摘要
目的探讨天津地区新型冠状病毒肺炎(COVID-19)患者的流行病学特征、临床及影像学特点。方法回顾性分析2020年1月21日—3月15日天津市海河医院收治的135例有完整病历资料的COVID-19患者的人口学、流行病学、临床资料、实验室指标及影像学特征。根据病情分为轻症(轻型+普通型)组(n=74)和重症(重型+危重型)组(n=61),比较2组临床表现、流行病学特征、实验室指标改变及影像学特点。结果135例COVID-19患者中合并基础疾病70例(51.9%),重症组合并心律失常者较多,发热、乏力、胸闷、厌食的发生率较高(P<0.05)。聚集性感染为主,共26起,涉及74例(54.8%),通过1次核酸检测确诊112例(83.0%)。135例中发病时有症状者126例(93.3%),核酸转阴平均14(10,20)d;无症状9例(6.7%),其核酸转阴平均7.0(5.5,13.0)d。外周血细胞主要为淋巴细胞下降40例(29.6%),C反应蛋白升高65例(48.1%)、白细胞介素6升高57例(42.2%),D-二聚体升高62例(45.9%),纤维蛋白原升高33例(24.4%),乳酸脱氢酶升高36例(26.7%),肌红蛋白升高9例(6.7%)。胸部CT示127例(94.1%)有异常表现,病变以胸膜下区分布为主122例(96.1%),其中磨玻璃密度影为主要表现106例(83.5%),重症组双肺受累、且3个肺叶以上分布、磨玻璃影和实变影更多见(均P<0.05),大部分患者经治疗可吸收,或遗留少许纤维条索。最终好转出院133例(98.5%),死亡2例(1.5%)。结论天津地区COVID-19感染以家族聚集性为主,多数合并基础疾病,淋巴细胞计数降低较为明显,总体预后良好。早期胸部CT检查可以弥补胸部X线检查的局限性,尽早行胸部CT检查及多次呼吸道标本的核酸检测有利于早期诊断,减少漏诊。
Objective To explore the epidemiological,clinical and imaging characteristics of patients with novel coronavirus disease 2019(COVID-19)in Tianjin.Methods The demographics,epidemiological,clinical data,laboratory tests and radiological characteristics of 135 COVID-19 patients hospitalized in Tianjin Haihe Hospital from January 21 to March 15,2020 were retrospectively analyzed.The patients were divided into 2 groups according to the severity of illness:mild group(n=74)and severe group(n=61).The general data,clinical data and CT findings were compared between the two groups.Results In the 135 COVID-19 patients,70 cases(51.9%)also had basic diseases.In the severe group,the comorbidity rate of arrhythmia was higher(P<0.05),and the incidence rates of fever,fatigue,chest tightness and anorexia were higher(P<0.05).There were 26 cases of cluster infection,involving 74 cases(54.8%).One hundred and twelve cases(83.0%)were confirmed by nucleic acid examination once.Among the 135 cases,126 cases(93.3%)had symptoms at the time of onset,and the median time for nucleic acid to turn negative was 14(10,20)days.Nine cases(6.7%)were asymptomatic,with the median time 7.0(5.5,13.0)days for nucleic acids shifted to the negative.Peripheral blood cells showed mainly lymphocyte decreased in 40 cases(29.6%),C-reactive protein(CRP)increased in 65 cases(48.1%),interleukin-6 increased in 57 cases(42.2%),D-dimer increased in 62 cases(45.9%),fibrinogen increased in 33 cases(24.4%),lactate dehydrogenase(LDH)increased in 36 cases(26.7%)and myoglobin increased in 9 cases(6.7%).Chest CT examination showed abnormalities in 127 cases(94.1%).The pathological changes were mainly distributed in the subpleural area in 122 cases(96.1%),among which ground glass density was the main manifestation in 106 cases(83.5%).In the severe group,bilateral lung involvement and the distribution of above 3 pulmonary lobes,ground glass and consolidation shadows were more common(all P<0.05).In most patients,the lesions can be absorbed by treatment,or a little fiber sliver
作者
于洪志
邵红霞
邢志珩
秦中华
付莎莎
胡松
吴琦
YU Hong-zhi;SHAO Hong-xia;XING Zhi-heng;QIN Zhong-hua;FU Sha-sha;HU Song;WU Qi(Department of Respiratory and Critical Care Medicine,Tianjin Haihe Hospital,Tianjin Institute of Respiratory Disease,Tianjin 300350,China;Department of Radiology,Tianjin Haihe Hospital,Tianjin Institute of Respiratory Disease,Tianjin 300350,China;Department of Laboratory Medicine,Tianjin Haihe Hospital,Tianjin Institute of Respiratory Disease,Tianjin 300350,China)
出处
《天津医药》
CAS
北大核心
2020年第7期577-582,共6页
Tianjin Medical Journal
基金
天津市卫生健康新冠肺炎防治科技项目(2020xkm02、2020xkc04)。
