Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province
Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province
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DOI：
10.1097/cm9.0000000000000744
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发表时间：
2020-05-05
影响因子：
6.1
通讯作者：
Liu, Hui-Guo
中科院分区：
文献类型：
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作者：
Liu, Kui;Fang, Yuan-Yuan;Liu, Hui-Guo
背景2019年在中国湖北省武汉市引起肺炎疫情的新型冠状病毒（2019-nCoV）于2020年1月被分离出来。本研究旨在调查其流行病学史，并分析此次疫情期间感染2019-nCoV患者的临床特征，治疗方案和预后。方法回顾性收集2019年12月30日至2020年1月24日湖北省9家三级医院呼吸科收治的137例2019-nCoV感染患者的临床资料，包括一般情况、临床表现、实验室检查结果、影像学特征及治疗方案。结果137例患者（男61例，女76例，年龄20-83岁，中位年龄57岁）均无明确的华南海鲜批发市场接触史。主要初始症状包括发热（112/137，81.8%）、咳嗽（66/137，48.2%）和肌肉疼痛或疲劳（44/137，32.1%），其他较不典型的初始症状出现频率较低，包括心悸、腹泻和头痛。近80%的患者白色细胞计数正常或降低，72.3%（99/137）的患者存在淋巴细胞减少。所有病例均存在肺部受累，大多数胸部计算机断层扫描显示多个肺叶病变，其中一些是致密的;磨玻璃样阴影与实变阴影或索状阴影共存。由于缺乏有效药物，治疗侧重于对症和呼吸支持。根据部分重症患者的病情，给予免疫球蛋白G。全身性皮质类固醇治疗未显示出显著益处。值得注意的是，早期呼吸支持有助于疾病恢复和改善预后。死亡风险主要与年龄、潜在慢性疾病和从出现初始症状到呼吸困难的中位时间间隔相关。结论多数2019-nCoV肺炎患者以发热为首发症状，多数患者胸部影像学仍表现为典型的病毒性肺炎表现。有基础合并症的中老年患者易发生呼吸衰竭，预后可能较差。
Background The 2019 novel coronavirus (2019-nCoV) causing an outbreak of pneumonia in Wuhan, Hubei province of China was isolated in January 2020. This study aims to investigate its epidemiologic history, and analyze the clinical characteristics, treatment regimens, and prognosis of patients infected with 2019-nCoV during this outbreak. Methods Clinical data from 137 2019-nCoV-infected patients admitted to the respiratory departments of nine tertiary hospitals in Hubei province from December 30, 2019 to January 24, 2020 were retrospectively collected, including general status, clinical manifestations, laboratory test results, imaging characteristics, and treatment regimens. Results None of the 137 patients (61 males, 76 females, aged 20-83 years, median age 57 years) had a definite history of exposure to Huanan Seafood Wholesale Market. Major initial symptoms included fever (112/137, 81.8%), coughing (66/137, 48.2%), and muscle pain or fatigue (44/137, 32.1%), with other, less typical initial symptoms observed at low frequency, including heart palpitations, diarrhea, and headache. Nearly 80% of the patients had normal or decreased white blood cell counts, and 72.3% (99/137) had lymphocytopenia. Lung involvement was present in all cases, with most chest computed tomography scans showing lesions in multiple lung lobes, some of which were dense; ground-glass opacity co-existed with consolidation shadows or cord-like shadows. Given the lack of effective drugs, treatment focused on symptomatic and respiratory support. Immunoglobulin G was delivered to some critically ill patients according to their conditions. Systemic corticosteroid treatment did not show significant benefits. Notably, early respiratory support facilitated disease recovery and improved prognosis. The risk of death was primarily associated with age, underlying chronic diseases, and median interval from the appearance of initial symptoms to dyspnea. Conclusions The majority of patients with 2019-nCoV pneumonia present with fever as the first symptom, and most of them still showed typical manifestations of viral pneumonia on chest imaging. Middle-aged and elderly patients with underlying comorbidities are susceptible to respiratory failure and may have a poorer prognosis.