Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
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DOI：
10.1016/s0140-6736(20)30183-5
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发表时间：
2020-02-15
期刊：
影响因子：
168.9
通讯作者：
Cao, Bin
中科院分区：
文献类型：
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作者：
Huang, Chaolin;Wang, Yeming;Cao, Bin
中国武汉最近发生的一系列肺炎病例是由一种新型β冠状病毒，即2019新型冠状病毒（2019-nCoV）引起的。我们报告了这些患者的流行病学、临床、实验室和放射学特征以及治疗和临床结局。我们通过实时RT-PCR和下一代测序前瞻性地收集和分析了实验室确认的2019-nCoV感染患者的数据。使用世卫组织和国际严重急性呼吸道和新发感染联合会共享的标准化数据收集表从电子病历中获得数据。研究人员还直接与患者或其家属沟通，以确定流行病学和症状数据。结果截至2020年1月2日，已有41名住院患者被确定为实验室确诊的2019-nCoV感染。大多数受感染的患者是男性（41人中有30人[73%]）;不到一半的人患有基础疾病（13人[32%]），包括糖尿病（8人[20%]），高血压（6人[15%]）和心血管疾病（6人[15%]）。中位年龄为49.0岁（IQR 41.0-58.0）。41例患者中有27例（66%）曾在华南海鲜市场接触。发现一个家族聚集性病例，发病时的常见症状为发热（41例患者中的40例[98%]），咳嗽（31 [76%]），以及肌痛或疲劳（18人[44%]）;不常见的症状是痰生产（39例中11例[28%]）、头痛（38例中3例[8%]）、咯血（39例中2例[5%]）和腹泻（38例中1例[3%]）。40例患者中有22例（55%）发生呼吸困难（从疾病发作至呼吸困难的中位时间为8.0天[IQR 5.0-13.0]）。41例患者中26例（63%）出现淋巴细胞减少症。41例患者均为肺炎，胸部CT均异常。并发症包括急性呼吸窘迫综合征（12例[29%]）、RNA血症（6例[15%]）、急性心脏损伤（5例[12%]）和继发性感染（4例[10%]）。13例（32%）患者入住ICU，6例（15%）患者死亡。与非ICU患者相比，ICU患者的IL 2、IL 7、IL 10、GSCF、IP 10、MCP 1、MIP 1A和TNF α的血浆水平更高。解读2019-nCoV感染引起与严重急性呼吸综合征冠状病毒相似的严重呼吸道疾病聚集，与ICU入院和高死亡率相关。我们对疾病的起源、流行病学、人类传播持续时间和临床谱的认识存在重大差距，需要通过今后的研究加以弥补。版权所有（C）2020爱思唯尔有限公司保留所有权利。
Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients.Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not.Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49.0 years (IQR 41.0-58.0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8.0 days [IQR 5.0-13.0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNF alpha.Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Copyright (C) 2020 Elsevier Ltd. All rights reserved.