新型冠状病毒肺炎28例的临床特征分析

目的分析28例新型冠状病毒肺炎(novel coronavirus pneumonia,NCP)患者的临床特征及诊疗经验。方法收集2020年1月22日至2月5日南宁市第四人民医院收治的28例NCP患者的临床资料。回顾性分析患者的临床表现、流行病学史、实验室检查、影像学检查和治疗方案。结果28例NCP患者中,1例轻型,25例普通型,2例重型,咽拭子新型冠状病毒核酸检测均为阳性;其中有4起家庭聚集性发病。临床症状以发热、咳嗽为主,短期内进展迅速。28例患者自发病以来体温(腋下)峰值在36.6~39.5℃,其中5例患者整个病程中无发热,体温峰值≤37.0℃。患者从接触至出现症状的时间为1~12 d,从出现症状至核酸检测阳性时间为0~13 d。入院时白细胞计数降低者2例,C反应蛋白升高者5例;丙氨酸转氨酶异常者6例;天冬氨酸转氨酶异常者3例,肌酸激酶升高者10例;肌酸激酶同工酶升高者3例;乳酸脱氢酶升高者4例;降钙素原水平均在正常范围。胸部计算机断层成像表现主要为磨玻璃影(21例),边缘模糊(18例),斑点、斑片影(17例),部分肺纹理增粗、紊乱(7例),可见条索影(7例),病变常进展迅速。1例11岁患儿单用α-干扰素雾化吸入;27例患者予α-干扰素雾化吸入,洛匹那韦利托那韦抗病毒治疗,其中4例出现不良反应后停用。截至2月12日,共9例患者治愈出院,均为普通型,无死亡。结论NCP发病早期以发热、咳嗽为主,肺部病变进展迅速,应尽早、反复多次进行呼吸道病原体检测,以提高新型冠状病毒核酸检测阳性率,对于核酸检测阴性的可疑人群应慎重解除隔离。

Clinical characteristics of 28 patients with novel coronavirus pneumonia

Objective To analyze the clinical characteristics and experiences in diagnosis and treatment of the patients with novel coronavirus pneumonia(NCP).Methods Clinical data of 28 patients with NCP in the Fourth People′s Hospital of Nanning from January 22 to February 5 in 2020 were collected.The clinical manifestations,epidemiological history,laboratory tests,imaging examinations and treatments of patients were analyzed retrospectively.Results The 28 patients with NCP included one mild case,25 ordinary cases and two severe cases.They were all positive for 2019 novel coronavirus(2019-nCoV)nucleic acid in throat swabs.There were four groups of family clusters.The clinical symptoms were mainly fever and cough,which progressed rapidly in a short period of time.Since the onset of illness,the peak values of axillary temperature of the 28 patients were 36.6℃to 39.5℃,while five patients had no fever throughout the course of the disease with the peak temperature≤37.0℃.The illness onset ranged from 1 to 12 days after exposure,and the time from the symptom onset to the positive results of the nucleic acid tests was 0 to 13 days.There were two patients presented with decreased white blood cell counts,five patients with elevated C reactive protein,six patients with abnormal alanine aminotransferase,three patients with abnormal aspartate aminotransferase,10 patients with elevated creatine kinase,three patients with elevated creatine kinase isoenzyme,four patients with elevated lactate dehydrogenase,and all with normal procalcitonin levels.The chest computed tomography examinations showed that the common features of patients with NCP were ground glass shadows(21 cases),blurred edges(18 cases),speckles and patchy shadows(17 cases),thickening and disorder of some lung textures(seven cases),and visible band shadows(seven cases).Pulmonary lesions often progressed rapidly.A included 11-year-old child was treated with alpha-interferon alone.A total of 27 patients were treated with alpha-interferon inhalation and lopinavir/ritonavir,while four occured withdrawal due to adverse reactions.Up to February 12,nine patients had been cured and discharged who were all ordinary cases,without death cases.Conclusions The NCP patients mostly present with fever and cough.Pulmonary lesions often progress rapidly.Respiratory pathogen testing should be conducted as early as possible and repeatedly.Disisolation should be cautious for suspected people who are negative for 2019-nCoV nucleic acid in pharynx swabs.