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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
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/OL]. 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/OL]. 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。

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.

表1 患者的基本情况
表2 患者的临床表现
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
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.
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