作者：郭丽蕊,张艳冰,杨吉安,林璞旋,唐燕娣,陈秋香

单位：

1.430060 湖北省武汉市，武汉大学人民医院神经外科 2.430060 湖北省武汉市，武汉大学人民医院肝胆外科 3.433100 湖北 省潜江市中心医院神经外科 通信作者：张艳冰，E-mail：zhangyanbing0207@126.com

Units：

1.Department of Neurosurgery, People's Hospital of Wuhan University, Wuhan 430060, China 2.Department of Hepatobiliary Surgery, People's Hospital of Wuhan University, Wuhan 430060, China 3.Department of Neurosurgery, Qianjiang Central Hospital, Qianjiang 433100, China Corresponding author: ZHANG Yanbing, E-mail: zhangyanbing0207@126.com

关键词：

新型冠状病毒肺炎; 实验室检查; 预后; 危险因素;

Keywords：

COVID-19; Laboratory examination; Prognosis; Risk factors

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.267

Funds：

潜江市科技局科研项目（潜科文 2021-11-001）

摘要：

背景目前,新型冠状病毒肺炎(COVID-19)仍是全球亟待解决的重大公共卫生事件,而早期预警和病情判断对有效控制患者病情进展具有重要意义。目的 分析COVID-19患者实验室检查指标及其预后的危险因素。方法 选取2020-02-01至2020-05-01在武汉大学人民医院住院的COVID-19患者90例作为观察组,另选取同期同年龄段以发热、咳嗽入院的普通肺炎患者90例作为对照组。比较两组患者实验室检查指标及不同预后(分为生存和死亡)患者临床资料。COVID-19患者预后的影响因素分析采用多因素Logistic回归分析。结果 观察组患者白细胞计数(WBC)、淋巴细胞计数(L)、中性粒细胞计数(N)低于对照组(P <0.05)。观察组患者丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、C反应蛋白(CRP)高于对照组,总胆红素(TBiL)、清蛋白(Alb)、胆碱酯酶(ChE)、Ca2+低于对照组(P <0.05)。观察组患者CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞水平低于对照组(P <0.05)。死亡患者年龄≥60岁、有吸烟史、有高血压病史、有慢性阻塞性肺疾病(COPD)病史、咳嗽性质为湿咳、起病合并头痛、疾病分型为重症者占比及ALT、AST、CRP高于生存患者,L及CD3+T淋巴细胞、CD4+T淋巴细胞、CD8+T淋巴细胞水平低于生存患者(P <0.05)。多因素Logistic回归分析结果显示,年龄≥60岁、咳嗽性质为湿咳、起病合并头痛、疾病分型为重症、CRP≥40.3 mg/L、CD3+T淋巴细胞水平<1 289个/μl、CD4+T淋巴细胞水平<560个/μl、CD8+T淋巴细胞水平<522个/μl是COVID-19患者预后的危险因素(P<0.05)。结论 与普通肺炎患者相比,COVID-19患者肝功能及淋巴细胞功能损伤更为严重,免疫力更差。且年龄≥60岁、咳嗽性质为湿咳、起病合并头痛、疾病分型为重症、高水平CRP及低水平CD3+、CD4+、CD8+T淋巴细胞是COVID-19患者预后的危险因素。

Abstract：

【Abstract】 Background Corona virus disease 2019 (COVID-19) is still a major public health event that needs tobe solved urgently in the world, early warning and condition judgment is of great significance to effectively control the progressof patients' condition.Objective To analysis the laboratory examination indexes and risk factors for prognosis in patients withCOVID-19. Methods A total of 90 patients with COVID-19 hospitalized in the People's Hospital of Wuhan University fromFebruary 1, 2020 to May 1, 2020 were selected as the observation group, and 90 patients with common pneumonia hospitalizedwith fever and cough during the same period and at the same age were selected as the control group. The laboratory examinationindexes between the two groups and the clinical data of patients with different prognosis (survival and death) were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of prognosis in patients with COVID-19.ResultsThe white blood cell count (WBC) , lymphocyte count (L) , neutrophil count (N) in the observation group were lowerthan those in the control group (P < 0.05) . Alanine aminotransferase (ALT) , aspartate aminotransferase (AST) , gamma glutamyltransferase (GGT) and C-reactive protein (CRP) in the observation group were higher than those in the control group, and totalbilirubin (TBiL) , albumin (Alb) , cholinesterase (ChE) and Ca2+ were lower than those in the control group (P < 0.05) . The levelsof CD3+ T lymphocytes, CD4+ T lymphocytes and CD8+ T lymphocytes in the observation group were lower than those in the controlgroup (P < 0.05) . The proportion of patients with ≥ 60 years old, smoking history, history of hypertension, history of chronicobstructive pulmonary disease (COPD) , wet cough, onset with headache and serious type and ALT, AST, CRP in dead patientswere higher than those in survival patients, and the levels of L, CD3+ T lymphocytes, CD4+ T lymphocytes and CD8+ T lymphocyteswere lower than those in survival patients (P < 0.05) . Multivariate Logistic regression analysis results showed that≥ 60 years old,wet cough, onset with headache, serious type, CRP ≥ 40.3 mg/L, CD3+ T lymphocytes < 1 289/μ l, CD4 + T lymphocyte < 560/μ land CD8 + T lymphocyte < 522/μl were the risk factors for the prognosis of patients with COVID-19 (P < 0.05) .ConclusionCompared with patients with common pneumonia,damage of liver function and lymphocyte function is more seriousin patients with COVID-19, and mmunity is worse. The≥ 60 years old, wet cough, onset with headache, serious type, high-levelCRP and low-level CD3+ , CD4+ , CD8+ T lymphocytes are the risk factors for the prognosis of patients with COVID-19.

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