天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (7): 577-582.doi: 10.11958/20201093

• 新冠专题 •    下一篇

天津地区新型冠状病毒肺炎患者临床特征分析

于洪志1 ，邵红霞1 ，邢志珩2 ，秦中华3 ，付莎莎1 ，胡松1 ，吴琦1△   

  1. 1 天津市海河医院呼吸与危重症医学科，天津市呼吸疾病研究所（邮编 300350），2 放射科，3 检验科
  • 收稿日期:2020-04-26 修回日期:2020-06-06 出版日期:2020-07-15 发布日期:2020-07-16
  • 作者简介:于洪志（1978），男，硕士，副主任医师，主要从事呼吸危重症、感染性疾病、肺结核相关研究

Analysis of clinical characteristics of patients with COVID-19 in Tianjin

YU Hong-zhi1 , SHAO Hong-xia1 , XING Zhi-heng2 , QIN Zhong-hua3 , FU Sha-sha1 , HU Song1 , WU Qi1△   

  1. 1 Department of Respiratory and Critical Care Medicine, 2 Department of Radiology, 3 Department of Laboratory Medicine, Tianjin Haihe Hospital, Tianjin Institute of Respiratory Disease, Tianjin 300350, China
  • Received:2020-04-26 Revised:2020-06-06 Published:2020-07-15 Online:2020-07-16

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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。

关键词: 肺炎, 病毒性；冠状病毒属；新冠肺炎；新型冠状病毒；治疗体会；临床特征；天津

Abstract: 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 was left. The 133 cases (98.5%) were eventually discharged after improvement, and 2 cases (1.5%) died. Conclusion The COVID- 19 in Tianjin area is mainly familial cluster, and most of them have basic diseases. The lymphocyte count is decreased obviously, and prognosis is favorable. Early chest CT examination can make up for the limitations of chest radiographs. It is recommended that chest CT examination and multiple nucleic acid tests of respiratory tract specimens should be carried out as soon as possible to achieve the early diagnosis and reduce missed diagnosis.

Key words:

Tianjin