摘要
目的旨在确定新冠肺炎(COVID-19)患者外周血淋巴细胞计数变化能否成为预测病情分型(轻型或普通型、重型、危重型)及转归的生物学指标。方法从一个单中心数据库(2020年1月25日—8月15日期间广州医科大学附属市八医院确诊的80例新型冠状病毒肺炎患者)中回顾性收集数据。整个队列研究分为两组,A组(淋巴细胞减少组)为发病10天以内外周血淋巴细胞计数出现减少的患者,共40例。B组(淋巴细胞正常组)为发病10天以内外周血淋巴细胞计数正常的患者,共40例。观察两组患者病情变化及血常规变化,登记分型(轻型或普通型、重型、危重型)及病情变化时间。A组患者中根据淋巴细胞计数复查结果再分为两组,3天后复查淋巴细胞计数仍低于正常,纳入为持续减少组;淋巴细胞计数恢复正常,纳入为恢复正常组。两组再根据病情分型进行组间对比。结果A组患者中入院时确诊为重型的2例,危重型0例,其他均为轻型或普通型,而最终发展为重型和危重型患者分别为17例(42.5%)和8例(20.0%);而B组患者中发展为重型为1例(2.5%),发展为危重型为0例(0.0%),具有明显差异性。A组和B组患者在性别、BMI、临床表现(发热、咳嗽、乏力)、胸部CT病灶(双侧、单侧、无)、入院时发病时间上均未见明显差异。在年龄上,A组为(52.7±16.8)岁,B组为(43.3±15.6)岁,两组具有明显差异性(P=0.012)。A组中55.0%的患者有慢性基础病(高血压、糖尿病、冠心病等),而B组为32.5%,两组具有差异性(P=0.043)。A组患者外周血淋巴细胞计数减少距发病平均时间为5.65天,而病情加重距发病平均时间为8.48天。A组患者首次粒细胞与淋巴细胞比(NLR)为(4.98±3.54),而B组患者为(1.72±0.97),两组具有明显差异性(t=5.626,P=0.000)。A组患者平均住院天数(25.3±11.61)d,B组为(16.20±4.71)d,两组具有明显差异性(t=4.607,P=0.000)。A组患者最终死亡1例,B组无死亡患者。Logistic多因素回归分析结果提示淋巴细胞计数减少、年龄、首次NLR是重型/危重型COVID-19独立危险因素,尤其是当淋巴细胞计数减少,发展为重型/危重型风险增加20.858倍。淋巴细胞计数预测重型/危重型COVID-19的ROC曲线AUC=0.855,Cut-off值为1.04×109/L,灵敏度和特异度分别为77.8%和99.6%。持续减少组中发展为重型及危重型的患者分别有15例(37.5%)及8例(20.0%),而恢复正常组发展为重型及危重型分别为2例(15.4%)及0例(0.0%),具有明显统计学差异(P=0.000)。结论新型冠状病毒肺炎患者外周血淋巴细胞计数可作为早期预测病情分型及评估病情转归(持续加重或好转)的一个良好的生物学指标,在发病10天内外周血淋巴细胞计数持续正常的患者发展为重型或危重型的可能性极低。
Objective The aim is to determine whether changes in peripheral blood lymphocyte counts in patients with new coronary pneumonia(COVID-19)can be used as a biological indicator for predicting disease classification(light or normal,severe,and critical)and outcome.Methods Data was collected retrospectively from a single-center database(from January 25,2020 to August 15,2020,80 patients with new coronavirus pneumonia diagnosed in the Eighth Hospital Affiliated to Guangzhou Medical University).The entire cohort study was divided into two groups.Group A(lymphopenia group)was the patients whose peripheral blood lymphocyte count decreased within 10 days after the onset of onset,a total of 40 cases.Group B(normal lymphocyte group)included patients with normal peripheral blood lymphocyte counts within 10 days of onset,a total of 40 cases.Observe the changes in the condition of the two groups of patients and the changes in blood routine,the registration classification(light or normal,severe,critical)and the time of the change of the condition.Patients in group A were further divided into two groups based on the results of the lymphocyte count review.After 3 days,the lymphocyte count was still lower than normal after the review and was included in the continuous decrease group;the lymphocyte count returned to normal and was included in the normalized group.The two groups were compared according to the disease classification.Results Among the patients in group A,2 cases were diagnosed as severe at the time of admission,0 cases were critically severe,and the others were mild or common.However,17 cases(42.5%)and 8 cases(20.0%)eventually developed into severe and critically ill patients,respectively.;In group B,1 case(2.5%)developed severe and 0 cases(0.0%)developed critically.There is a significant difference.There were no significant differences in gender,BMI,clinical manifestations(fever,cough,fatigue),chest CT lesions(bilateral,unilateral,none),and time to onset of patients in group A and group B.In terms of age,group A was(52.7±16.8)years old,and group B was(43.3±15.6)years old.There was a significant difference between the two groups(P=0.012).55.0%of patients in group A had chronic underlying diseases(hypertension,diabetes,coronary heart disease,etc.),while the rate in group B was 32.5%.There was a difference between the two groups(P=0.043).The average time from the onset of the onset of the peripheral blood lymphocyte count of the patients in group A was 5.65 days,and the average time from the onset of the onset of the disease was 8.48 days.The first granulocyte-to-lymphocyte ratio(NLR)of group A was(4.98±3.54),while that of group B was(1.72±0.97).There was a significant difference between the two groups(t=5.626,P=0.000).The average length of hospital stay in group A was(25.3±11.61)days and that in group B was(16.20±4.71)days.There was a significant difference between the two groups(t=4.607,P=0.000).One patient in group A eventually died,and no patient in group B died.Logistic multivariate regression analysis showed that lymphocyte count decrease,age,and first NLR were independent risk factors for severe/critical COVID-19,especially when the lymphocyte count decreased,the risk of developing severe/critical COVID-19 increased by 20.858 times.The ROC curve of lymphocyte count predicting severe/critical COVID-19 is AUC=0.855,the Cut-off value is 1.04×109/L,and the sensitivity and specificity are 77.8%and 99.6%,respectively.In the continuous reduction group,15 cases(37.5%)and 8 cases(20.0%)developed into severe and critical cases,respectively,while in the normal group,2 cases(15.4%)and 0 cases developed into severe and critical cases,respectively(0.0%),with a significant statistical difference(P=0.000).Conclusion The peripheral blood lymphocyte count of patients with new coronavirus pneumonia can be used as a good biological indicator for early prediction of disease classification and assessment of disease progression(continuous worsening or improvement).The development of patients whose peripheral blood lymphocyte count continues to be normal within 10 days of onset The possibility of being severe or critical is extremely low.
作者
郑会聪
郑啼婴
黄韫
林路平
胡中伟
ZHENG Huicong;ZHENG Tiying;HUANG Yun;LIN Luping;HU Zhongwei(Guangzhou Eighth People’s Hospital,Guangzhou Medical University,Guangzhou 510000,China)
出处
《现代医院》
2021年第9期1451-1455,共5页
Modern Hospitals
基金
广东省科技创新专项资金(广东省防控新型冠状病毒感染科技攻关应急专项)项目(2020B111115001)。
关键词
新冠病毒肺炎
淋巴细胞计数
病情分型
Novel coronavirus(COVID-19)pneumonia
Lymphocyte count
Classification
