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	新型冠状病毒肺炎向重型发展的临床特征及实验室指标
其他题名	Clinical features and laboratory indicators in progression of corona virus disease 2019 to severe type
	郎明健; 张智; 付国齐; 黄鲜; 刘晓; 李娟
来源期刊	中国中西医结合急救杂志
ISSN	1008-9691
出版年	2020
卷号	27 期号:1 页码:23-26
中文摘要	目的观察2019新型冠状病毒肺炎(简称新冠肺炎)确诊患者治疗过程中的临床特征及实验室指标变化,评估新冠肺炎患者的临床预后指标。方法收集2020年 1月22日至2月7日于成都市郫都区人民医院感染性疾病科集中收治的新冠肺炎确诊患者的病历资料,检测相关实验室指标,结合临床病情变化,分析其流行病学特征、临床表现、实验室检查、影像学特征及疾病转归预测指标。结果共纳入17例新冠肺炎确诊患者,收治时均不符合重型新冠肺炎标准。在治疗过程中,5例发展为重型(重症组),12例为轻型或普通型(非重症组)。14例患者于发病前2周内有湖北省疫区旅居史。新冠肺炎患者常见临床表现主要包括发热〔76.5 %(13例)〕、咳嗽〔64.7%(11例)〕、咽痛〔47.1%(8例)〕等上呼吸道感染症状,重症组体温略高于非重症组〔(38.90.6)℃比(3 7.60.8)℃〕,呼吸困难与乏力人数所占比例高于非重症组〔100%(5/5)比8.3%(1/12)〕。重症组入院时超敏C-反应蛋白(hs-CR P)、乳酸脱氢酶(LDH)明显高于非重症组〔hs-CRP(mg/L):31.328.33比 7.337.28,LDH(U/L): 384 111比 240 60,均 P<0.05〕,淋巴计数细胞(LYM)明显低于重症组(* 10~9/L:0.740.21比1.240.46, P<0.05);随着病情进展,重症组转院前hs-CRP、LDH较人院时进一步明显升高〔hs-CRP(mg/L):59.3238.28比31.32 8.33, LDH(U/L): 49891比 384 111,均 P<0.05〕,LYM较人院时进一步明显降低(10~9/L:0.520.19比0.740.21,P<0.05);非重症组出院前上述指标水平较入院时均有所改善,但差异均无统计学意义〔hs-CRP(mg/L):2.222.75 比 7.337.28, LDH(U/L): 210 42 比24060,LYM(10~9/L): 1.61 0.36比1.240.46,均P>0.05〕,除1例患者hs-CRP仍偏高,其余上述指标均恢复至正常范围。两组入院时D- 二聚体水平均处于正常范围;随病情进展,重症组转院前D-二聚体水平较人院时轻度升高,但差异无统计学意义(mg/L:0.760.56比0.420.2 6,P>0.05);非重症组D-二聚体水平轻度下降,差异无统计学意义(mg/L:0.330.34比0.560.43, P>0.05)。结论本院收治的新冠肺炎患者仍以输人性病例为主,无特异性临床症状。而LYM进行性降低,hs-CRP、LDH水平进行性升高可能是预测新冠肺炎发展为重症的实验室指标。
英文摘要	Objective To observe the clinical oharacteristics and laboratory index changes during the treatment process of corona virus disease 2019(COVID-19), and to evaluate the clinical prognosis. Methods The medical records of COVID-19 patients from the infectious diseases department of Pidu District People's Hospital of Chengdu from January 22 to February 7, 2020 were collected. The laboratory data were collected and combined with clinical changes, the epidemiological characteristics, clinical manifestations, laboratory examination, imaging features and prognosis prediction indicators were analyzed. Results A total of 17 patients were included. All of them did not meet the criteria for severe cases. In the course of treatment, 5 patients developed into severe oases(severe group)and 12 patients were mild or common cases(non-severe group). Fourteen patients had a history of living in epidemic areas in Hubei Province within two weeks before the onset of the disease. The common clinical manifestations of COVID-19 patients mainly included fever [76.5%(13 cases)], cough [64.7%(11 cases)], sore throat [47.1%(8 cases)] and other upper respiratory tract infection symptoms. The body temperature of severe group was slightly higher than that of non-severe group [(38.9 + 0.6)℃ vs.(37.6 0.8)℃], but severe group had obvious dyspnea and fatigue symptoms than non-severe group [100%(5/5)vs. 8.30%(1/12)]. The levels of hypersensitive C-reactive protein(hs-CRP)and lactate dehydrogenase(LDH)in the severe group were significantly higher than those in the non-severe group [hs-CRP(mg/L): 31.32 8.33 vs. 7.33 7.28, LDH(U/L): 384111 vs. 24060, all P < 0.05], and lymphocyte count(LYM)was significantly lower(* 10~9/L: 0.74 0.21 vs. 1.240.46,P < 0.05); with the progress of the disease, the levels of hs-CRP and LDH in the severe group were higher than those at admission [hs-CRP(mg/L): 59.32 38.28 vs. 31.32 8.33, LDH(U/L): 498 91 vs. 384 111,all P < 0.05], LYM was significantly lower than that at admission(* 10~9 /L: 0.520.19 vs. 0 740 21,P < 0.05); The levels of the above indexes in the non-severe group were improved before discharge, without significant differences [hs-CRP(mg/L): 2.222.75 vs. 7.337.28, LDH(U/L): 21042 vs. 24060,LYM(* 10~9/L):1.61 0.36 vs. 1.24 0.46,all P > 0.05]; except one case of hs-CRP was still high, all the above indexes returned to the normal range. The level of D-dimer in the two groups was in the normal range; with the progress of the disease, the level of D-dimer in the severe group was slightly higher than that at admission, but the difference was not statistically significant(mg/L: 0.76 0.56 vs. 0.42 0.26,P > 0.05); the level of D-dimer in non-severe group decreased slightly,but there was no significant difference(mg/L: 0.33 0.34 vs. 0.56 0.43, P > 0.05). Conclusions The patients with COVID-19 in our hospital are still mainly imported cases with no specific clinical symptoms. However, the progressive decrease in LYM and the progressive increase in levels of hs-CRP and LDH may be laboratory indicators for predicting the development of COVID-19 into severe cases.
中文关键词	新型冠状病毒肺炎 ; 重型 ; 临床特征 ; 实验室指标
英文关键词	Corona virus disease 2019 Severe case Clinical features Laboratory indicators
类型	Article
语种	中文
收录类别	CSCD
WOS类目	General & Internal Medicine
CSCD记录号	CSCD:6667331
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/354137
作者单位	郎明健, 成都中医药大学附属成都市第五人民医院心内科, 成都, 四川 611130, 中国. 张智, 成都中医药大学附属成都市第五人民医院心内科, 成都, 四川 611130, 中国. 付国齐, 成都中医药大学附属成都市第五人民医院心内科, 成都, 四川 611130, 中国. 黄鲜, 成都中医药大学附属成都市第五人民医院重症医学科, 成都, 四川 611130, 中国. 刘晓, 成都中医药大学附属成都市第五人民医院呼吸与危重症医学科, 成都, 四川 611130, 中国. 李娟, 成都市郫都区人民医院感染性疾病科, 成都, 四川 611730, 中国.
推荐引用方式 GB/T 7714	郎明健,张智,付国齐,等. 新型冠状病毒肺炎向重型发展的临床特征及实验室指标[J],2020,27(1):23-26.
APA	郎明健,张智,付国齐,黄鲜,刘晓,&李娟.(2020).新型冠状病毒肺炎向重型发展的临床特征及实验室指标.中国中西医结合急救杂志,27(1),23-26.
MLA	郎明健,et al."新型冠状病毒肺炎向重型发展的临床特征及实验室指标".中国中西医结合急救杂志 27.1(2020):23-26.