摘要
目的回顾分析新型冠状病毒家庭聚集性感染病例的临床特征,研究其流行病学关联。方法选取2020年1月28日和2月3日接诊的3例患者为研究对象,收集临床资料,分析一般情况、临床症状、血液检验及CT影像学的特征。分析3例患者及其密切接触者之间的流行病学关联。结果3例患者出自同一家庭,系父母与儿子,其中2例确诊新型冠状病毒肺炎,1例影像学高度疑似,但4次病毒核酸检测阴性。确诊2例患者中,普通型1例、重型1例,重型患者既往有基础疾病。疑似的1例患者,无任何自觉症状,但胸部CT提示典型双肺、外带、多发磨玻璃影、浸润影,无其他疾病可解释。流行病学分析发现,首先确诊的1号患者并没有确诊病例接触史,也无武汉旅行史。因此,有可能在1号患者发病之前接触过无症状的隐性感染者。结论新型冠状病毒肺炎的临床表现缺乏特异性,胸部CT有助于发现确立诊断的线索;目前病毒检测手段的准确性有待提高,多次病毒核酸检测阴性,也不能轻易排除诊断。
Objective To retrospectively analyze clinical characteristics of novel coronavirus(2019-nCoV)infected cases caused by clustering of disease in family and to study their epidemiological correlations.Methods Clinical data of 3 patients who were visited during January 28 and February 3,2020 was collected to analyze general conditions,clinical symptoms,blood tests and CT imaging features.Epidemiological correlations between 3 patients with their close contacts were analyzed.Results The 3 patients belonged to the same family,who were parents and their son.Two of them were diagnosed as having corona virus disease 2019(COVID-19),and one patient was highly suspected in imaging,but results by 4 times of viral nucleic acid tests were all negative.Of the 2 diagnosed patients,one was of the common type,while the other one was of the severe type.The severe patients had a basic disease in the past.One suspected patient did not have any subjective symptoms,but the patient's chest CT showed typical double lungs,takeout,multiple ground glass shadows and infiltrated shadows,and no other diseases could be explained for these.Epidemiological analysis found that the No.1 diagnosed patient had no confirmed case contact history and no Wuhan travel history.Therefore,it is possible that the No.1 diagnosed patient had contact someone with asymptomatic recessive infection before the onset of disease.Conclusion Clinical manifestations of COVID-19 lack specificity,and chest CT is helpful for finding clues to confirm a diagnosis.The accuracy of current viral detection methods needs to be improved.Even if results by viral nucleic acid tests for many times are negative,the diagnosis can not be ruled out easily.
作者
刘雁冰
王辉
范瑞云
张亮
杨和平
石磊
牛晨
孙华
LIU Yan-bing;WANG Hui;FAN Rui-yun;ZHANG Liang;YANG He-ping;SHI Lei;NIU Chen;SUN Hua(Fever Clinic,Peace Hospital District,983 Hospital of PLA Joint Logistics Support Forces,Tianjin 300020,China)
出处
《解放军医药杂志》
CAS
2020年第3期1-4,9,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
关键词
新型冠状病毒肺炎
临床特征
流行病学
家庭
感染
核酸检测
Corona virus disease 2019
Clinical characteristics
Epidemiology
Family
Infection
Nucleic acid detection
