重庆市江北区COVID-19患者临床和实验室特征分析

Clinical characteristics and laboratory features of patients with coronavirus disease 2019 in Jiangbei District of Chongqing

摘要:

目的：回顾性分析重庆市江北区42例新型冠状病毒肺炎（coronavirus disease 19，COVID-19）确诊患者和疑似患者的临床资料和实验室数据，为制定疫情防控策略和措施提供科学依据。方法：收集2020年1月24日至3月21日在重庆市红十字会医院（江北区人民医院）诊治的21例COVID-19确诊患者（核酸检测阳性）和21例疑似患者（临床症状、胸部CT高度怀疑）资料，对其基本信息、流行病学特征、实验室检查、CT结果、出院后随访情况等进行调查分析及比较。结果：42例病例中，湖北返回人员9人（21.4%），有确诊人员接触史19人（45.2%），无确诊人员接触史14人（33.3%），2组患者差异有统计学意义（P＜0.001）。42例患者平均年龄（44.48±16.49）岁；男性59.5%，女性40.5％。主要临床症状有发热、咳嗽、乏力，其中5例无症状。确诊患者白细胞计数（white blood cell count，WBC）、淋巴细胞绝对值（lymphocyte count，LYM）、中性粒细胞绝对值（neutrophil count，NEU）、淋巴细胞百分比（lymphocyte percentage，LYM%）、中性粒细胞百分比（neutrophil percentage，NEU%）水平低于疑似患者，确诊组WBC下降<3.5×109个/L的患者所占比例高于疑似组（19.0%），疑似组NEU≥6.3×109个/L的患者所占比例高于确诊组（33.3%），差异有统计学意义（P＜0.05）。42例患者中，41例有CT影像学改变（97.62％）。出院后随访发现，3例确诊患者出现核酸复阳，疑似患者无核酸检测阳性；2例确诊患者出现胸痛症状；共26例（61.9%）患者CT提示肺部病灶基本吸收，2组患者肺部病灶吸收情况无统计学差异。结论：2组患者流行病学史比较有显著差异，故对有接触史或可疑接触史的人群，建议及早筛查病毒核酸、血清IgG/IgM抗体及胸部影像学检查。COVID-19患者的临床表现无特异性，甚至还存在无症状患者。与疑似患者相比，确诊患者有外周血WBC、LYM%及LYM、NEU%和NEU的下降可作为确诊的依据。出院后随访发现确诊患者有核酸复阳和胸痛等症状，建议确诊和疑似患者出院后均应加强核酸复查和可能后遗症的防治。

Abstract:

Objective：To retrospectively analyze the clinical data and laboratory data of patients with coronavirus disease 2019 （COVID-19） and suspected patients in Jiangbei District of Chongqing，so as to provide scientific basis for formulating prevention and control strategies and measures. Methods：From January 24 to March 21 in 2020，data of 21 COVID-19 patients with positive nucleic acid and 21 suspected patients with highly doubtable CT and nucleic acid who were diagnosed in our hospital were collected. The ba－sic information，epidemiology，clinical features，laboratory results，CT results and post-discharge follow up in different groups were ret－rospectively analyzed. Results：Among the 42 patients，9 patients（9/42，21.4%） came back from Hubei province，19 patients（19/42，45.2%） had history of diagnosed patients 14（14/42，33.3%） had no history of communicable disease，with significant difference between two groups（P<0.001）. The median age was（44.48±16.49） years old; the ratio of males was 59.5% and of females was 40.5%. Common symptoms at onset were fever，cough and fatigue，but 5 patients had no clinical symptoms. Compared with the suspected diagnosed group，white blood cell count（WBC），neutrophil count（NEU），lymphocyte count（LYM），lymphocyte percentage（LYM%） and neu－trophil percentage（NEU%） were decreased significantly in the diagnosed group. 19.0% COVID-19 patients had a lower Patients with decreased WBC<3.5×109/L ratio in the diagnosed group were higher than those in the suspected group（19.0%） and pa－tients with NEU≥6.3×109/L ratio in the suspected group were higher than those in the diagnosed group（33.3%），with signifi－cant difference（P<0.05）. Among 42 patients，41 patients had CT changes（97.62%）. During the follow up，3 diagnosed patients were rechecked for nucleic acid-positive，which was not happened a－mong suspected patients；2 diagnosed patients had chest pain；CT of 26 patients（61.9%） suggested that lung lesions were basically ab－sorbed，without statistically significant differences between two groups. Conclusion：There are significant differences in epidemiological history between two groups. Therefore，we should detect the nucleic acid，serum IgM-Ab/IgG-Ab and chest CT of patients who has epidemic history or suspected contact history as soon as possible. Clinical symptoms of the COIVD-19 patient have no specificity，to some extent，some asymptomatic patients exist. Compared with suspected patients，the descended data level of WBC，LYM，LYM%，NEU% and NEU can be taken as diagnosed evidence According to the post-discharge follow-up，it is found that some COVID-19 patients are rechecked for nucleic acid-positive and have chest pain，suggesting that confirmed and suspected patients should recheck for nucleic acid，so as to strengthen the prevention and treatment of possible sequela.