比较因 COVID-19、H7N9 和 H1N1 住院的患者。

Comparison of patients hospitalized with COVID-19, H7N9 and H1N1.

机构信息

Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, 519000, China.

Diagnosis and Treatment of Infectious Diseases Research Laboratory, Shenzhen Third People's Hospital, Shenzhen, 518112, China.

出版信息

Infect Dis Poverty. 2020 Dec 2;9(1):163. doi: 10.1186/s40249-020-00781-5.

DOI:10.1186/s40249-020-00781-5

PMID:33261654

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7707904/

Abstract

BACKGROUND

There is an urgent need to better understand the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), for that the coronavirus disease 2019 (COVID-19) continues to cause considerable morbidity and mortality worldwide. This paper was to differentiate COVID-19 from other respiratory infectious diseases such as avian-origin influenza A (H7N9) and influenza A (H1N1) virus infections.

METHODS

We included patients who had been hospitalized with laboratory-confirmed infection by SARS-CoV-2 (n = 83), H7N9 (n = 36), H1N1 (n = 44) viruses. Clinical presentation, chest CT features, and progression of patients were compared. We used the Logistic regression model to explore the possible risk factors.

RESULTS

Both COVID-19 and H7N9 patients had a longer duration of hospitalization than H1N1 patients (P < 0.01), a higher complication rate, and more severe cases than H1N1 patients. H7N9 patients had higher hospitalization-fatality ratio than COVID-19 patients (P = 0.01). H7N9 patients had similar patterns of lymphopenia, neutrophilia, elevated alanine aminotransferase, C-reactive protein, lactate dehydrogenase, and those seen in H1N1 patients, which were all significantly different from patients with COVID-19 (P < 0.01). Either H7N9 or H1N1 patients had more obvious symptoms, like fever, fatigue, yellow sputum, and myalgia than COVID-19 patients (P < 0.01). The mean duration of viral shedding was 9.5 days for SARS-CoV-2 vs 9.9 days for H7N9 (P = 0.78). For severe cases, the meantime from illness onset to severity was 8.0 days for COVID-19 vs 5.2 days for H7N9 (P < 0.01), the comorbidity of chronic heart disease was more common in the COVID-19 patients than H7N9 (P = 0.02). Multivariate analysis showed that chronic heart disease was a possible risk factor (OR > 1) for COVID-19, compared with H1N1 and H7N9.

CONCLUSIONS

The proportion of severe cases were higher for H7N9 and SARS-CoV-2 infections, compared with H1N1. The meantime from illness onset to severity was shorter for H7N9. Chronic heart disease was a possible risk factor for COVID-19.The comparison may provide the rationale for strategies of isolation and treatment of infected patients in the future.

摘要

背景

目前迫切需要更好地了解新型冠状病毒，即严重急性呼吸综合征冠状病毒 2（SARS-CoV-2），因为 2019 年冠状病毒病（COVID-19）继续在全球范围内造成相当大的发病率和死亡率。本文旨在将 COVID-19 与其他呼吸道传染病区分开来，如禽流感 A（H7N9）和甲型流感（H1N1）病毒感染。

方法

我们纳入了经实验室确诊感染 SARS-CoV-2（n=83）、H7N9（n=36）和 H1N1（n=44）病毒的住院患者。比较了患者的临床表现、胸部 CT 特征和病情进展。我们使用 Logistic 回归模型探讨可能的危险因素。

结果

COVID-19 和 H7N9 患者的住院时间均长于 H1N1 患者（P<0.01），并发症发生率和重症病例数均高于 H1N1 患者。H7N9 患者的住院病死率高于 COVID-19 患者（P=0.01）。H7N9 患者的淋巴细胞减少、中性粒细胞增多、丙氨酸氨基转移酶、C 反应蛋白、乳酸脱氢酶升高与 H1N1 患者相似，均显著高于 COVID-19 患者（P<0.01）。H7N9 或 H1N1 患者的发热、乏力、黄痰、肌痛等症状均较 COVID-19 患者明显（P<0.01）。SARS-CoV-2 的病毒脱落平均持续时间为 9.5 天，H7N9 为 9.9 天（P=0.78）。对于重症患者，COVID-19 从发病到病情严重的平均时间为 8.0 天，H7N9 为 5.2 天（P<0.01），COVID-19 患者的慢性心脏病合并症较 H7N9 更为常见（P=0.02）。多变量分析显示，与 H1N1 和 H7N9 相比，慢性心脏病是 COVID-19 的可能危险因素（OR>1）。