切换至 "中华医学电子期刊资源库"
高级检索
中华临床实验室管理电子杂志

中华临床实验室管理电子杂志 ›› 2021, Vol. 09 ›› Issue (02) : 110 -117. doi: 10.3877/cma.j.issn.2095-5820.2021.02.010

所属专题： 文献；

临床研究

重症和非重症新冠肺炎患者的临床特征对比及危险因素分析
何梦璋1, 杨崇艳2, 吴雄婷1, 黎鹏3, 王淼4, 胡丽4, 徐勇3,†()   
  1. 1. 510260　广东广州，广州医科大学附属第二医院
    2. 650011　云南昆明，云南省老年病医院
    3. 437400　湖北咸宁，湖北通城县人民医院
    4. 437000　湖北咸宁，咸宁市中心医院
  • 收稿日期:2020-12-02 出版日期:2021-05-28
  • 通信作者: 徐勇

Comparision of clinical characteristics and risk factors analysis between severe and non-severe COVID-patients

Mengzhang He1, Chongyan Yang2, Xiongting Wu1, Peng Li3, Miao Wang4, Li Hu4, Yong Xu3,†()   

  1. 1. The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong 510260, China
    2. The Geriatrics Hospital of Yunnan Province, Kunming Yunnan 650011, China
    3. Tongcheng People's Hospital, Xianning Hubei 43700, China
    4. Xianning Central Hospital, Xianning Hubei 43700, China
  • Received:2020-12-02 Published:2021-05-28
  • Corresponding author: Yong Xu
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

何梦璋, 杨崇艳, 吴雄婷, 黎鹏, 王淼, 胡丽, 徐勇. 重症和非重症新冠肺炎患者的临床特征对比及危险因素分析[J]. 中华临床实验室管理电子杂志, 2021, 09(02): 110-117.

Mengzhang He, Chongyan Yang, Xiongting Wu, Peng Li, Miao Wang, Li Hu, Yong Xu. Comparision of clinical characteristics and risk factors analysis between severe and non-severe COVID-patients[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2021, 09(02): 110-117.

目的

观察重症及非重症新冠肺炎患者的临床特征及住院期间检验结果的动态改变，并分析发生重症新冠肺炎的相关危险因素。

方法

在这项回顾性研究中，我们收集了入住通城县人民医院及咸宁市中心医院的59例确诊为新冠肺炎感染的患者。其中重症患者12例，非重症患者47例，比较两组患者的临床特征、住院期间检验结果的动态变化，并采用单变量及多变量分析发生重症新冠肺炎的相关危险因素。

结果

重症患者的平均年龄大，常伴有基础病史(糖尿病、高血压、冠心病和COPD)。重症患者的症状出现至就诊时间和发热天数较长，且其热峰高于非重症新冠肺炎患者(P＜0.05)。重症患者出现气促、骨肌肉疼痛症状的比例更高，常伴有中性粒细胞增高、淋巴细胞减少、血小板减少。重症患者的D-二聚体、CRP、PCT、AST和血肌酐水平均高于非重症患者(P＜0.05)。在住院第二周重症和非重症患者淋巴细胞减少的比例上升至83.34%和32.60%，D-二聚体升高的比例上升至66.67％和26.09％，ALT升高(＞100 U/L)的比例上升至16.67％和4.35％。在第三周和第四周，大部分非重症患者的淋巴细胞恢复正常，D-二聚体、CRP和PCT下降至正常水平，而部分重症患者的淋巴细胞仍较低，其ALT、D-二聚体、CRP和PCT仍维持在高水平。

结论

在多变量回归分析中发现D-二聚体升高是发生重症新冠肺炎的危险因素。

关键词: 重症新冠肺炎, 临床特征, 危险因素分析
Objective

To observe the clinical characteristics and dynamic changes of laboratory results in severe and non-severe COVID-19 patients, and to analyze the related risk factors for the occurrence of severeCOVID-19.

Methods

59 patients confirmed with COVID-19 infection were included from Tongcheng People's Hospital and Xianning Central Hospital, including 12 severe patients and 47 non-severe patients. The clinical characteristics and the dynamic changes of laboratory test during hospitalization of the two groups were compared, univariate as well as multiple logistic regressions were used to analyze the risk factors of severe COVID-19.

Results

Severe patients was older on the average age than non-severe patients, and often accompanied by a history of diabetes, hypertension, coronary heart disease and COPD. The time from symptoms onset to treatment and fever days were longer and the peak temperature were higher in severe patients (P＜0.05). Severe patients had a higher proportion of shortness of breath and bone-muscle pain, often accompanied by increased neutrophils, lymphopenia, thrombocytopenia. Elevated D-dimer, CRP, procalcitonin, AST and serum creatinine were also found in severe COVID-19 patients(P＜0.05). In the second week of hospitalization, the proportion of lymphopenia in severe and non-severe patients increased to 83.34% and 32.60%, the proportion of elevated D-dimer increased to 66.67% and 26.09%, and the proportion of elevated ALT (＞100 U/L) increased to 16.67% and 4.35%. In the third and fourth weeks, the lymphocytes of most non-severe patients returned to normal, and D-dimer, CRP and PCT decreased to normal levels. While the lymphocytes of some severe patients were still low, with high levels of ALT, D-dimer, CRP, and PCT.

Conclusion

In the multivariate regression analysis, it was found that elevated D-dimer was the risk factors of severe COVID-19.

Key words: Severe COVID-19, Clinical characteristics, Risk factors
表1 患者的基本情况
项目 重症患者 非重症患者 P值
平均年龄(岁) 57.00(48.25~68.00) 36.00(28.00~49.00) ＜0.001
男/女比例 8/4 27/20 0.745
传染接触史例(%)

武汉居住

 2(12.67) 9(19.15) 0.133

近期去过武汉

 3(25.00) 16(34.04) 0.734

与武汉相关人接触

 2(16.67) 20(42.55) 0.179

无

 5(41.67) 2(4.26) 0.181
症状出现至就诊时(天) 5.00(3.00~7.75) 1.00(1.00~4.00) 0.019
基础病史例(%) 5(41.67) 2(4.26) 0.003

高血压

 2(8.33) 0(0.00) ＜0.01

糖尿病

 3(25.00) 1(2.13) 0.024

冠心病

 1(8.33) 0(0.00) ＜0.01

COPD

 1(8.33) 0(0.00) ＜0.01

慢性肝炎

 0(0.00) 1(2.13)
并发症例(%)

脓毒血症

 4(33.33) 0(0.00) ＜0.01

急性呼吸窘迫

 7(58.33) 0(0.00) ＜0.01

急性肾功能不全

 2(16.67) 0(0.00) ＜0.01

急性心功能不全

 1(8.33) 0(0.00) ＜0.01
临床转归例(%)

治愈

 8(66.67) 47(100.00) ＜0.01

死亡

 2(16.67) 0(0.00) ＜0.01

转院

 2(16.67) 0(0.00) ＜0.01
表2 患者的临床表现
项目 重症患者 非重症患者 P值
发热例(%) 12(100) 35(74.47) 0.101
发热天数(天) 5.00(2.00~7.00) 2.00(0~4.00) 0.009
热峰(℃) 38.85(38.35~39.50) 37.95(37.10~38.65) 0.003
咳嗽(%) 11(91.67) 35(74.47) 0.268
咳痰(%) 9(75) 33(70.21) 1.000
咽痛(%) 3(25) 18(38.30) 0.509
气促(%) 5(41.67) 2(4.26) 0.003
疲劳乏力(%) 11(91.67) 35(74.47) 0.268
腹泻(%) 0(0) 1(2.13) 1.000
骨骼或肌肉疼痛(%) 2(16.67) 0(0.00) 0.039
图1 重症和非重症新冠肺炎患者的血常规变化及比例柱状图。
图2 重症和非重症新冠肺炎患者的肝肾功能变化及比例柱状图。
图3 重症和非重症新冠肺炎患者的D-二聚体、CRP、PCT变化及比例柱状图。
表3 重症COVID-19相关危险因素logistic分析
危险因素 OR P值 OR 95%置信区间
下限 上限
ALT 1.014 0.127 0.989 1.097
D-二聚体 4.915 0.011 1.442 16.758
淋巴细胞数 0.002 0.075 0.000 1.821
1
Park SE. Epidemiology, virology, and clinical features of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2; Coronavirus Disease-19)[J]. Clin Exp Pediatr, 2020, 63(4):119-124.
2
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. The Lancet, 2020, 395(10223):497-506.
3
Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia[J]. N Engl J Med, 2020, 382(13):1199-1207.
4
Zhou P, Yang XL, Wang XG, et al. Apneumonia outbreak associated with a new coronavirus of probable bat origin[J]. Nature, 2020, 579(7798):270-273.
5
Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019[J]. N Engl J Med, 2020, 382(8):727-733.
6
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study[J]. The Lancet, 2020, 395(10229):1054-1062.
7
Zhang JJ, Dong X, Cao YY, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China[J]. Allergy, 2020, 75(7):1730-1741.
8
Li J, Gong X, Wang Z, et al. Clinical features of familial clustering in patients infected with2019 novel coronavirus in Wuhan, China[J]. Virus Res, 2020, 286:198043.
9
Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China[J]. N Engl J Med, 2020, 382(18):1708-1720.
10
Liu J, Zheng X, Tong Q, et al. Overlapping and discrete aspects of the pathology andpathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV[J]. J Med Virol, 2020, 92(5):491-494.
11
Lan J, Ge J, Yu J, et al. Structure of the SARS-CoV-2 spike receptor-binding domain bound to the ACE2 receptor[J]. Nature, 2020, 581(7807):215-220.
12
Joob B, Wiwanitkit V. Pulmonary Pathology of Early Phase 2019 Novel Coronavirus Pneumonia[J]. JThorac Oncol, 2020, 15(5):700-704.
13
Peiris JS, Chu CM, Cheng VC, et al. Clinical progression and viral load in a communityoutbreak of coronavirus-associated SARS pneumonia: a prospective study[J]. The Lancet, 2003, 361(9371):1767-1772.
14
Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome[J]. Lancet Respir Med. 2020,8(4):420-422.
15
Wong RS, Wu A, To KF, et al. Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis[J]. BMJ, 2003, 326(7403):1358-1362.
16
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study[J]. The Lancet, 2020, 395(10223):507-513.
[1] 王月丽, 宋砾, 牛宝荣, 陈炎, 张楠, 何怡华. 心脏血管肉瘤的临床及超声心动图特征[J]. 中华医学超声杂志（电子版）, 2023, 20(04): 398-403.
[2] 缪黄泰, 李潇颖, 张明, 聂绍平. 急性心肌梗死后心脏破裂患者院内死亡的危险因素分析[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 187-192.
[3] 董晓燕, 赵琪, 唐军, 张莉, 杨晓燕, 李姣. 奥密克戎变异株感染所致新型冠状病毒感染疾病新生儿的临床特征分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 595-603.
[4] 王胜男, 孙挥宇, 接英, 谢雯, 毛菲菲, 李丹, 鲁丹, 刘夕瑶. 慢性丙型肝炎患者干眼临床特征[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(01): 48-54.
[5] 李小娟, 李炜佳, 彭凌燕, 周鹏莹, 李桂娥, 刘相辰. 体检人群中前列腺钙化灶的检出率及临床特征分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 336-338.
[6] 刘麒, 曾弘, 徐子昕, 方超, 黄铭, 郑俊炯, 吴少旭, 钟广正, 林天歆, 黄健, 董文. 乳头状肾细胞癌单中心11年临床诊治与预后分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 351-355.
[7] 孟原竹, 蒋国路, 陈小兵, 蒋莉. 肺结核合并侵袭性肺曲霉感染临床特征及危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 541-543.
[8] 田井梅, 何俊, 何永琴, 张玉梅, 郑文红, 袁玉霞. 老年慢性阻塞性肺疾病合并髋部骨折围术期31例临床特征分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 418-420.
[9] 李华娟, 唐英俊, 王赛妮, 徐旺, 林玲, 李羲, 黄华萍. 肺结节临床与CT影像学特征分析及良恶性预测模型构建[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 318-323.
[10] 李雅丽, 薛敏君, 韩福. 38例肺隐球菌患者CT及临床特征分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 236-238.
[11] 徐冰, 程明斌, 赵国华. CT影像学征象对局灶性肺炎型肺癌与肺部炎性病变的鉴别意义[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 58-60.
[12] 王欣, 孙丹琦, 黄瑾瑜. 高分辨弥散加权成像ADC直方图参数与直肠癌临床特征相关性的回顾性研究[J]. 中华结直肠疾病电子杂志, 2023, 12(02): 132-138.
[13] 王红权, 詹杰, 彭春晓, 梅振华, 邹亮. 肠白塞病的研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(02): 220-226.
[14] 张碧莹, 路明, 陈静, 苏元波, 李美娇, 沈宁. 发热门诊轻症鹦鹉热衣原体肺炎的早期识别[J]. 中华临床医师杂志(电子版), 2023, 17(01): 33-36.
[15] 苏琪皓, 解利红, 孟宪梅, 王觅柱, 王晶, 张静洁, 汤泊夫, 江振宇. 消化道毛细血管扩张特征及内镜治疗效果观察[J]. 中华胃肠内镜电子杂志, 2023, 10(03): 180-184.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号