【摘要】 目的回顾性分析新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)死亡患者与治愈患者的临床特点差异,提取患者死亡的预警信号,为针对COVID-19的诊疗及预后评估提供参考依据。方法选取自2020-01-20/2020-03-01日作者医院收治住院的248例确诊COVID-19患者,其中符合研究标准的死亡病例共105例(死亡组),治愈病例143例(重型组61例,普通型组82例)。收集并比较3组患者的临床资料,包括一般情况、临床症状、病程、实验室检查等进行对比分析。结果男性患者总体发病高于女性;死亡病例组老年人和有基础疾病患者比例较高(P<0.05);实验室检查发现死亡病例组患者的白细胞计数(white blood cell,WBC)、C反应蛋白(C reactive protein,CRP)、降钙素原(procalcitonin,PCT)、丙氨酸氨基转移酶(aspartate aminotransferase,AST)、肌酐(creatinine,Cr)、凝血酶原时间(prothrombin time,PT)、活化的部分凝血活酶时间(activated partial thromboplastin time,APTT)、D-二聚体(D-dimer,D-D)、肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)、肌红蛋白(myoglobin,Mb)、超敏肌钙蛋白Ⅰ(high-sensitivity troponin I,hs-TnⅠ)和血糖相比重型组和普通组患者均显著升高(P<0.05),而淋巴细胞计数(lymphocyte,LYM)、LYM%、血小板计数(platelet,PLT)、细胞免疫相关淋巴细胞亚型(CD3、CD4、CD8、CD19、CD16+56)、白蛋白(albumin,Alb)和肾小球滤过率(glomerular filtration rate,GFR)均显著降低(P<0.05)。多因素COX回归分析结果显示:年龄较大(HR=1.041,95%CI:1.023～1.058)、合并脑血管疾(HR=2.730,95%CI:1.382～4.687)、WBC升高(HR=1.150,95%CI:1.103～1.199)、LYM%降低(HR=0.891,95%CI:0.854～0.931)、AST升高(HR=1.012,95%CI:1.004～1.020)、Cr升高(HR=1.002,95%CI:1.000～1.004)、CD3降低(HR=0.996,95%CI:0.984～1.003)是影响COVID-19患者死亡风险的危险因素。结论观察结果中显著异常的指标可能是COVID-19患者发展成急性呼吸窘迫综合征甚至死亡的危险预警信号,其中WBC、LYM%、AST、Cr、CD3与患者死亡的关系最为密切,一旦出现,应当引起足够重视并加强对症治疗。另外,细胞免疫在新冠状病毒感染过程中起着重要作用,且在疾病的早期诊断和预后方面有着重要的参考意义。更多还原

【Abstract】 Objective To retrospectively evaluate the clinical characteristics of patients with coronavirus disease 2019(COVID-19), and extract early-warning signals of death, to provide reference for the diagnosis, treatment and prognosis assessment of COVID-19.Methods A total of 248 confirmed COVID-19 patients admitted to the author’s hospital from January 20, 2020 to March 1, 2020 were selected. Among them, 105 cases died(death group) and 143 cases cured(61 cases in the severe group, 82 cases in the general group). Clinical data of the 3 groups were collected and compared, including general conditions, clinical symptoms, course of disease, laboratory tests, etc.Results Males showed higher incidence of COVID-19 than females(P<0.05).The proportion of elderly patients and patients with underlying diseases in the death group was higher(P<0.05).Laboratory examination found white blood cell(WBC),C reactive protein(CRP),procalcitonin(PCT), aspartate aminotransferase(AST),creatinine(Cr),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer(D-D),creatine kinase isoenzymes(CK-MB),myoglobin(Mb),high-sensitivity troponin I(hs-TnⅠ) and blood glucose in death group were significantly higher than those of severe group and general group(P<0.05),while the lymphocyte count(LYM), LYM%, platelet count(PLT), cellular immune-related lymphocyte subtypes(CD3, CD4, CD8, CD19, CD16+56), albumin(Alb) and glomerular filtration rate(GFR) were all significantly reduced in death group(P<0.05). The results of multivariate COX regression analysis showed that older age(HR=1.041,95%CI:1.023-1.058),combined with cerebrovascular disease(HR=2.730,95%CI:1.382-4.687),increased WBC(HR=1.150,95%CI:1.103-1.199), LYM% decreased(HR=0.891,95%CI:0.854-0.931), AST increased(HR=1.012,95%CI:1.004-1.020),Cr increased(HR=1.002,95%CI:1.000-1.004),CD3 reduction(HR=0.996,95%CI:0.984-1.003) were risk factors that affect the risk of death in COVID-19 patients.Conclusion The significant abnormal indicators in the observation results may be dangerous warning signs for patients with COVID-19 to develop acute respiratory distress syndrome or even death,of which,WBC, LYM%, AST, Cr, and CD3 are most closely related to the death of patients. Once they appear, enough attention should be paid and symptomatic treatment should be strengthened. In addition, cellular immunity plays an important role in the process of SARS-cov-2 infection, and has important reference significance in the early diagnosis and prognosis of the disease.更多还原