作者：李雅琳1 ，单南冰 2 ，孙伟 2 ，王保贵 3 ，李东风 1

单位：

1.236000 安徽省阜阳市人民医院重症医学科　；2.236000 安徽省阜阳市第二人民医院重症医学科；　3.236000 安徽省阜阳市人民医院感染科；通信作者：李东风，E-mail：fylidongfeng@163.com

Units：

1.Department of Critical Care Medicine，the People's Hospital of Fuyang，Fuyang 236000，China；2.Department of Critical Care Medicine，the Second People's Hospital of Fuyang，Fuang 236000，China；3.Department of Infectious Disease，the People's Hospital of Fuyang，Fuyang 236000，China；Corresponding author：LI Dongfeng，E-mail：fylidongfeng@163.com

关键词：

新型冠状病毒肺炎；疾病特征；诊断；治疗；预后；对比研究

Keywords：

COVID-19；Disease attribute；Diagnosis；Treatment；Prognosis；Comparative study

CLC：

R 563.1

DOI：

DOI：10.3969/j.issn.1008-5971.2020.03.004

Funds：

阜阳市首批新型冠状病毒感染的肺炎疫情防控应急科技攻关项目

摘要：

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。

Abstract：

Backgroud　There are many reports about COVID-19 epidemic recently，however，clinical researcheson COVID-19 are still insufficient at present，especially in reports about comparison of clinical features between COVID-19patients with conventional type and heavy/critical type. Objective　To compare the clinical features between COVID-19 patientswith conventional type and heavy/critical type. Methods　A total of 49 patients with COVID-19 were selected in the SecondPeople's Hospital of Fuyang from 2020-02-05 to 2020-02-27，including 22 cases with conventional type and 27 cases withheavy/critical type. General information，epidemiologic features，initial symptoms，laboratory examination results，chestCT examination results，therapeutic methods and prognosis were compared between COVID-19 patients with conventionaltype and heavy/critical type. Results　（1）Compared with those in COVID-19 patients with conventional type，COVID-19patients with heavy/critical type showed statistically significantly higher male ratio，incidence of diabetes，proportion of patientsperformed fatigue，chest tightness and shortness of breath as initial symptoms（P<0.05）；age in COVID-19 patients withheavy/critical type was statistically significantly older than that in COVID-19 patients with conventional type（P<0.05）；therewas no statistically significant difference in incidence of hypertension，cardiovascular disease，hepatitis B or other underlyingdiseases，incubation period，with a clear history of exposure in Wuhan or not，with contact history of confirmed cases of COVIDor not，onset forms，proportion of patients performed fever，cough，expectoration or diarrhea as initial symptom betweenCOVID-19 patients with conventional type and heavy/critical type（P>0.05）.（2）Compared with those in COVID-19 patientswith conventional type，COVID-19 patients with heavy/critical type showed higher neutrophil fraction，D-dimer，LDH，PCTand IL-6，lower lymphocyte count and albumin，and shorter PT（P<0.05）；there was no statistically significant differencein white blood cell count，platelet count，APTT，FIB，AST，ALT，blood creatinine or BUN between COVID-19 patientswith conventional type and heavy/critical type（P>0.05）.（3）Incidence of bilateral lung infection in COVID-19 patients withheavy/critical type was statistically significantly higher than that in COVID-19 patients with conventional type.（4）Utilizationrates of antibiotics，glucocorticoids，gamma globulin and high flow oxygen therapy/auxiliary ventilation in COVID-19 patientswith heavy/critical type were statistically significantly higher than those in COVID-19 patients with conventional type，whileratio of air entrainment and nasal catheter oxygen inhalation in COVID-19 patients with heavy/critical type was statisticallysignificantly lower than that in COVID-19 patients with conventional type，respectively（P<0.05）；there was no statisticallysignificant difference in ratio of interferon atomization therapy or plasmapheresis between COVID-19 patients with conventionaltype and heavy/critical type（P>0.05）. Up to 2020-03-05，all of the 49 patients with COVID-19 were cured and discharged.Conclusion　Compared to COVID-19 patients with conventional type，most of COVID-19 patients with heavy/critical typeperform fatigue，chest tightness and shortness of breath as initial symptoms，merged with diabetes and complicated with lunginfection，with elevated neutrophil fraction，D-dimer，LDH，PCT and IL-6，but decreased lymphocyte count and albumin；there is some difference in therapeutic methods between COVID-19 patients with conventional type and therapeutic method，however prognosis of the 49 patients is relatively good after symptomatic treatment.

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