武汉输入性与本地续发COVID-19病例流行病学及临床特征对比性研究

Comparative study on epidemiology and clinical characteristics in patients with imported and local secondary COVID-19

摘要:

目的：探讨武汉输入性及本地续发新型冠状病毒肺炎（corona virus disease 2019，COVID-19）病例之间的差异。方法：收集2020年1月24日至2月26日河南省南阳市各定点医院收治入院的可明确流行病史的129例COVID-19确诊患者，根据发病前14 d内有无武汉或湖北地区旅居史，分为输入性病例组（n=70）和本地续发病例组（n=59），对比2组流行病学、临床特征、实验室和影像特征及预后的差异。结果：南阳地区早期确诊病例主要为输入性病例，晚期确诊病例主要为本地续发病例。2组病例首发症状中，最常见的症状均表现为发热，但整个病程中输入性病例组以中等发热为主，本地续发病例组以低热为主，鼻塞、流涕、咽干、咽痛等上呼吸道症状在本地续发病例组中较多首发出现，喘息症状在输入性病例组中较多首发出现。输入性病例组外周血淋巴细胞计数明显低于本地续发病例组，输入性病例组降钙素原（procalcitonin，PCT）值明显高于本地续发病例组。影像学对比发现，输入性病例组入院时胸部CT多呈现进展期及重症期表现，本地续发病例组多呈早期表现。输入性病例组入院时即呈现进展期及重症期表现的比例明显高于本地续发病例组。输入性病例组重症及危重症患者比例明显高于本地续发病例组，输入性病例组死亡3例，而本地续发病例组无死亡病例，3例死亡病例均为男性。结论：输入性病例与本地续发病例在临床症状、实验室检查及影像学表现方面存在差异，输入性病例组比本地续发病例组重症或危重症患者数多，死亡率高。

Abstract:

Objective：To explore the difference between the imported and local secondary cases of coronavirus disease 2019（COVID-19）. Methods：A total of 129 confirmed COVID-19 cases with a clear epidemiological history admitted to hospitals in Nanyang from January 24 to February 26，2020 were enrolled in this study. The patients were divided into the imported group（n=70） and the local secondary group（n=59） according to the travel history to or a residence history in Wuhan or in the surrounding areas in Hubei Province within 14 days before the illness. The differences of the epidemiological，clinical，laboratory and imaging characteristics and prognosis in two groups were compared. Results：The early diagnosed cases were mainly imported cases，and the later diagnosed ones were mainly local secondary cases. The most common first symptom in the two groups was fever：the imported case group was mainly the moderate fever，and the local secondary case group was mainly the low fever throughout the course. Upper respiratory symptoms，such as nasal congestion，runny nose，dry throat，and sore throat，were more common in the local secondary group，whereas wheezing symptoms were more common in the imported group. The lymphonpenia in the imported case group was significantly lower than that in the local secondary case group. Procalcitonin（PCT） in the imported group was significantly higher than those in the local secondary group. Chest CT in the imported case group showed more advanced and severe period performance when admitted to hospital，and the local secondary case group showed more early performance. Progressive and severe symptoms in the imported case group was signifi－cantly higher than those in the local secondary case group. The proportion of severe and critical severe patients in the imported case group was significantly higher than that in the local secondary case group. Three deaths （all males） were noted in the imported case group，whereas no death was recorded in the local group. Conclusion：There are differences in clinical symptoms，laboratory examina－tions and chest CT performance between imported and local secondary cases. The imported case group has more severe or critical severe patients，with a higher mortality.