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中国辽宁省65例住院COVID-19患者的流行病学和临床特征

Epidemiological and clinical characteristics of 65 hospitalized patients with COVID-19 in Liaoning, China.

作者信息

Zhang Wei, Ban Yuan, Wu Yun-Hai, Liu Jin-Yang, Li Xing-Hai, Wu Hao, Li Huan, Chen Rui, Yu Xiao-Xu, Zheng Rui

机构信息

Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.

Department of Critical Care Medicine, The Sixth People's Hospital of Shenyang, Shenyang 110006, Liaoning Province, China.

出版信息

World J Clin Cases. 2021 Apr 6;9(10):2205-2217. doi: 10.12998/wjcc.v9.i10.2205.

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) has spread rapidly to multiple countries through its infectious agent severe acute respiratory syndrome coronavirus 2. The severity, atypical clinical presentation, and lack of specific anti-viral treatments have posed a challenge for the diagnosis and treatment of COVID-19. Understanding the epidemiological and clinical characteristics of COVID-19 cases in different geographical areas is essential to improve the prognosis of COVID-19 patients and slow the spread of the disease.

AIM

To investigate the epidemiological and clinical characteristics and main therapeutic strategy for confirmed COVID-19 patients hospitalized in Liaoning Province, China.

METHODS

Adult patients ( = 65) with confirmed COVID-19 were enrolled in this retrospective study from January 20 to February 29, 2020 in Liaoning Province, China. Pharyngeal swabs and sputum specimens were collected from the patients for the detection of severe acute respiratory syndrome coronavirus 2 nucleic acid. Patient demographic information and clinical data were collected from the medical records. Based on the severity of COVID-19, the patients were divided into nonsevere and severe groups. All patients were followed until March 20, 2020.

RESULTS

The mean age of 65 COVID-19 patients was 45.5 ± 14.4 years, 56.9% were men, and 24.6% were severe cases. During the 14 d before symptom onset, 25 (38.5%) patients lived or stayed in Wuhan, whereas 8 (12.3%) had no clear history of exposure. Twenty-nine (44.6%) patients had at least one comorbidity; hypertension and diabetes were the most common comorbidities. Compared with nonsevere patients, severe patients had significantly lower lymphocyte counts [median value 1.3 × 10/L (interquartile range 0.9-1.95) 0.82 × 10/L (0.44-1.08), < 0.001], elevated levels of lactate dehydrogenase [450 U/L (386-476) 707 U/L (592-980), < 0.001] and C-reactive protein [6.1 mg/L (1.5-7.2) 52 mg/L (12.7-100.8), < 0.001], and a prolonged median duration of viral shedding [19.5 d (16-21) 23.5 d (19.6-30.3), = 0.001]. The overall median viral shedding time was 19.5 d, and the longest was 53 d. Severe patients were more frequently treated with lopinavir/ritonavir, antibiotics, glucocorticoid therapy, immunoglobulin, thymosin, and oxygen support. All patients were discharged following treatment in quarantine.

CONCLUSION

Our findings may facilitate the identification of severe cases and inform clinical treatment and quarantine decisions regarding COVID-19.

摘要

背景

2019冠状病毒病(COVID-19)通过其病原体严重急性呼吸综合征冠状病毒2迅速传播至多个国家。COVID-19的严重性、非典型临床表现以及缺乏特异性抗病毒治疗方法,对其诊断和治疗构成了挑战。了解不同地理区域COVID-19病例的流行病学和临床特征,对于改善COVID-19患者的预后及减缓疾病传播至关重要。

目的

调查在中国辽宁省住院的确诊COVID-19患者的流行病学和临床特征以及主要治疗策略。

方法

本回顾性研究纳入了2020年1月20日至2月29日在中国辽宁省确诊为COVID-19的成年患者(≥65岁)。采集患者的咽拭子和痰液标本用于检测严重急性呼吸综合征冠状病毒2核酸。从病历中收集患者的人口统计学信息和临床数据。根据COVID-19的严重程度,将患者分为非重症组和重症组。所有患者随访至2020年3月20日。

结果

65例COVID-19患者的平均年龄为45.5±14.4岁,男性占56.9%,重症病例占24.6%。在症状出现前的14天内,25例(38.5%)患者居住或去过武汉,而8例(12.3%)无明确暴露史。29例(44.6%)患者至少有一种合并症;高血压和糖尿病是最常见的合并症。与非重症患者相比,重症患者的淋巴细胞计数显著更低[中位数为1.3×10⁹/L(四分位间距0.9 - 1.95)对0.82×10⁹/L(0.44 - 1.08),P<0.001],乳酸脱氢酶水平升高[450 U/L(386 - 476)对707 U/L(592 - 980),P<0.001],C反应蛋白水平升高[6.1 mg/L(1.5 - 7.2)对52 mg/L(12.7 - 100.8),P<0.001],病毒 shedding 中位数持续时间延长[19.5天(16 - 21)对23.5天(19.6 - 30.3),P = 0.001]。总体病毒 shedding 时间中位数为19.5天,最长为53天。重症患者更常接受洛匹那韦/利托那韦、抗生素、糖皮质激素治疗、免疫球蛋白、胸腺肽和氧疗。所有患者经隔离治疗后均出院。

结论

我们的研究结果可能有助于识别重症病例,并为COVID-19的临床治疗和隔离决策提供参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eda0/8026826/272b3c5ee857/WJCC-9-2205-g001.jpg

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