新型冠状病毒肺炎患者实验室检查临床特点分析

Clinical characteristics of laboratory examination on patients with COVID-19

摘要:

目的：观察新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）实验室检查指标与疾病严重程度的关系，并找出其发展成重型肺炎的危险因素。方法：纳入湖北省鄂州市第三人民医院综合楼隔离病房收治的COVID-19患者81例，其中普通型49例、重型32例，收集2组患者年龄、性别、慢性基础疾病、临床实验室检查指标进行统计对比分析，并使用受试者工作特征（receiver operating characteristic，ROC）曲线评估检查指标的预测价值。结果：81例COVID-19中，非重症组年龄（49.86±13.79）岁，重症组年龄（62.84±13.26）岁，重症组的年龄大于非重症组（P<0.05），合并有慢性基础疾病及白细胞计数（white blood cell count，WBC）、中性粒细胞计数（neutrophil count，NEU）、NEU百分比、C反应蛋白（C-reactive protein，CRP）、总胆红素（total bilirubin，TBIL）、肌酸激酶（creatine kinase，CK）、乳酸脱氢酶（lactate dehydrogenase，LDH）值越高的COVID-19患者越容易发展成重症肺炎（P<0.05）；同时淋巴细胞计数（lymphocyte count，LYM）、LYM百分比、白蛋白值越低的COVID-19患者也容易发展成重症患者（P<0.05）；对COVID-19患者重症风险的预测，患者年龄、WBC、NEU、NEU百分比、LYM、LYM百分比、ALB、CRP和LDH的ROC曲线下面积（area under the receiver-operating characteristic curve，AUC）分别为0.757、0.711、0.783、0.904、0.850、0.921、0.754、0.848和0.807。重复测量方差分析显示，NEU百分比、LYM百分比、CRP和LDH在不同病情组和治疗时间之间存在显著交互效应。结论：年龄大及合并慢性基础疾病的COVID-19患者更容易发展成重症，临床上可通过WBC、NEU、NEU百分比、LYM、LYM百分比、ALB、CRP和LDH评估COVID-19的严重程度，尤其是NEU百分比、LYM百分比结合患者年龄及肺部CT表现可预测其非重症患者进展成重症患者的危险性，以及时调整治疗方案。

Abstract:

Objective：To investigate the relationship between laboratory examination indexes and disease severity of coronavirus dis－ease 2019（COVID-19），and to find out the risk factors for the severe pneumonia. Methods：Eighty-one cases of COVID-19 admitted to the isolation ward of the third people’s Hospital in Ezhou City，Hubei Province，including 49 common cases and 32 severe cases were collected and analyzed statistically in terms of age，gender，chronic basic diseases，and clinical laboratory examination indexes of the two groups and the receiver operating characteristic（ROC） curve was used to evaluate the predictive value of the examination in－dexes. Results：Among the 81 cases，the age of the common group was （49.86±13.79） years old，that the age of the severe group was （62.84±13.26） years old，and the age of severe group was older than that of common group（P<0.05）. Patients complicated with higher values of chronic basic diseases，white blood cell count（WBC），neutrophil count（NEU），NEU percentage，C-reactive protein（CRP），total bilirubin（TBIL），creatine kinase（CK），and lactate dehydrogenase（LDH） were more likely to develop severe pneumonia（P<0.05）. At the same time，the lower the lymphocyte count（LYM），LYM percentage and albumin values of COVID-19 patients were al－so prone to severe patients（P<0.05）. After anti-infection and anti-virus treatment，the above indexes gradually returned to normal. To predict the risk of severe COVID-19 patients，the area under the receiver-operating characteristic curve（AUC） of age，WBC，NEU，NEU%，LYM，LYM%，ALB，CRP and LDH were 0.757，0.711，0.783，0.904，0.850，0.921，0.754，0.848 and 0.807 respectively. Repeated measurement analysis of variance showed that there was significant interaction between different condition groups of NEU%，LYM%，CRP，LDH and treatment time. Conclusion：Older COVID-19 patients with chronic diseases are more likely to develop severe pneumonia. Clinically，WBC，NEU，NEU%，LYM，LYM%，ALB，CRP and LDH can be used to assess the severity of COVID-19. Especially，NEU%，LYM% combined with the age of patients and the CT manifestations of lung can be used to predict the risk of progression from common patient to severe patient，so as to adjust the treatment plan in time.