无锡 48 例 COVID-19 感染住院患者的临床特征和结局:一项回顾性队列研究。

Clinical characteristics and outcomes of 48 patients hospitalized for COVID-19 infection in Wuxi: A retrospective cohort study.

机构信息

Department of Respiratory and Critical Care Medicine, Wuxi Fifth People's Hospital.

Department of Radiology.

出版信息

Medicine (Baltimore). 2021 Feb 5;100(5):e23991. doi: 10.1097/MD.0000000000023991.

Abstract

Since the first infected case of Coronavirus Disease 2019 (COVID-19) was reported in Wuhan, China in December 2019, the virus has spread swiftly, inflicting upon millions of people around the globe. The objective of the study is to investigate and analyze the clinical characteristics and outcomes of patients infected with COVID-19 in Wuxi, China.Cross-sectional study.The Fifth People's Hospital of Wuxi, China.A total of 48 COVID-19 patients were enrolled in the study from 23 January 2020 to 8 March 2020, and the clinical data of these subjects were collected.Epidemiological, clinical, laboratory, and radiologic characteristics, as well as treatment and outcome data, were collected and analyzed.Of these 48 patients with confirmed COVID-19, 3 were mild cases (6.3%), 44 were moderate cases (91.7%), 1 was severe case (2.1%). The median age of the subjects was 45 years (interquartile range [IQR], 24-59; range, 5-75 years). Twenty-five of the patients (52.1%) were male and 23 (47.9%) were female. Twenty-eight cases (58.3%) returned to Wuxi, Jiangsu Province. Thirty-four (70.8%) cases were infected due to clustering epidemic and 29 cases (85.3%) were attributable to family-clustering epidemic. No obvious clinical symptoms were observed in the cohort of patients, except for 3 mild cases. The most common symptoms include fever (41 [85.4%]), cough (28 [58.3%]), asthenia (13 [27.1%]), expectoration (11 [22.9%]), diarrhea (10 [20.8%]), and dyspnea (5 [10.4%]). Seventeen (35.4%) patients had lower lymphocyte values than baseline, 31 patients (64.6%) had higher d-dimers to exceed the normal range. The distribution of high-resolution computed tomography (HRCT)-positive lesions were as follows: left lung in 5 cases (10.4%), right lung in 9 cases (18.8%), and bilateral lungs in 31 cases (64.6%). In terms of density of lesions: 28 cases (58.3%) showed ground glass shadows in the lung, 7 cases (14.6%) showed solid density shadows, and 10 cases (20.8%) showed mixed density shadows. Extrapulmonary manifestations found that mediastinal lymph nodes were enlarged in 2 cases (4.2%) and that pleural effusion was present in 1 case (2.1%). All patients underwent treatment in quarantine. Forty-five (93.8%) patients received antiviral treatments, 22 (45.8%) patients received antibacterial treatments, 6 (12.5%) patients received glucocorticoid treatments, 2 (4.2%) patients received high flow oxygen inhalation treatments, and 6 (12.5%) patients received noninvasive ventilation treatments. As of 8 March 2020, all 48 patients included in this study were cured. The average time of hospitalization of the 48 patients was 18 ± 6 (mean ± SD) days, the average time of the lesion resorption was 11 ± 4 days, and the average time taken to achieve negativity in the result of nucleic acid examination was (10 ± 4) days.The epidemiological characteristics of 48 COVID-19 patients in Wuxi were mainly imported cases and clustered cases. The clinical manifestations of these patients were mainly fever and cough. Laboratory results showed that the lymphocytopenia and increased d-dimer are positively correlated with disease severity. Pulmonary imaging showed unilateral or bilateral ground glass infiltration. Most of the patients entered clinical recovery stage within 15 days after hospitalization.

摘要

自 2019 年 12 月中国武汉报告首例新型冠状病毒病(COVID-19)感染病例以来,该病毒迅速传播,给全球数百万人带来了影响。本研究旨在调查和分析中国无锡 COVID-19 感染患者的临床特征和结局。

横断面研究。中国无锡市第五人民医院。共纳入 2020 年 1 月 23 日至 2020 年 3 月 8 日期间的 48 例 COVID-19 患者,收集这些患者的临床数据。收集并分析了患者的流行病学、临床、实验室和影像学特征,以及治疗和结局数据。

在这 48 例确诊 COVID-19 患者中,3 例为轻症(6.3%),44 例为普通型(91.7%),1 例为重症(2.1%)。患者中位年龄为 45 岁(四分位距[IQR]:24-59;范围:5-75 岁)。25 例患者(52.1%)为男性,23 例(47.9%)为女性。28 例(58.3%)患者为江苏无锡输入性病例,34 例(70.8%)因聚集性疫情感染,29 例(85.3%)因家庭聚集性疫情感染。该患者队列中除 3 例轻症患者外,其余患者均无明显临床症状。最常见的症状包括发热(41 例[85.4%])、咳嗽(28 例[58.3%])、乏力(13 例[27.1%])、咳痰(11 例[22.9%])、腹泻(10 例[20.8%])和呼吸困难(5 例[10.4%])。17 例(35.4%)患者淋巴细胞计数较基线下降,31 例(64.6%)患者 D-二聚体升高超过正常值。高分辨率计算机断层扫描(HRCT)阳性病变的分布如下:左肺 5 例(10.4%),右肺 9 例(18.8%),双肺 31 例(64.6%)。病变密度:28 例(58.3%)表现为磨玻璃影,7 例(14.6%)表现为实性密度影,10 例(20.8%)表现为混合密度影。肺外表现为纵隔淋巴结肿大 2 例(4.2%),胸腔积液 1 例(2.1%)。所有患者均在隔离病房接受治疗。45 例(93.8%)患者接受抗病毒治疗,22 例(45.8%)患者接受抗菌治疗,6 例(12.5%)患者接受糖皮质激素治疗,2 例(4.2%)患者接受高流量吸氧治疗,6 例(12.5%)患者接受无创通气治疗。截至 2020 年 3 月 8 日,本研究纳入的 48 例患者均治愈出院。48 例患者的平均住院时间为 18±6(均数±标准差)天,肺部病变吸收的平均时间为 11±4 天,核酸检测结果转为阴性的平均时间为(10±4)天。

无锡 48 例 COVID-19 患者的流行病学特征主要为输入性病例和聚集性病例,临床表现主要为发热和咳嗽。实验室结果显示,淋巴细胞减少和 D-二聚体升高与疾病严重程度呈正相关。肺部影像学表现为单侧或双侧磨玻璃样浸润。大多数患者在住院后 15 天内进入临床康复阶段。

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