14例新型冠状病毒肺炎病例流行病学和临床特征

 

目的 了解新型冠状病毒肺炎（COVID-19）确诊病例、排除病例的流行病学特征及临床特征，为临床诊疗提供建议。方法 将某院留观的COVID-19疑似患者，新型冠状病毒（2019-nCoV）核酸检测阳性的患者列为确诊病例组（确诊组），2019-nCov核酸检测至少二次阴性，经上海市静安区专家组会诊后予以排除的患者列为排除病例组（排除组），比较两组患者在流行病学、 临床表现、实验室检查以及影像学资料方面的差异。结果 确诊组14例 患者中，男女性别比1.33∶1，年龄中位数为 51.5（38.3，63.0）岁，有明确流行病学史的10例（71.43%）；排除组 84例患者中，男女性别比0.95∶1，年龄中位数37（29.0，59.75）岁，有明确流行病学史的14例（16.67%）；两组在年龄分布、流行病学史上差异均有统计学意义（均P<0.05），在性别、居住地分布以及临床表现上差异均无统计学意义（均P>0.05）。确诊组白细胞正常或降低的患者数占比高于排除组（92.86% VS 72.62%），差异有统计学意义（P<0.001），淋巴细胞百分比减少的患者数占比低于排除组（P=0.001）。两组胸部CT结果比较，确诊组患者磨玻璃样渗出影、斑片渗出影等改变所占的比例高于排除组患者，差异有统计学意义（P<0.05）；确诊组患者由散在或多发肺炎进展为 磨玻璃样肺炎的中位时间为3（2，5）d。结论 患者年龄、明确的流行病学史、白细胞计数、淋巴 细胞百分比，肺部磨玻璃样等CT表现是 COVID-19的特征因素，临床医生在诊疗时应加以甄别，进一步提高 COVID-19诊断的准确性。

Epidemiological and clinical characteristics of 14 cases of COVID-19

Objective To understand epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) confirmed cases and excluded cases, and provide recommendations for clinical diagnosis and treatment. Methods Patients with suspected COVID-19 staying in a hospital were studied, those who were with positive 2019-nCoV nucleic acid test were as confirmed case group, those who were with negative 2019-nCoV nucleic acid test for at least two times, and excluded after consultation by Jing''an District expert group of Shanghai were as excluded case group, differences in epidemiology, clinical manifestation, laboratory examination and imaging data between two groups were compared. Results Of 14 confirmed cases, male-female ratio was 1.33:1, median age was 51.5 years (38.3, 63.0), 10 cases (71.43%) had a clear epidemiological exposure history; of 84 excluded cases, male-female ratio was 0.95:1, median age was 37 years (29.0, 59.75), 14 cases (16.67%) had a clear epidemiological exposure history; there were both significant differences in age distribution and epidemiological exposure history between two groups (both P<0.05), but no significant differences in gender distribution, residence distribution and clinical manifestations (all P>0.05). The percentage of patients with normal or decreased leukocytes in confirmed case group was higher than that in excluded case group (92.86% vs 72.62%, P<0.001), percentage of patients with decreased lymphocyte was lower than that in excluded case group (P=0.001). Comparison of chest CT of two groups showed that the percentage of ground glass exudation shadow and spot exudation shadow in confirmed case group was higher than that in excluded case group, difference was statistically significant (P<0.05); the median time from scattered or multiple pneumonia to ground glass pneumonia in confirmed case group was 3 (2, 5) days. Conclusion Characteristic factors for COVID-19 are age, clear epidemiological history, leukocyte count, percentage of lymphocyte, and CT manifestations of ground glass-like lung, clinicians should discriminate in diagnosis and treatment, further improve diagnosis accuracy of COVID-19.