南通地区聚集性新型冠状病毒肺炎患者临床特征分析

目的:分析南通地区聚集性新型冠状病毒肺炎(COVID-19)患者的临床特点。方法:采用单中心回顾性研究,收集2020年1月27日至2月17日南通市第三人民医院隔离收治的15例聚集性COVID-19患者资料。按照病例暴露场所将患者分为5组,分析其流行病学特征、临床表现、实验室检查和影像学特点。结果:15例患者中,男性7例,女性8例。年龄为27～67岁,5组患者平均年龄为(47.33±14.38)岁、(51.50±5.50)岁、(65.00±1.00)岁、(52.00±1.79)岁、(57.33±12.28)岁。潜伏期平均为(3.00±1.41)d、(5.50±0.50)d、(5.00±0.00)d、(9.20±4.26)d、(8.67±4.11)d。轻型患者1例(6.7%),普通型13例(86.7%),重型1例(6.7%)。5组患者中,临床表现以发热为主的患者13例(86.7%),乏力14例(93.3%),咳嗽9例(58.7%),呼吸困难6例(40%)。基础疾病以高血压为主,并发症以肝损害为主,1例(6.7%)无任何临床表现。患者均有不同程度CD4~+T淋巴细胞计数、CD8~+T淋巴细胞计数及B淋巴细胞计数下降,其中3组平均淋巴细胞计数下降明显。感染指标如C-反应蛋白(CRP)、红细胞沉降率(ESR)、铁蛋白普遍升高,降钙素原(PCT)均表现为正常。肝功能除天门冬氨酸转氨酶(AST)轻度升高外,余均正常。乳酸水平均升高。氧合指数有1组(20%)患者明显降低。影像学改变主要为双侧病变,无胸腔积液。结论:南通地区聚集性COVID-19病例以家庭聚集性病例为主,中老年患者居多,慢性病高血压为常见基础疾病,肝损害为主要并发症,基本为普通型。临床表现主要为发热、乏力、咳嗽。实验室检查血乳酸水平均升高,T淋巴细胞计数明显下降,余无特异性改变。

Clinical characteristics of patients with clustering novel coronavirus pneumonia in Nantong

Objective: To analyze the clinical characteristics of patients with clustering of novel coronavirus pneumonia (COVID-19) in Nantong. Methods: The retrospective single-center research method was used to collect the general data of 15 cases of clustered COVID-19 patients isolated in Nantong Third People''s Hospital from January 27 to February 17, 2020. According to the cluster epidemic investigation and analysis, we divided patients into five groups, and analyzed their epidemiological characteristics, clinical manifestations, laboratory and imaging characteristics. Results: Of the 15 patients, 7 were male and 8 were female.The age range was 27 to 67 years old. The average age of the patients in the five groups were (47.33±14.38), (51.50±5.50), (65.00±1.00), (52.00±1.79), and (57.33±12.28) years old. The average incubation period were (3.00±1.41)d, (5.50±0.50)d, (5.00±0.00)d, (9.20±4.26)d, (8.67±4.11)d. 1(6.7%) patient was light, 13(86.7%) were normal, and 1(6.7%) was severe. Common symptoms included fever (13 cases, 86.7%), fatigue (14 cases, 93.3%), cough (9 cases, 58.7%), dyspnea (6 cases, 40%). The main underlying disease was hypertension, and the liver damage was the main complication. 1(6.7%) case didn''t have any clinical manifestations. All of the patients had decreased lymphocyte counts. The CD4⁺T lymphocyte counts, CD8⁺T lymphocyte counts, and B lymphocyte counts decreased and the average lymphocyte counts of three groups decreased significantly. Infection indicators such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and ferritin were generally elevated, and procalcitonin (PCT) was normal. Except for a slight increase in aspartate aminotransferase (AST), liver function was normal. The lactic acid level was high. The oxygenation index decreased significantly in one group (20%). The imaging changes were mainly bilateral lesions without pleural effusion. Conclusions: The cases of COVID-19 in Nantong are mainly clustered in families. They tend to be middle-aged and elderly, and often co-exist with chronic diseases and hypertension. Liver damage is the main complication, which is basically common. Clinical manifestations are fever, fatigue, and cough. Laboratory tests show that blood lactate levels are high, T-lymphocyte counts are significantly reduced, and the rest remain unchanged.