【摘要】 目的 探讨糖尿病并发新型冠状病毒肺炎（corona virus disease 2019,COVID 19）患者的临床常规实验室指标变化及其临床意义。方法 收集2020年1月21日～3月2日在河南省南阳市中心医院感染性疾病科就诊的COVID 19患者，分为糖尿病（diabetes mellitus,DM）组和非糖尿病（non-diabetes mellitus,NDM）组，采用Mann-Whitney U检验和Kruskal-Wallis H检验比较组间常规检测指标的差异，并用Logistic回归对重症患者进行危险因素分析。结果 (1)共有NDM组36例，DM组17例，DM组的年龄显著高于NDM组（59.12±10.92岁vs 45.03±16.73岁），差异具有统计学意义（t=3.31,P=0.001）；(2)与NDM组相比，DM组的中性粒细胞计数[（5.85±3.29）×109/L]，纤维蛋白原浓度（4.71±1.37 g/L）,D-二聚体[0.63(0.22,2.81) mg/L],C反应蛋白[18.30(12.81,54.10)mg/L]和白细胞介素-4(2.55±0.49pg/ml)水平显著高于NDM组[（3.41±1.93）×10~9/L,3.54±0.82 g/L, 0.22(0.16,0.39) mg/L,8.05(1.59,16.45)mg/L,(2.01±0.63pg/ml)]，差异均有统计学意义（t=2.45～3.40，均P<0.05），而淋巴细胞计数显著低于NDM组[（0.83±0.45）×109/L vs(1.32±0.50)×10~9/L]，差异有统计学意义（t=-3.42,P=0.001）；(3)随着血糖水平的升高，COVID-19患者的淋巴细胞计数逐渐降低[（1.50±0.41）×109/L,(1.19±0.55)×10~9/L,(0.78±0.33)×109/L]，差异有统计学意义（F=13.93,P=0.001），而纤维蛋白原浓度（3.24±0.54 g/L,3.90±0.98 g/L,4.63±1.53 g/L）、D-二聚体[0.16(0.12,0.42)mg/L, 0.27(0.16, 0.44)mg/L,0.63(0.22,2.81)mg/L]和C反应蛋白[5.10(1.58,10.84)mg/L,9.40(2.80,28.40)mg/L,27.93(12.81,64.39)mg/L]水平逐渐升高，差异有统计学意义（F=9.30～13.32，均P <0.05）；(4) DM组患重症（包括重型和危重型）COVID-19的比例显著高于NDM组（58.80%vs 16.67%），差异有统计学意义（χ~2=0.43,P=0.002），且住院时间显著长于NDM患者（15.18±5.43天vs 10.39±5.82天），差异有统计学意义（t=2.87,P=0.004）。调整性别和年龄后发现，淋巴细胞计数（风险比[HR]=0.023,P=0.011）、糖尿病（HR=5.33,P=0.026）是COVID-19患者罹患重症的独立危险因素。结论 糖尿病并发COVID-19患者处于高凝状态，炎症反应更显著，糖尿病是COVID-19患者罹患重症的独立危险因素。更多还原

【Abstract】 Objective To explore the clinical routine laboratory changes and their clinical significance in patients with diabetes mellitus complicated with corona virus disease 2019(COVID-19). Methods The test data of COVID-19 patients were collected from January 21st to March 2nd, 2020 in the Department of Infectious Diseases, Nanyang Central Hospital of Henan Province.The patients were divided into a Diabetes Mellitus(DM) group and a non-Diabetes Mellitus(NDM) group. Mann-Whitney U test and Kruskal-Wallis H test were used to compare the differences between the two groups, and Logistic regression analysis was used to analyze the risk factors of severe patients. Results(1) There were 36 cases in the non-DM group and 17 cases in the DM group. The age of the DM group was significantly higher than that of the non-DM group(59.12±10.92 years vs 45.03±16.73years), the difference was statistically significant(t=3.31, P=0.001).(2)The neutrophil count[(5.85±3.29)×109/L], FIB(4.71±1.37 g/L), D-dimer [0.63(0.22,2.81) mg/L], C-reactive protein [18.30(12.81,54.10)mg/L] and interleukin-4 levels(2.55±0.49pg/ml)of the DM group were significantly higher than those in the non-DM group[(3.41±1.93)×109/L,3.54±0.82 g/L,0.22(0.16,0.39) mg/L,8.05(1.59,16.45)mg/L,2.01±0.63pg/ml],the differences were statistically significant(t=2.45 ～ 3.40,all P < 0.05), while the lymphocyte count was significantly lower than those of the non-DM group[(0.83±0.45)×109/L vs(1.32±0.50)×109/L],the difference was statistically significant(t=-3.42,P=0.001).(3) With the increase of blood glucose levels, the lymphocyte count [(1.50±0.41)×109/L,(1.19±0.55)×109/L,(0.78±0.33)×109/L] of COVID-19patients gradually decreased, while FIB(3.24±0.54 g/L,3.90±0.98 g/L,4.63±1.53 g/L), D-dimer [0.16(0.12,0.42)mg/L,0.27(0.16,0.44)mg/L,0.63(0.22,2.81)mg/L] and C-reactive protein [5.10(1.58,10.84)mg/L,9.40(2.80,28.40)mg/L,27.93(12.81,64.39)mg/L] levels gradually increased,the differences were statistically significant(F=9.30～ 13.93,respectively,all P < 0.05).(4) The proportion of severe COVID-19(58.80% vs 16.67%) and hospital stay(15.18±5.43day vs 10.39±5.82 day)in the DM group were significantly higher than that of the non-DM group, the differences were statistically significant（χ2=0.43, P=0.002;t=2.87, P=0.004）. After adjusting for gender and age, lymphocyte count(hazard ratio [HR]=0.023, P=0.011) and diabetes(HR=5.33, P=0.026) were independent risk factors for severe COVID-19 patients.Conclusion COVID-19 patients with diabetes were in a hypercoagulable state, and the inflammatory response was more pronounced. Individualized hypoglycemic therapy should be implemented for them.更多还原