Qi Xu, Kong Hui, Ding Wenqiu, Wu Chaojie, Ji Ningfei, Huang Mao, Li Tiantian, Wang Xinyu, Wen Jingli, Wu Wenjuan, Wu Mingjie, Huang Chaolin, Li Yu, Liu Yun, Tang Jinhai
Department of Respiratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Division of Intensive Care Unit, Wuhan Jin Yin-tan Hospital, Wuhan, China.
Front Med (Lausanne). 2021 Jun 16;8:638194. doi: 10.3389/fmed.2021.638194. eCollection 2021.
This study aimed to detect, analyze, and correlate the clinical characteristics, blood coagulation functions, blood calcium levels, and inflammatory factors in patients with mild and severe COVID-19 infections. The enrolled COVID-19 infected patients were from Wuhan Jin Yin-tan Hospital (17 cases, Wuhan, China), Suzhou Infectious Disease Hospital (87 cases, Suzhou, China), and Xuzhou Infectious Disease Hospital (14 cases, Xuzhou, China). After admission, basic information was collected; X-ray and chest CT images were obtained; and data from routine blood tests, liver and kidney function, myocardial enzymes, electrolytes, blood coagulation function, (erythrocyte sedimentation rate) ESR, C-reactive protein (CRP), IL-6, procalcitonin (PCT), calcitonin, and other laboratory tests were obtained. The patients were grouped according to the clinical classification method based on the pneumonia diagnosis and treatment plan for new coronavirus infection (trial version 7) in China. The measurements from mild (56 cases) and severe cases (51 cases) were compared and analyzed. Most COVID-19 patients presented with fever. Chest X-ray and CT images showed multiple patchy and ground glass opacities in the lungs of COVID 19 infected patients, especially in patients with severe cases. Compared with patients with mild infection, patients with severe infection were older ( = 0.023) and had a significant increase in AST and BUN. The levels of CK, LDH, CK-MB, proBNP, and Myo in patients with severe COVID-19 infection were also increased significantly compared to those in patients with mild cases. Patients with severe COVID-19 infections presented coagulation dysfunction and increased D-dimer and fibrin degradation product (FDP) levels. Severe COVID-19 patients had low serum calcium ion (Ca) concentrations and high calcitonin and PCT levels and exhibited serious systemic inflammation. Ca in COVID-19 patients was significantly negatively correlated with PCT, calcitonin, D-dimer, PFDP, ESR, CRP and IL-6. D-dimer in COVID-19 patients was a significantly positively correlated with CRP and IL-6. In conclusion, patients with severe COVID-19 infection presented significant metabolic dysfunction and abnormal blood coagulation, a sharp increase in inflammatory factors and calcitonin and procalcitonin levels, and a significant decrease in Ca. Decreased Ca and coagulation dysfunction in COVID-19 patients were significantly correlated with each other and with inflammatory factors.
本研究旨在检测、分析和关联轻度和重度新型冠状病毒肺炎（COVID-19）感染患者的临床特征、凝血功能、血钙水平及炎症因子。纳入的COVID-19感染患者来自武汉金银潭医院（17例，中国武汉）、苏州传染病医院（87例，中国苏州）和徐州传染病医院（14例，中国徐州）。入院后，收集基本信息；获取X线和胸部CT图像；并收集血常规、肝肾功能、心肌酶、电解质、凝血功能、红细胞沉降率（ESR）、C反应蛋白（CRP）、白细胞介素-6（IL-6）、降钙素原（PCT）、降钙素及其他实验室检查数据。根据中国《新型冠状病毒感染的肺炎诊疗方案（试行第七版）》中的临床分类方法对患者进行分组。对轻度（56例）和重度（51例）患者的测量结果进行比较和分析。大多数COVID-19患者出现发热。胸部X线和CT图像显示COVID-19感染患者肺部有多发斑片状及磨玻璃样阴影，尤其是重症患者。与轻度感染患者相比，重度感染患者年龄更大（P = 0.023），天门冬氨酸氨基转移酶（AST）和尿素氮（BUN）显著升高。重度COVID-19感染患者的肌酸激酶（CK）、乳酸脱氢酶（LDH）、肌酸激酶同工酶（CK-MB）、氨基末端脑钠肽前体（proBNP）和肌红蛋白（Myo）水平也较轻度患者显著升高。重度COVID-19感染患者出现凝血功能障碍，D-二聚体和纤维蛋白降解产物（FDP）水平升高。重度COVID-19患者血清钙离子（Ca）浓度降低，降钙素和PCT水平升高，表现出严重的全身炎症反应。COVID-19患者的Ca与PCT、降钙素、D-二聚体、PFDP、ESR、CRP和IL-6显著负相关。COVID-19患者的D-二聚体与CRP和IL-6显著正相关。总之，重度COVID-19感染患者存在明显的代谢功能障碍和凝血异常，炎症因子及降钙素和降钙素原水平急剧升高，Ca显著降低。COVID-19患者Ca降低和凝血功能障碍相互之间及与炎症因子均显著相关。
