新型冠状病毒肺炎患者不同临床转归影响因素分析

目的:回顾性分析新型冠状病毒肺炎(COVID-19)治愈患者和死亡患者的临床特征,分析差异,为临床诊疗提供参考。方法:选取2020年1月10日至2月15日华中科技大学同济医学院附属同济医院收治的113例COVID-19患者为研究对象,根据病情转归分为治愈组69例,死亡组44例。收集2组患者的临床特征、实验室检查、影像学结果等,分析组间差异以及与预后的关系。结果:113例COVID-19患者平均年龄为(58.6±15.9)岁,男性68人,女性45人。死亡组患者较治愈组患者年龄更大,男性比例更高,合并症比例更高,差异有统计学意义(P<0.05)。影像学方面,死亡组更多表现为双肺的弥漫病变(P<0.05)。在实验室检查中,死亡组患者较治愈组患者白细胞计数和中性粒细胞计数增加,淋巴细胞计数降低(P<0.05)。在炎症相关指标中,死亡组患者C-反应蛋白(CRP)、铁蛋白、D-D二聚体、乳酸脱氢酶(LDH)、白细胞介素2受体(interleukin 2 receptor,IL-2R)、IL-6、IL-8、IL-10、肿瘤坏死因子-α(TNF-α)明显高于治愈组患者(P<0.01)。对有差异的指标进行受试者工作特征(ROC)曲线分析,发现D-D二聚体的曲线下面积高于其他指标,灵敏度为90.3%,特异度为90.2%,是较好的预测指标。结论:高龄、男性、有合并症的COVID-19患者死亡风险更大;CRP、D-D二聚体、IL-2R等细胞因子水平的升高均提示预后不良;D-D二聚体对于患者预后有着较高的预测价值,综合考虑各项指标,更有助于判断患者转归,指导治疗。

Risk factors and their influence on the COVID-19 patients with different outcome

Objective:To retrospectively analyze the clinical characteristics of COVID-19 cured and dead patients,analyze the differences,and provide theoretical basis for clinical diagnosis and treatment.Methods:Totally,113 COVID-19 patients treated in Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from January 10 to February 15,2020 were divided into cured group(n=69)and death group(n=44).The clinical features,laboratory examination and imaging results of the two groups were collected,and the differences between the two groups and their relationship with prognosis were analyzed.Results:113 COVID-19 patients with an average age of(58.6±15.9)years old,includes 68 males and 45 females.Compared with the cured group,the patients in the death group were older,the proportion of males was higher,the proportion of complications was higher,and the differences were statistically significant(P<0.05).In terms of imaging,the death group was more likely to show diffuse infection of both lungs(P<0.05).In the laboratory examination,the leukocyte count and neutrophil count of the death group were significantly higher than those of the cured group,while the lymphocyte count was significantly lower(P<0.05).Among the inflammation related indexes,C-reactive protein(CRP),ferritin,D-D dimer,lactate dehydrogenase(LDH),interleukin 2 receptor(IL-2R),IL-6,IL-8,IL-10 and tumor necrosis factor(TNF-α)in the death group were significantly higher than those in the cured group.Receiver operating characteristic(ROC)curve analysis of indexes with statistical differences showed that the area under the curve of D-D dimer was higher than other indexes,with sensitivity of 90.3%and specificity of 90.2%.Conclusions:The risk of death is higher in the elderly,male patients with underlying disease.The high levels of CRP,D-D dimer,IL-2R and other cytokines suggest poor prognosis.D-D dimer has a high predictive value for the prognosis of patients.Comprehensive consideration of various indicators is more helpful to judge the outcome of patients and guide treatment.