Li Biliang, Zhang Shiguo, Luo Shilin, Liu Chun, Jia Weijun, Jiang Huating, Dai Qian
Department of Respiratory and Critical Medicine, Bazhong Central Hospital, Bazhong 636000, Sichuan, China.
Department of Critical Medicine, Dazhou Central Hospital, Dazhou 635002, Sichuan, China.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Mar;33(3):352-356. doi: 10.3760/cma.j.cn121430-20200317-00227.
To analyze the epidemiological, clinical characteristics and treatment of coronavirus disease 2019 (COVID-19) in Northeastern Sichuan, and summarize experience in time to provide reference for clinical diagnosis and treatment.
A retrospective study was conducted. Fifty-nine patients with COVID-19 admitted to Bazhong Central Hospital and Dazhou Central Hospital from January 27th to February 9th, 2020 were selected as the subjects. The data of demography, epidemiology, laboratory examination, chest CT and related clinical treatment were collected. According to the severity of the disease, the patients were divided into three types: mild, general and severe types, and the differences of the above indices among different clinical types were compared.
(1) General information and epidemiology: 31 cases (52.5%) were male, 28 cases (47.5%) were female, the average age was (42.0±16.4) years old, and the patients over 40 years old accounted for the largest proportion (35 cases, 59.3%). The proportion of clinical type was 72.9% (43 cases) in general type, and 62.7% (37 cases) were imported type. With the increase of disease severity, the average age of patients also showed a significant increase trend [the age of the mild, general and severe patients were (30.9±13.6), (42.7±15.3), (55.8±18.9) years old, P < 0.01]. The proportion of patients with more than one basic disease in severe patients was significantly higher than those in mild and general patients [66.7% (4/6) vs. 20.0% (2/10), 9.3% (4/43), both P < 0.05]. In the distribution of clinical symptoms, the proportion of severe patients with chest distress/dyspnea was significantly higher than those in mild and general patients [66.7% (4/6) vs. 10.0% (1/10), 11.6% (5/43), both P < 0.05]. (2) Laboratory examination index: the total number of white blood cell count (WBC), neutrophils count (NEU), C-reactive protein (CRP) in severe patients were higher than those in mild patients and general patients [WBC (×10/L): 7.21±4.35 vs. 5.85±1.69, 5.43±2.04; NEU (×10/L): 6.09±4.43 vs. 3.95±1.45, 3.54±1.83; CRP (mg/L): 16.00 (8.20, 46.43) vs. 5.00 (0.00, 16.13), 15.00 (3.13, 28.58)], the albumin (Alb) level in severe patients was lower than those in mild and general patients (g/L: 38.00±5.35 vs. 49.23±5.27, 39.81±2.15, both P < 0.05), while the hemoglobin (Hb) level in mild patients was higher than that in severe and general patients (g/L: 155.2±12.1 vs. 141.3±6.8, 131.1±11.7, both P < 0.05). (3) Chest imaging: the CT manifestations of typical cases were single or multiple ground glass shadows. With the progress of the disease, the focus gradually increased, the scope gradually expanded, and multiple solid shadows of lung lobes were involved. (4) Treatment: all patients received at least 2 kinds of antiviral therapy, and the application rate of Interferon and Ribavirin in severe patients were higher than those in mild and general patients [100.0% (6/6) vs. 80.0% (8/10), 97.7% (42/43); 83.3% (5/6) vs. 0% (0/10), 20.9% (9/43); all P < 0.05]. (5) Prognosis: until March 6th 2020, 50 patients (84.8%) were discharged from the hospital after rehabilitation, and the remaining 9 patients were still under treatment, none deaths.
The proportion of severe patients with chest distress/dyspnea is higher, the older the patients are and the more basic diseases are, the more likely they are to develop into severe type. High resolution chest CT could be considered for suspected cases or even fever patients, which may show the progress of the disease.
分析川东北地区新型冠状病毒肺炎（COVID-19）的流行病学、临床特征及治疗情况，及时总结经验，为临床诊治提供参考。
采用回顾性研究方法。选取2020年1月27日至2月9日入住巴中市中心医院和达州市中心医院的59例COVID-19患者作为研究对象。收集患者的人口学、流行病学、实验室检查、胸部CT及相关临床治疗资料。根据疾病严重程度将患者分为轻型、普通型和重型三型，比较不同临床类型上述指标的差异。
（1）一般资料及流行病学：男性31例（52.5%），女性28例（47.5%），平均年龄（42.0±16.4）岁，40岁以上患者占比最大（35例，59.3%）。临床类型以普通型为主，占72.9%（43例），输入型占62.7%（37例）。随着疾病严重程度增加，患者平均年龄呈显著上升趋势[轻型、普通型和重型患者年龄分别为（30.9±13.6）、（42.7±15.3）、（55.8±18.9）岁，P<0.01]。重型患者中合并一种以上基础疾病的比例显著高于轻型和普通型患者[66.7%（4/6） vs. 20.0%（2/10），9.3%（4/43），P均<0.05]。在临床症状分布方面，重型患者中出现胸闷/呼吸困难的比例显著高于轻型和普通型患者[66.7%（4/6） vs. 10.0%（1/10），11.6%（5/43），P均<0.05]。（2）实验室检查指标：重型患者白细胞计数（WBC）、中性粒细胞计数（NEU）、C反应蛋白（CRP）总数均高于轻型和普通型患者[WBC（×10/L）：7.21±4.35 vs. 5.85±1.69，5.43±2.04；NEU（×10/L）：6.09±4.43 vs. 3.95±1.45，3.54±1.83；CRP（mg/L）：16.00（8.20，46.43） vs. 5.00（0.00，16.13），15.00（3.13，28.58）]，重型患者白蛋白（Alb）水平低于轻型和普通型患者（g/L：38.00±5.35 vs. 49.23±5.27，39.81±2.15，P均<0.05），而轻型患者血红蛋白（Hb）水平高于重型和普通型患者（g/L：155.2±12.1 vs. 141.3±6.8，131.1±11.7，P均<0.05）。（3）胸部影像学：典型病例CT表现为单发或多发磨玻璃影。随着病情进展，病灶逐渐增多，范围逐渐扩大，累及多个肺叶实变影。（4）治疗：所有患者均接受至少2种抗病毒治疗，重型患者中干扰素和利巴韦林的应用率高于轻型和普通型患者[100.0%（6/6） vs. 80.0%（8/10），97.7%（42/43）；83.3%（5/6） vs. 0%（0/10），20.9%（9/43）；P均<0.05]。（5）预后：截至2020年3月6日，50例（84.8%）患者康复出院，其余9例仍在治疗中，无死亡病例。
重型患者中胸闷/呼吸困难比例较高，患者年龄越大、基础疾病越多，越易发展为重型。对于疑似病例甚至发热患者，可考虑行高分辨率胸部CT检查，其可显示疾病进展情况。
