普通型与重型/危重型新型冠状病毒肺炎患者临床特征的对比研究

背景近期关于新型冠状病毒肺炎(COVID-19)疫情的报道较多,但目前关于COVID-19的临床研究尚不足,且关于普通型与重型/危重型COVID-19患者临床特征的对比研究报道较少。目的比较普通型与重型/危重型COVID-19患者的临床特征。方法选取2020年2月5日-2020年2月27日阜阳市第二人民医院收治的COVID-19患者49例,其中普通型22例、重型/危重型27例。比较不同临床分型COVID-19患者一般资料、流行病学特征、首发症状、实验室检查指标、胸部CT检查结果、治疗方法及预后。结果(1)COVID-19重型/危重型患者男性比例、糖尿病发生率及首发症状为疲劳乏力、胸闷气促者所占比例高于普通型患者,年龄大于普通型患者(P<0.05);不同临床分型COVID-19患者高血压、心血管疾病、乙型肝炎及其他基础疾病发生率,潜伏期,有无武汉地区明确接触史、COVID-19确诊病例接触史,发病形式,首发症状为发热、咳嗽、咳痰、腹泻者所占比例比较,差异无统计学意义(P>0.05)。(2)COVID-19重型/危重型患者中性粒细胞分数及D-二聚体、乳酸脱氢酶(LDH)、降钙素原(PCT)、白介素6(IL-6)水平高于普通型患者,淋巴细胞计数、白蛋白水平低于普通型患者,凝血酶原时间(PT)短于普通型患者(P<0.05);不同临床分型COVID-19患者白细胞计数、血小板计数、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血肌酐、尿素氮(BUN)比较,差异无统计学意义(P>0.05)。(3)COVID-19重型/危重型患者双肺感染发生率高于普通型患者(P<0.05)。(4)COVID-19重型/危重型患者抗生素、糖皮质激素、丙种球蛋白使用率及高流量氧疗/辅助通气治疗率高于普通型患者,吸空气、鼻导管吸氧治疗率低于普通型患者(P<0.05);不同临床分型COVID-19患者干扰素雾化治疗率、血浆置换治疗率比较,差异无统计学意义(P>0.05)。截至3月5日,所有患者治愈出院。结论与普通型COVID-19患者相比,重型/危重型COVID-19患者首发症状多表现为疲劳乏力、胸闷气促,多合并糖尿病并表现为双肺感染,中性粒细胞分数及D-二聚体、LDH、PCT、IL-6水平升高,淋巴细胞计数、白蛋白水平下降;不同临床分型COVID-19患者治疗方法存在一定差异,但经对症治疗后预后均较好。     

不同病情严重程度的新型冠状病毒肺炎患者凝血功能分析

目的:分析新型冠状病毒肺炎(COVID-19)患者的凝血指标情况及影响凝血功能的相关因素,为COVID-19患者抗凝治疗提供参考。方法:回顾性分析2020年2月初至3月,华中科技大学同济医学院附属协和医院西院区收治的COVID-19确诊患者123例,其中普通型组(n=39)、重型组(n=66)和危重型组(n=18)。比较三组患者的一般情况、凝血指标、Padua评分,分析影响患者凝血功能和病情程度的危险因素。结果:普通型组与重型组,普通型与危重型在年龄、Padua评分上差异有统计学意义;普通型组与危重型组,重型组与危重型组在D-Dimer水平差异有统计学意义。将普通型及重型+危重型按是否D-Dimer1.00μg/mL各分为两亚组,分析影响凝血指标因素,结果显示重型+危重型亚组患者在白蛋白、前白蛋白及谷丙转氨酶之间差异有统计学意义。结论:年龄、D-Dimer、VTE高危是COVID-19患者病情加重的危险因素,年龄越大、D-Dimer越高、VTE高危的患者病情越重,患者的凝血功能与肝功能相关。     

新型冠状病毒肺炎患者心肌损伤标志物初步探讨

目的:初步探讨不同临床分型新型冠状病毒肺炎(COVID-19)患者心肌损伤标志物特征。方法:本研究是一项回顾性单中心研究,纳入了2020年1月至2020年2月,共122例COVID-19确诊病例,其中轻型/普通型共92例,重型/危重型共30例。通过实时RT-PCR确诊病例,并收集流行病学,人口统计学,临床分析,放射学特征和实验室数据。结果:根据患者病情临床分型,将所有COVID-19患者分为两组,一组为轻型和普通型,另一组为重型/危重型患者。比较两组患者一般情况结果显示:重症/危重型COVID-19患者年龄、WBC、中性粒细胞百分比、血清淀粉样蛋白A、尿素氮、谷草转氨酶、心率、体温、呼吸次数、死亡率和肺部病变范围均高于轻型/普通型患者,而淋巴细胞数、淋巴细胞百分比和血氧饱和度则低于轻型/普通型患者(P<0.05)。比较不同病情分型COVID-19患者心肌损伤标志物水平和急性心肌受损的比例结果提示:重型/危重型患者心肌酶指标、心肌酶升高所占比例和hs-cTnI水平均高于轻型/普通型患者,急性心肌受损的比例(11.1%vs.42.3%)也明显升高(P<0.05)。结论:重症COVID-19患者发生急性心肌损伤的比例为42.3%;重症COVID-19患者心肌酶、hs-cTnI水平高于轻症患者。     

纤维蛋白原联合D-二聚体对新型冠状病毒肺炎预后的预测价值

目的探讨纤维蛋白原联合D-二聚体对COVID-19临床预后的预测价值。方法回顾性分析281例住院治疗的COVID-19患者的临床资料,分析纤维蛋白原联合D-二聚体与COVID-19预后相关性。结果共回顾收集281例住院治疗的COVID-19患者,其中男性157例,女性124例,年龄24-97岁,平均56.7±13.7岁,普通型80例(28.5%),重型132例(47.0%),危重型69(24.6%)。合并至少一种慢性疾病共171例(61.2%)。死亡组患者年龄高于存活组,高龄患者比例与存在基础疾病史的比例,也高于存活组(p<0.05)。死亡组患者纤溶指标(D-二聚体、纤维蛋白原)高于存活组,血浆白蛋白水平低于存活组(P<0.0001)。死亡组患者血红蛋白和淋巴细胞计数低于存活组(P<0.0001),而白细胞计数、单核细胞计数、C-反应蛋白水平高于存活组(P<0.05)。死亡组患者心肌损伤指标(TnI、BNP)高于存活组(P<0.01)。Cox回归提示,纤溶指标异常、淋巴细胞减少、低蛋白血症、心肌损伤是患者住院期间死亡相关的危险因素。D-二聚体升高(≥2.00mg/L)联合纤维蛋白原升高(≥8.11g/L)对COVID-19患者住院期间死亡具有危险因素(敏感性0.80,特异性0.81)。结论D-二聚体和纤维蛋白原是预测COVID-19死亡的指标,早期抗炎联合抗凝治疗可能是提高COVID-19临床救治成功率的一个途径。     

新型冠状病毒肺炎所致凝血功能障碍及其对预后的影响

目的 分析新型冠状病毒肺炎(COVID-19)感染患者血浆D-二聚体、血浆纤维蛋白(原)降解产物(FDPs)等凝血指标的特点,并探讨其对患者病情的预测价值。方法 收集南京医科大学第二附属医院自2022年12月至2023年1月收治的COVID-19感染患者100例,分为轻型组(n=29例),中型组(n=40例)及重型/危重型组(n=31例)。记录患者血浆D-二聚体、FDPs等凝血相关指标水平,分析3组患者凝血指标水平的特点。采用SPSS 27.0软件进行数据分析。根据数据类型,组间比较分别采用LSD-t检验、方差分析、χ²检验、Kruskal-Wallis检验及Bonfferoni校正检验。采用受试者工作特征(ROC)曲线评价FDPs、D-二聚体、年龄及联合分析对预测COVID-19感染患者病死的诊断价值。结果 重型/危重型组患者高龄、合并基础疾病比例及死亡率高于轻型组、中型组,差异有统计学意义(P<0.05);中型组患者血浆FDPs水平、重型/危重型组患者血浆FDPs、D-二聚体水平均高于轻型组,差异有统计学意义(P<0.05);FDPs、D-二聚体、年龄、FDPs与D-二聚体两项联合分析、FDPs与D-二聚体、年龄三项联合分析的ROC曲线下面积分别为0.785(95%CI 0.645～0.926;P<0.01)、0.811(95%CI 0.691～0.03;P<0.01)、0.725(95%CI 0.558~0.891;P<0.05)、0.766(95%CI 0.581~0.951;P<0.05)、0.875(95%CI 0.789~0.962;P<0.01),灵敏度分别为90.9%、100.0%、72.7%、81.8%、100.0%,特异度分别为61.8%、50.6%、78.7%、71.9%、62.9%。结论 COVID-19感染患者血浆D-二聚体、FDPs水平明显升高,且合并高龄对COVID-19感染疾病严重程度及不良预后具有重要预测价值。     

新型冠状病毒肺炎患者凝血及纤溶功能障碍的影响因素及其对预后的影响

目的：评估新型冠状病毒肺炎（COVID-19）患者凝血及纤溶功能损伤相关因素及凝血、纤溶功能障碍对预后的影响。方法：回顾性分析263例COVID-19确诊病例,按照COVID-19诊疗方案（试行第七版）分为轻、重、危重型3组,进一步将其分为非危重型（包括轻型及重型）和危重型2组,分析2组患者的临床特征;根据患者的血清D-二聚体（D-Dimer）及纤维蛋白原降解产物（FDP）水平的正常与否,将2组患者分为D-Dimer正常与异常组及FDP正常与异常组,比较其氧合指标及炎症反应相关指标,将差异有统计学意义的指标纳入多因素logistic回归分析;按照患者是否发生死亡（本研究中死亡病例仅存于危重型患者之中）分为死亡组与存活组,分析2组患者的凝血及纤溶功能,将差异有统计学意义的指标纳入多因素logistic回归分析。结果：非危重型患者D-Dimer异常组较正常组经皮氧饱和度（SpO2）及淋巴细胞计数显著降低,C反应蛋白（CRP）、白细胞及中性粒细胞计数显著升高,白介素6（IL-6）升高患者显著增多,多因素分析结果示：随着SpO2及淋巴细胞计数升高,D-Dimer水平升高的风险降低[OR= 0.806,95%CI（0.707,0.919）,P=0.001及OR=0.09,95%CI（0.010,0.819）,P=0.033]。非危重型患者FDP正常组与异常组上述指标比较结果同上,多因素分析示随着SpO2升高,FDP水平升高的风险降低[OR= 0.868,95%CI（0.768,0.979）,P=0.022]。危重患者FDP异常组较正常组SpO2显著降低（P<0.05）,FDP其余指标及D-Dimer上述指标比较,差异无统计学意义（均P＞0.05）。死亡组较存活组凝血及纤溶功能异常更显著：凝血酶原时间（PT）更长、血清D-Dimer及FDP水平更高（均P<0.05）,死亡患者与存活患者的凝血及纤溶功能多因素分析结果示,PT延长是死亡的危险因素[OR=3.372,95%CI（1.493,7.612）,P=0.003]。结论：入院时较低的SpO2可能导致COVID-19患者血清D-Dimer和FDP水平升高;死亡患者较存活患者凝血及纤溶功能异常更显著,PT延长可能是患者死亡的危险因素。     

广西地区9例重型/危重型新型冠状病毒肺炎患者的临床特征分析

［摘要］　目的　分析广西地区重型、危重型新型冠状病毒肺炎（COVID-19）患者的临床特征,为重型、危重型COVID-19患者临床诊治提供参考。方法　收集2020-02-16～2020-03-16广西壮族自治区人民医院邕武医院收治的9例重型、危重型COVID-19患者的病史、实验室检查、影像学等资料,总结临床诊疗经验。结果　9例重型、危重型COVID-19患者年龄41～85岁,男5例,女4例;重型2例,危重型7例。与重型COVID-19患者相比,危重型患者入院时中性粒细胞比例、D-二聚体、降钙素原、乳酸脱氢酶水平相对较高,淋巴细胞计数、血清白蛋白水平相对较低。2例重型患者均需鼻导管/面罩吸氧,2例危重型患者需高流量吸氧,5例危重型患者需行有创机械通气。2例危重型患者需体外膜肺氧合（ECMO）支持治疗。6例危重型患者并发急性呼吸窘迫综合征、肺部细菌真菌感染、多器官功能障碍综合征。入院后28 d评估病情转归,痊愈出院7例;截至3月16日,2例危重型患者COVID-19治愈后,因基础疾病转至非负压病房ICU治疗。结论　综合治疗及个体化治疗可有效改善重型、危重型COVID-19预后。     

胃癌患者凝血-纤溶状态的临床研究

目的:探讨胃癌患者凝血-纤溶状态变化的临床意义.方法:对80例胃癌患者(胃癌组)的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)、血浆D-二-聚体(D-dimer)进行回顾性分析,并与胃炎组、胃溃疡组、健康组比较.结果:胃癌组与胃溃疡组、胃炎组、健康组比较,PT、APTT、TT值缩短,FIB、D-dimer值增高(均P＜0.05).低分化胃癌PT、APTT、TT、FIB及D-二聚体与高分化胃癌比较差异均有统计学意义(P＜0.05),低分化胃癌与中分化胃癌之间比较差异无统计学意义(P＞0.05),中分化胃癌D-二聚体与高分化胃癌比较差异有统计学意义(P＜0.05).有淋巴结转移胃癌和无淋巴结转移胃癌PT、APTT、TT、FIB及D-二聚体比较差异均有统计学意义(P＜0.05).结论:胃癌患者可能出现复杂的凝血-纤溶系统的改变,检测PT、APTT、TT、FIB及血浆D-二聚体有重要的临床意义.     

维持性血液透析患者新型冠状病毒感染和死亡的危险因素分析

目的：观察维持性血液透析(MHD)患者新型冠状病毒感染(COVID-19)的临床特征，分析患者进展为重型/危重型和死亡的危险因素。方法：回顾性观察2022-12-01～2023-02-01期间COVID-19的MHD患者流行病学特征、基线血液检查结果及透析相关指标，比较重型/危重型与死亡患者临床特征，并进行危险因素分析。结果：共纳入303例MHD患者，279例(92.1%)COVID-19,重型/危重型占7.9%,死亡率4.7%。与轻型/普通型相比，重型/危重型COVID-19患者年龄更大，糖尿病肾脏疾病(DKD)比例和合并糖尿病、冠心病、慢性阻塞性肺疾病(COPD)的比例更高，中心静脉导管使用率更高，基线的血红蛋白、血清白蛋白更低。多因素Logistic分析显示，高龄、糖尿病、COPD、基线血红蛋白较低是MHD患者重型/危重型COVID-19的独立危险因素；死亡患者年龄更大，抗中性粒细胞胞质抗体相关血管炎(AAV)肾损害以及合并糖尿病、冠心病、COPD的比例更高，基线血红蛋白、血清白蛋白更低。多因素Logistic分析显示，高龄、合并糖尿病、COPD、原发病AAV肾损害、较低的基线血...     

北京65例新型冠状病毒肺炎患者临床特征分析

目的分析新型冠状病毒肺炎(COVID-19)确诊病例的流行病学、临床症状及实验室检查指标,为全面总结COVID-19的临床特征与正确评价患者预后提供依据。方法采用回顾性研究方法,以2020年1月20日—2月29日期间本中心收治的65例COVID-19患者为研究对象,根据临床症状将患者分为轻型组(18例),普通型组(31例)和重/危重型组(16例)3组,对所有患者流行病学、临床症状及实验室检查指标进行分析。结果 65例COVID-19患者中男37例(57%),女28例(43%);年龄3～85岁,平均(46.63±18.63)岁。从出现症状到入院平均时长为(7.00±5.02)d,住院时间为(17.07±10.51)d。3组间及两两分组之间年龄比较差异均具有统计学意义(P均0.05),即年龄越大的患者病情越重。相较于轻型组和普通型组患者,重/危重型组患者合并有更多的基础疾病。COVID-19患者临床症状以发热(75%)、咳嗽(57%)、肌痛或乏力(43%)为主,其余症状还包括咳痰,头痛,胸闷、气短及腹泻等。24例(37%)有武汉暴露史,19例(29%)有家族聚集性接触史。实验室检查结果显示:3组患者WBC和淋巴细胞绝对计数降低;D-二聚体,CRP,IL-6及ESR水平升高。在重/危重型组患者中,8例(50%)出现淋巴细胞绝对计数下降,9例(9/14,64%)出现D-二聚体水平升高。此外,重/危重型组患者中,CRP、IL-6、降钙素原和ESR水平都显著升高。COVID-19患者住院时间与淋巴细胞绝对计数呈负相关。结论 COVID-19患者的临床特点复杂,一般以发热、咳嗽、肌痛或乏力为主要症状。与轻型组和普通型组患者相比,重/危重型组患者淋巴细胞绝对计数减少和炎症相关的指标上升更显著,免疫平衡失调,可能影响患者的疾病进展、恢复和预后。     

The effect of coagulation factors in 2019 novel coronavirus patients: A systematic review and meta-analysis

Background:The role of coagulation dysfunction in Severe Coronavirus Disease 2019 (COVID-19) is inconsistent. We aimed to explore the impact of coagulation dysfunction amongst patients with COVID-19.Methods:We searched PubMed, Cochrane and Embase databases from December 1, 2019 to April 27, 2020 following Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Data about coagulation (Platelets, PT, APTT, fibrin, fibrinogen degradation products, D-dimer), prevalence of coagulation dysfunction and mortality were extracted. Meta regression was used to explore the heterogeneity.Results:Sixteen observational studies were included, comprising 2, 139 patients with confirmed COVID-19. More severe COVID-19 cases tended to have higher mean D-dimer (SMD 0.78, 95% CI 0.53 to 1.03, P < .001). The similar pattern occurred with PT and fibrin, with a contrary trend for PLTs. Coagulation dysfunction was more frequent in severe cases compared to less severe (SMD 0.46, 95% CI 0.25 to 0.67, P < .001). Higher mortality was associated with COVID-19-related coagulopathy (RR 10.86, 2.86 to 41.24, P < .001). Prevalence of ARDS was increased in more severe patients than less severe cases (RR 16.52, 11.27 to 24.22, P < .001). PT, fibrin and D-dimer levels elevated significantly in non-survivors during hospitalization.Conclusion:Presence of coagulation dysfunction might be associated with COVID-19 severity, and coagulopathy might be associated with mortality. Coagulation markers including PT, fibrin and D-dimer may imply the progression of COVID-19. This illuminates the necessity of effectively monitoring coagulation function for preventing COVID-19-related coagulopathy, especially in severe patients. For the obvious heterogeneity, the quality of the evidence is compromised. Future rigorous randomized controlled trials that assess the correlation between coagulation and COVID-19 are needed.Trial registration:PROSPERO (CRD42020183514).     

Global haemostatic tests demonstrate the absence of parameters of hypercoagulability in non-hypoxic mild COVID-19 patients: a prospective matched study

Severe COVID-19 patients demonstrate hypercoagulability, necessitating thromboprophylaxis. However, less is known about the haemostatic profile in mild COVID-19 patients. We performed an age and gender-matched prospective study of 10 severe and 10 mild COVID-19 patients. Comprehensive coagulation profiling together with Thromboelastography and Clot Waveform Analysis were performed. FBC, PT, APTT, D-dimer, fibrinogen and CWA were repeated every 3 days for both groups and repeat TEG was performed for severe patients up till 15 days. On recruitment, severe patients had markers reflecting hypercoagulability including raised median D-dimer 1.0 μg/mL (IQR 0.6, 1.4) (p?=?0.0004), fibrinogen 5.6 g/L (IQR 4.9, 6.6) (p?=?0.002), Factor VIII 206% (IQR 171, 203) and vWF levels 265.5% (IQR 206, 321). Mild patients had normal values of PT, aPTT, fibrinogen and D-dimer, and slightly elevated median Factor VIII and von Willebrand factor (vWF) levels. Repeated 3-day assessments for both groups showed declining trends in D-dimer and Fibrinogen. CWA of severe COVID-19 group demonstrated hypercoagulability with an elevated median values of aPTT delta change 78.8% (IQR 69.8, 85.2) (p?=?0.001), aPTT clot velocity (min1) 7.8%/s (IQR 6.7, 8.3) (p?=?0.001), PT delta change 22.4% (IQR 19.4, 29.5) (p?=?0.004), PT min1 7.1%/s (IQR 6.3, 9.0) (p?=?0.02), PT clot acceleration (min 2) 3.6%/s² (IQR 3.2, 4.5) (p?=?0.02) and PT clot deceleration (max2) 2.9%/s² (IQR 2.5, 3.5) (p?=?0.02). TEG of severe patients reflected hypercoagulability with significant increases in the median values of CFF MA 34.6 mm (IQR 27.4,38.6) (p?=?0.003), CRT Angle 78.9° (IQR 78.3, 80.0) (p?=?0.0006), CRT A10 67.6 mm (IQR 65.8, 69.6) (p?=?0.007) and CFF A10 32.0 mm (IQR 26.8, 34.0) (p?=?0.003). Mild COVID-19 patients had absent hypercoagulability in both CWA and TEG. 2 severe patients developed thromboembolic events while none occurred in the mild COVID-19 group. Mild COVID-19 patients show absent parameters of hypercoagulability in global haemostatic tests while those with severe COVID-19 demonstrated parameters associated with hypercoagulability on the global haemostatic tests together with raised D-Dimer, fibrinogen, Factor VIII and vWF levels.

     

凝血指标、炎症指标与COVID-19的关系研究

背景 COVID-19病情严重程度与凝血指标、炎症指标异常等存在一定关系。目的探讨凝血指标、炎症指标与COVID-19的关系。方法回顾性选取武汉大学人民医院2020年1—5月收治的COVID-19患者280例作为观察组,根据预后将其分为存活亚组(n=231)和死亡亚组(n=49)。另选取2020年3—9月本院健康体检者120例作为对照组。分别比较观察组与对照组、存活亚组与死亡亚组一般资料、凝血指标[包括凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、D-二聚体(D-D)]、炎症指标[包括C反应蛋白(CRP)、降钙素原(PCT)]。采用多因素Cox比例风险回归分析探讨COVID-19患者预后的影响因素,绘制受试者工作特征曲线(ROC曲线)分析凝血指标、炎症指标对COVID-19的诊断价值及其预后的预测价值。结果观察组PT长于对照组,血浆FIB、D-D水平及血清CRP、PCT水平高于对照组(P <0.05)。存活亚组年龄小于死亡亚组,冠心病发生率和血浆FIB、D-D及血清CRP、PCT水平低于死亡亚组,PT短于死亡亚组(P <0.05);多因素Cox比例风险回归分析结果显示:年龄[HR=2.869,95%CI(1.497,5.500)]、冠心病[HR=3.796,95%CI(1.680,8.579)]、PT[HR=2.596,95%CI(1.703,3.957)]、血浆D-D水平[HR=2.289,95%CI(1.473,3.557)]及血清CRP[HR=2.542,95%CI(1.607,4.021)]、PCT[HR=2.596,95%CI(1.724,3.910)]水平是COVID-19患者预后的影响因素(P <0.05)。ROC曲线分析结果显示,PT、血浆FIB水平、血浆D-D水平、血清CRP水平、血清PCT水平诊断COVID-19的ROC曲线下面积(AUC)分别为0.592[95%CI(0.542,0.641)]、0.665[95%CI(0.616,0.711)]、0.680[95%CI(0.631,0.725)]、0.690[95%CI(0.642,0.735)]、0.632[95%CI(0.583,0.680)];PT、血浆D-D水平、血清CRP水平、血清PCT水平预测COVID-19患者预后的AUC分别为0.536[95%CI(0.479,0.596)]、0.593[95%CI(0.533,0.651)]、0.603[95%CI(0.543,0.660)]、0.637[95%CI(0.577,0.693)]。结论年龄、冠心病、PT、血浆D-D水平及血清CRP、PCT水平是COVID-19患者预后的影响因素,而凝血指标、炎症指标对COVID-19诊断及其预后预测并无较大价值。     

伴或不伴血管钙化的新型冠状病毒肺炎危重症患者临床特征及转归的回顾性分析

目的分析伴或不伴血管钙化的新型冠状病毒肺炎(COVID-19)危重症患者临床特征及转归的差异。方法对2020年2月入住华中科技大学同济医学院附属同济医院重症监护室的COVID-19危重症患者进行回顾性分析。根据胸部CT表现,将患者分为血管钙化组和非血管钙化组,其中血管钙化组又分为主动脉钙化组、冠状动脉钙化组和同时钙化组(主动脉、冠状动脉均有钙化)。比较不同组别患者的临床特征及转归。结果与非血管钙化组相比,血管钙化组患者年龄偏大,合并高血压与冠心病比例更高,表现为更高的白细胞计数、中性粒细胞计数、C反应蛋白、球蛋白、乳酸脱氢酶、国际标准化比值、D-二聚体、肌酐、肌酸激酶同工酶、高敏肌钙蛋白、肌红蛋白、N末端B型脑钠肽原,较低的淋巴细胞计数、血小板计数、白蛋白、估算的肾小球滤过率,且死亡风险更高。与主动脉钙化组比较,冠状动脉钙化组和同时钙化组的转归更差。结论血管钙化特别是冠状动脉钙化可能是COVID-19危重症患者预后不良的危险因素。     

Corona Virus Disease 2019 patients with different disease severity or age range: A single-center study of clinical features and prognosis

This study aimed to describe clinical characteristics and prognosis of Corona Virus Disease 2019 (COVID-19) patients, and to compare these features among COVID-19 patients with different disease severity or age range.Totally, 129 COVID-19 patients were retrospectively enrolled, and the information about demographics, comorbidities, medical histories, clinical symptoms, and laboratory findings at the time of hospital admission were collected. Meanwhile, their clinical outcomes were recorded. According to the fourth version of the guidelines on the Diagnosis and Treatment of COVID-19 by the National Health Commission of China, patients were divided into subgroups according to disease severity (moderate and severe/critical) or age (<40 years, 40–64 years and ≥65 years).In total patients, the most common clinical symptoms were fever and cough (all incidences over 50%). Other common clinical symptoms included tiredness/anorexia, shortness of breath, dyspnea, aching pain, expectoration, diarrhea, shivering, and nausea/vomiting. The mortality rate was 5.4%, and the median value of hospital stay was 16.0 (11.0–23.0) days. Subgroup analyses disclosed that severe/critical patients exhibited increased neutrophil count, neutrophils, C-reactive protein, calcitonin, alpha-hydroxybutyric dehydrogenase, lactate dehydrogenase, aspartate aminotransferase, gamma-glutamyl transferase, creatinine, and D-dimer levels, and more deaths compared with that in moderate patients. Regarding age, it correlated with more common fever, higher levels of red blood cell, neutrophil count, lymphocyte count, neutrophils, red cell volume distribution width standard deviation-coefficient of variation, calcitonin, alpha-hydroxybutyric dehydrogenase, Creatine Kinase, aspartate aminotransferase, gamma-glutamyl transferase, and D-dimer, raised death rate and prolonged hospital stay.Our findings provide valuable evidence regarding clinical characteristics and prognosis of COVID-19 patients to help with the understanding of the disease and prognosis improvement.     

Role of Cardiac Biomarkers in COVID-19: What Recent Investigations Tell Us?

Purpose of review: Although the respiratory system is the main target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is evident from recent data that other systems, especially cardiovascular and hematological, are also significantly affected. In fact, in severe form, COVID-19 causes a systemic illness with widespread inflammation and cytokine flood, resulting in severe cardiovascular injury. Therefore, we reviewed cardiac injury biomarkers' role in various cardiovascular complications of COVID 19 in recent studies. Recent findings: Cardiac injury biomarkers were elevated in most of the complicated cases of COVID-19, and their elevation is directly proportional to the worst outcome. Evaluation of cardiac biomarkers with markers of other organ damage gives a more reliable tool for case fatalities and future outcome. Summary: Significant association of cardiac biomarkers in COVID-19 cases helps disease management and prognosis, especially in severely ill patients.     

Relation of D-dimer levels of COVID-19 patients with diabetes mellitus

Background and aimsDiabetes is a frequent comorbidity in patients with Severe COVID-19 infection associated with a worse prognosis. Hypercoagulability with elevation in D-dimer levels has been demonstrated in patients with COVID-19. This study aims to study D-dimer levels in people with diabetes compared to those without diabetes among patients with COVID-19 infection.MethodsIn this observational study 98 moderate and severely ill patients with COVID-19 infection were included at a dedicated COVID hospital. The study group was divided into patients with diabetes and without diabetes. Peak D-dimer was measured in both the groups and compared using appropriate statistical tests.ResultsIn our study peak D-dimer levels were 1509 ± 2420 ng/mL (Mean ± SD) in people with diabetes and 515 ± 624 ng/mL (Mean ± SD) in patients without diabetes. Patients with diabetes had higher D-dimer levels which were statistically significant.ConclusionsThis study shows COVID-19 patients with diabetes had significantly higher D-dimer levels. Therefore, it is possible that COVID-19 infection with diabetes is more likely to cause hypercoagulable state with a worse prognosis. However clinical implications of these findings will need to be seen in further studies.     

Coagulation System Activation for Targeting of COVID-19: Insights into Anticoagulants,Vaccine-Loaded Nanoparticles,and Hypercoagulability in COVID-19 Vaccines

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, is currently developing into a rapidly disseminating and an overwhelming worldwide pandemic. In severe COVID-19 cases, hypercoagulability and inflammation are two crucial complications responsible for poor prognosis and mortality. In addition, coagulation system activation and inflammation overlap and produce life-threatening complications, including coagulopathy and cytokine storm, which are associated with overproduction of cytokines and activation of the immune system; they might be a lead cause of organ damage. However, patients with severe COVID-19 who received anticoagulant therapy had lower mortality, especially with elevated D-dimer or fibrin degradation products (FDP). In this regard, the discovery of natural products with anticoagulant potential may help mitigate the numerous side effects of the available synthetic drugs. This review sheds light on blood coagulation and its impact on the complication associated with COVID-19. Furthermore, the sources of natural anticoagulants, the role of nanoparticle formulation in this outbreak, and the prevalence of thrombosis with thrombocytopenia syndrome (TTS) after COVID-19 vaccines are also reviewed. These combined data provide many research ideas related to the possibility of using these anticoagulant agents as a treatment to relieve acute symptoms of COVID-19 infection.