武汉地区94例普通型与重型、危重型COVID-19患者临床特征比较

Comparison of clinical characteristics of 94 patients with common and severe or critical COVID-19 in Wuhan

摘要:

目的：分析新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）重型及危重型患者临床特征，为早期识别及干预此类患者提供可用临床依据。方法：回顾性分析2020年1月24日至3月10日在武汉市红十字会医院确诊为COVID-19的出院患者临床资料，根据病情严重程度，分为普通型、重型及危重型，比较重型及危重型患者与普通型患者人口学特征、临床特征、治疗及转归情况。结果：共纳入COVID-19确诊患者94例，其中男性46例，女性48例，中位年龄54岁，重型及危重型患者25例，普通型患者69例，治愈56例，好转32例，死亡6例。高血压、糖尿病、冠心病为COVID-19患者最常见的合并症，咳嗽、发热、乏力为其主要临床表现，磨玻璃影为胸部影像学特征。与普通型患者相比，重型及危重型患者年龄更大；高热、干咳及呼吸困难比例更高；淋巴细胞绝对计数及比值、白蛋白水平均明显下降[（0.80±0.11）×109个/L vs. （1.34±0.10）×109个/L，P<0.001；（15.510±1.913）% vs. （25.590±1.503）%，P<0.001；33.85（28.28~38.33） g/L vs. 38.70（36.03~41.43） g/L，P=0.003]，但中性粒细胞比值及C反应蛋白（C-reactive protein，CRP）明显增高[74.70（64.65~88.40）% vs. 62.25（53.53~72.60）%，P=0.002；65.15（11.23~123.49） mg/L vs. 4.51（1.54~15.39） mg/L，P<0.001]。重型及危重型患者胸部CT以双肺磨玻璃病变为主。治疗方面，重型及危重型患者使用3种及以上抗病毒药物比例和抗炎药物使用较普通型更高，但治愈率较普通型患者更低且死亡率更高。此外，治愈患者使用中药的比例高于死亡患者[23（41.07） vs. 1（16.67），P=0.082]。结论：重型及危重型COVID-19患者死亡率高，年龄更大，以老年患者居多，发热、干咳、呼吸困难为主要临床表现，实验室检查提示淋巴细胞绝对值及比值、白蛋白均明显降低，CRP及中性粒细胞比值增加，影像学以双肺磨玻璃病变为主，预后较差，死亡率高。目前针对COVID-19尚无疗效确切的治疗手段，中药及中成药的临床疗效需要更大样本、设计严格的临床研究进一步证实。

Abstract:

Objective：To analyze the clinical characteristics of severe and critical coronavirus disease 2019（COVID-19） confirmed patients，and provide clinical evidences for early identification and intervention. Methods：The clinical data of discharged patients with confirmed COVID-19 at Wuhan Red Cross Hospital from January 24 to March 10，2020 were retrospectively analyzed. According to the severity of the disease，they were divided into the general group，and the severe or critical group. The demographic characteris－tics，clinical characteristics，treatments，and outcomes were compared between the two groups. Results：A total of 94 patients with confirmed COVID-19 were selected，including 46 males and 48 females，with a median age of 54 years old. There were 25 patients in severe or critical group and 69 patients in general group. Totally，there were 56 cured，32 improved and 6 dead patients. Hypertension，diabetes，and coronary heart disease were the most common co－morbidities；cough，fever，and fatigue were the main clinical manifestations and ground-glass was the feature of imaging ex－amination in both groups. Compared with general patients，severe and critical patients had the following characteristics：they were older and had much more frequencies in fever，dry cough and dyspnea；they had lower lymphocyte count[（0.80±0.11）×109/L vs. （1.34±0.10）×109/L，P<0.001] and ratio[（15.510±1.913）% vs. （25.590±1.503）%，P<0.001]，albumin[33.85（28.28-38.33） g/L vs. 38.70（36.03-41.43） g/L，P=0.003]，higher neutrophil ratio[74.70（64.65-88.40）% vs. 62.25（53.53-72.60）%，P=0.002] and C-reac－tive protein[65.15（11.23-123.49） mg/L vs. 4.51（1.54-15.39） mg/L，P<0.001] level. Moreover，the majority severe and critical patients showed bilateral pneumonia according to imaging examination. In terms of treatment，severe and critical patients had higher rates of using 3 or more antiviral and anti-inflammatory drugs，however，the cure rate was lower with higher mortality rate. Furthermore，the proportion of using traditional Chinese medicine in cured patients was higher than that of dead patients[23（41.07） vs. 1（16.67），P=0.082]. Conclusion：Compared to the general COVID-19 patients，severe and critical COVID-19 patients had higher mortality，were older with bilateral pneumonia，and had more frequencies of fever，dry cough，and dyspnea. Blood laboratory tests had shown lower level of albumin and absolute counts and ratio of lymphocytes. On the contrary，CRP and blood neutrophil ratio were higher. Up to now，there have had no promising therapy to treat COVID-19，the clinical efficacy of traditional Chinese medicine needs to be fur－ther confirmed by larger sample design and rigorous clinical studies.