摘要
目的分析上海地区收治的新型冠状病毒肺炎患者的临床特点,探讨其进展为重症的危险因素。方法回顾性分析2020年1月20日至2月10日上海市公共卫生临床中心收治的292例成人新型冠状病毒肺炎患者的临床资料,其中重症患者21例,轻症患者271例。比较两组患者人口学特征、流行病学史、基础疾病和实验室检查等指标。计量资料比较采用t检验或Mann-Whitney U检验,计数资料比较采用χ^2检验。采用二元logistic回归方程分析影响患者进展为重症的危险因素。结果292例患者中,重症患者21例,重症率为7.2%,死亡1例,重症病死率为4.8%。21例重症患者年龄为(65.5±15.7)岁,其中男19例(90.5%),11例(52.4%)合并有基础疾病,7例(33.3%)亲属中存在确诊患者;271例轻症患者年龄为(48.7±15.7)岁,其中男135例(49.8%),74例(27.3%)有基础疾病,36例(13.3%)亲属中存在确诊患者;两组间比较差异均有统计学意义(t=-4.730,χ^2=12.930、5.938、4.744,均P<0.05)。与轻症患者比较,重症患者入院时的中性粒细胞绝对值、丙氨酸转氨酶、天冬氨酸转氨酶、乳酸脱氢酶、肌酐、血清胱抑素C、C反应蛋白、降钙素原、D-二聚体、B型钠尿肽前体、肌红蛋白、肌酸激酶、肌酸激酶同工酶、血清肌钙蛋白I水平较高(U=2091.5、1928.0、1215.5、729.0、1580.5、1375.5、947.5、789.5、1209.0、1434.0、638.0、964.5、1747.5、1258.0),而淋巴细胞绝对值、白蛋白、转铁蛋白、CD3^+T淋巴细胞计数、CD8+T淋巴细胞计数、CD4+T淋巴细胞计数水平较低(U=1263.5,t=4.716,U=1214.0、962.0、1167.5、988.0),差异均有统计学意义(均P<0.05)。进一步logistic回归分析发现,患者入院时白蛋白[比值比(odds ratio,OR)=0.806,95%可信区间(confidence interval,CI)0.675~0.961]、肌红蛋白(OR=1.010,95%CI 1.004~1.016)、C反应蛋白(OR=1.016,95%CI 1.000~1.032)、CD3+T淋巴细胞计数(OR=0.996,95%CI 0.991~1.000)、CD8+T淋巴细胞计数水平(OR=1.006,95%CI 1.001~1.010)与患者病情严重程度相关,是新型冠状病毒肺炎患者进展为重症的独立危险因素(均P<0.05)。结论上海地区收治的新型冠状病毒肺炎患者重症病例以老年男性居多,且多合并有基础疾病。白蛋白、肌红蛋白、C反应蛋白、CD3+T淋巴细胞计数和CD8+T淋巴细胞计数可作为重症患者的早期预警指标之一,值得更多临床关注。
Objective To analyze the clinical features of patients with corona virus disease 2019(COVID-19)in Shanghai and the risk factors for disease progression to severe cases.Methods The clinical data of 292 adult patients with COVID-19 hospitalized in Shanghai Public Health Clinical Center from January 20 to February 10,2020 were retrospectively analyzed,including 21 severe patients and 271 mild patients.The demographic characteristics,epidemiological history,history of underlying diseases and laboratory tests were compared between the two groups.Measurement data were compared using t test or Mann-Whitney U test.The count data were compared using chi-square test.The binary logistic regression equation was used to analyze the risk factors for the progression of patients to severe cases.Results Among the 292 patients,there were 21 severe cases with the rate of 7.2%.One patient died,and the mortality rate was 4.8%in severe patients.The severe patients aged(65.5±15.7)years old,and 19(90.5%)were male,11(52.4%)had underlying diseases,seven(33.3%)had close relatives diagnosed with COVID-19.The mild patients aged(48.7±15.7)years old,and 135(49.8%)were male,74(27.3%)had underlying diseases,36(13.3%)had close relatives diagnosed with COVID-19.The differences between two groups were all significant statistically(t=-4.730,χ^2=12.930,5.938 and 4.744,respectively,all P<0.05).Compared with the mild patients,the levels of absolute numbers of neutrophils,alanine aminotransferase,aspartate aminotransferase,lactate dehydrogenase,creatinine,serum cystatin C,C reactive protein(CRP),procalcitonin,D-dimer,pro-B-type natriuretic peptide(proBNP),serum myoglobin,creatine kinase(CK),creatine kinase isoenzyme(CK-MB),serum cardiactroponin I(cTn I)in severe patients were all significantly higher(U=2091.5,1928.0,1215.5,729.0,1580.5,1375.5,947.5,789.5,1209.0,1434.0,638.0,964.5,1747.5 and 1258.0,respectively,all P<0.05),while the levels of lymphocyte count,albumin,transferrin,CD3^+T lymphocyte count,CD8^+T lymphocyte count and CD4+T lymphocyte count in severe patients were all significantly lower(U=1263.5,t=4.716,U=1214.0,962.0,1167.5 and 988.0,respectively,all P<0.05).Further logistic regression analysis showed that the albumin(odds ratio(OR)=0.806,95%confiderce interval(CI)0.675-0.961),serum myoglobin(OR=1.010,95%CI 1.004-1.016),CRP(OR=1.016,95%CI 1.000-1.032),CD3^+T lymphocyte count(OR=0.996,95%CI 0.991-1.000)and CD8^+T lymphocyte count(OR=1.006,95%CI 1.001-1.010)at admission were independent risk factors for the progression of COVID-19 patients to severe illness(all P<0.05).Conclusions Severe patients with COVID-19 in Shanghai are predominantly elderly men with underlying diseases.Albumin,CRP,serum myoglobin,CD3^+T lymphocyte count and CD8+T lymphocyte count could be used as early warning indicators for severe cases,which deserve more clinical attention.
作者
凌云
林逸骁
钱志平
黄丹
张丹丹
李涛
刘敏
宋树丽
王军
张宇一
徐水宝
陈军
张建良
朱同玉
胡必杰
王胜
毛恩强
朱蕾
张文宏
卢洪洲
Ling Yun;Lin Yixiao;Qian Zhiping;Huang Dan;Zhang Dandan;Li Tao;Liu Min;Song Shuli;Wang Jun;Zhang Yuyi;Xu Shuibao;Chen Jun;Zhang Jianliang;Zhu Tongyu;Hu Bijie;Wang Sheng;Mao Enqiang;Zhu Lei;Zhang Wenhong;Lu Hongzhou(Department of Infectious Disease,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Department of Infectious Disease and Immunology,Shanghai Public Health Clinical Center,FPrudan University,Shanghai 201508,China;Department of Severe Hepatilis,Shanghai Public Health Clinical Center,Fudan Universily,Shanghai 201508,China;Department of Hepatobiliary Disease,Shanghai Public Health Clinical Center,Fudan Universily,Shanghai 201508,China;Department of Hepatology,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Department of Tuberculosis,Shanghai Public Health Clinical Center,Fudan Unirersity,Shanghai 201508,China;Department of Gastroenterology,Shanghai Public Henlth Clinical Center,Fudan University,Shanghai 201508,China;Department of Nephrology,Shanghai Publie Health Clinical Center,Fudan University,Shanghai 201508,China;Department of Thoracic Surgery,Shanghai Public Health Clinical Center,Fucdan University,Shanghai 201508,China;Department of Urology,Shanghai Public Health Clinical Center,Fudan University,Shanghai 201508,China;Department of Infectious Diseases,Zhongshan Hospital,Fudan Universily,Shanghai 200032,China;Department of Critical Care Medicine,Shanghai Tenth People's Hospital,Tongji University,Shanghai 200072,China;Department of Emergency,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Pulmonology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Infectious Diseases,Huashan Hospital,Fudan Universily,Shanghai 200040,China)
出处
《中华传染病杂志》
CAS
CSCD
2020年第4期193-198,共6页
Chinese Journal of Infectious Diseases
基金
复旦大学一流大学和一流学科建设项目(IDF162005)
上海市公共卫生临床中心新型冠状病毒"2019-nCoV"科研攻关院内专项课题(2020YJKY01)
上海市重点专科传染病项目(shslczdzk01102)
上海市"医苑新星"医学人才项目(2019-72)。
关键词
冠状病毒感染
肺炎
新型冠状病毒
重症
危险因素
Coronavirus infections
Pneumonia
2019 novel coronavirus
Severe case
Risk factor
