【摘要】 目的 探讨新型冠状病毒肺炎(新冠肺炎)患者的临床特点及其与预后的关系。方法 回顾性分析2020年1月19日至3月1日河南科技大学第一附属医院收治的28例新冠肺炎患者的临床资料,观察患者的流行病学史、潜伏期及确诊时间、临床表现及基础疾病、实验室检查、胸部CT表现及转归情况。结果28例新冠肺炎患者中,男性15例,女性13例;平均年龄51.9岁。其中11例患者到过疫区,15例有新冠肺炎确诊患者明确接触史,2例无明确接触史。临床症状包括发热(92.9%)、咳嗽(75.0%)、乏力(39.3%)、气促(28.6%)、肌肉酸痛(25.0%)、白黏痰(21.4%)、咽痛(17.9%)、恶心呕吐(10.7%)、头痛(7.1%)、流涕(3.6%)和腹痛(3.6%)。血常规检查显示,16例(57.1%)患者外周血淋巴细胞计数(LYM)有不同程度下降,17例(60.7%)患者C-反应蛋白(CRP)明显升高,12例(42.8%)患者乳酸脱氢酶(LDH)明显升高,15例(53.5%)降钙素原(PCT)升高,但均<1.0μg/L。胸部CT肺窗显示,新冠肺炎早期可见超早期磨玻璃影,多分布在单侧或双侧胸膜下或肺外带;初期可见磨玻璃影和网格样表现;进展期可出现肺实变或条索状改变,部分可见支气管充气征;病情好转后大部分影像学表现可完全消失,部分可形成肺纤维化表现。临床分型:普通型16例,重型9例,危重型3例。治疗10～23 d(平均18.1 d)后,28例患者咽拭子或痰液新型冠状病毒(2019-nCoV)核酸检测均转阴,生化指标恢复正常,其中26例痊愈出院,平均住院时间18 d,咽拭子核酸平均转阴时间13.8 d;1例核酸转阴后出现其他并发症,最终死亡;1例怀疑因肺栓塞死亡。结论 本院收治的新冠肺炎患者多有明确的流行病学史,以发热、咳嗽、乏力多见,实验室检查及胸部CT早期有特异性表现,大部分患者经治疗痊愈出院,有基础疾病的患者可出现并发症,严重者可导致患者死亡,应引起重视。更多还原

【Abstract】 Objective To investigate the clinical characteristics of patients with coronavirus disease 2019(COVID-19) and its relationship with prognosis.Methods The clinical data of 28 patients with COVID-19 admitted to the First Affiliated Hospital of Henan University of Science and Technology from January 19 to March 1,2020 were retrospectively analyzed.The epidemiological history,incubation period and time of confirmed diagnosis,clinical manifestations and underlying diseases,laboratory examinations,chest CT findings and outcomes of the patients were observed.Results Among the 28 patients with COVID-19,there were 15 males and 13 females;average age was51.9 years.Of these patients,11 cases had traveled to the epidemic area,15 had a contact history of confirmed COVID-19 patients,and 2 had no clear epidemic contact history.The clinical symptom manifestations revealed fever(92.9%),cough(75.0%),significant fatigue(39.3%),shortness of breath(28.6%),muscle soreness(25.0%),white sticky sputum(21.4%),sore throat(17.9%),nausea and vomiting(10.7%),headache(7.1%),runny nose(3.6%) and abdominal pain(3.6%).Routine blood examinations showed that peripheral blood lymphocyte count(LYM) was decreased in different degrees in16 patients(57.1%),C-reactive protein(CRP) was significantly increased in 17 patients(60.7%),lactate dehydrogenase(LDH) was obviously increased in 12 patients(42.8%),and procalcitonin(PCT) was markedly increased in 15 patients(53.5%),but all of them were less than 1.0 μg/L.The lung window of chest CT showed that the ultra-early ground glass opacity imaging of COVID-19 could be seen at the early stage,mostly distributed in the unilateral or bilateral subpleural or peripheral pulmonary zone;in the early stage,there were ground glass shadow and mesh appearance;in the advance stage,lung consolidation or cord changes might occur,and some bronchial air signs could be seen;after improvement,most of the imaging manifestations disappeared completely,and some of them could form pulmonary fibrosis manifestation.Classification of clinical types:there were 16 cases of common type,9 cases of severe type and 3 cases of critical type.After 10-23 days treatment(mean 18.1 days),the 2019 novel coronavirus(2019-nCoV) nucleic acid detection by pharyngeal swabs or sputum turned negative in all the 28 patients,and the biochemical indexes returned to normal.Among them,26 patients were cured and discharged from hospital,the mean length of hospital stay was 18 days,and the mean time of pharyngeal swab nucleic acid detection turning negative was 13.8 days;one case had other complications after nucleic acid turned negative and finally died;one patient died of suspected pulmonary emblism.Conclusions Most of the patients with COVID-19 in our hospital have a clear history of epidemiology.Fever,cough and fatigue symptoms are often seen.Laboratory examinations and chest CT have specific manifestations of this disease in early stage.Most of the patients are cured and discharged after treatment,but in some patients with underlying diseases,complications may occur and in serious situation,that may lead to death,which should be brought to attention.更多还原