactive protein levels (100% of P2 patients) and abnormal liver function. By chest CT scans, all P2 patients (100%), 15 of P3 patients (65.22%) and 16 of P4 patients (34.78%) showed abnormality with typical feature of ground glass opacity. All of P2 patients (100%) received oxygen therapy, and in contrast, 19 of P4 patients (41.3%) received oxygen therapy. Further, significant decreased nucleic acid positive periods was found in P4 group (16 days, IQR: 10-23), compared with that of P2 group (22 days, IQR: 16-27). Moreover, the severity ratios were sharply decreased from 50% (P2 patients) to 4.35% (P4 patients), and the case fatality rate is zero.
CONCLUSIONS
Judged from four passages of patients, early intervention contributes to the early recovery of COVID-19 patients.
背景
随着 2019 年新型冠状病毒在全球范围内的传播，关于超过两例患者的临床特征的知识还很匮乏。此外，在中国，自 2 月以来已实施了早期干预政策。早期干预是否有助于迅速康复尚不清楚。因此，在本研究中，我们专注于一个隔离区的患者，研究了病毒的四例连续传播的流行病学和临床特征。
方法
从 2020 年 1 月 25 日至 2 月 29 日，我们追溯了该隔离区所有 SARS-CoV-2 传播患者的数据，并根据 SARS-CoV-2 的传播情况对患者进行分组。收集并分析了患者的临床特征，包括实验室、影像学、治疗和结局。
结果
本研究共纳入 78 例病毒传播四例的患者。1 例患者将 SARS-CoV-2 传播给 8 例患者（第 2 例，P2），然后这些患者又感染了 23 例患者（第 3 例，P3），然后又感染了 46 例患者（第 4 例，P4）。P2 在出现症状时接受了抗病毒治疗，而 P4 在无症状期接受了抗病毒治疗。P2、P3 和 P4 患者的潜伏期分别为 7 天（IQR：2-12）、8 天（IQR：4-13）和 10 天（IQR：7-15）。P2 患者表现为淋巴细胞减少症（0.79×10/L）、淋巴细胞百分比下降（12.15%）、白细胞计数增加（6.51×10/L）、总胆红素水平升高（25%的 P2 患者）、C 反应蛋白水平升高（100%的 P2 患者）和肝功能异常。通过胸部 CT 扫描，所有 P2 患者（100%）、P3 患者中的 15 例（65.22%）和 P4 患者中的 16 例（34.78%）均显示出异常，具有典型的磨玻璃样混浊特征。所有 P2 患者（100%）均接受了氧疗，而相比之下，P4 患者中仅 19 例（41.3%）接受了氧疗。此外，与 P2 组（22 天，IQR：16-27）相比，P4 组的核酸阳性期明显缩短（16 天，IQR：10-23）。而且，严重程度比例从 50%（P2 患者）急剧下降到 4.35%（P4 患者），死亡率为零。
结论
从四例患者来看，早期干预有助于 COVID-19 患者的早期康复。
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