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  • 郑楷炼,宁方政,徐莹,陈怡,赵志越,孔祥毓,董宇超,赵峰,万小健.重型新型冠状病毒肺炎早期治疗效果的影响因素分析[J].第二军医大学学报,2020,41(4):371-377    [点击复制]
  • ZHENG Kai-lian,NING Fang-zheng,XU Ying,CHEN Yi,ZHAO Zhi-yue,KONG Xiang-yu,DONG Yu-chao,ZHAO Feng,WAN Xiao-jian.Risk factors affecting the early treatment effect of patients with severe coronavirus disease 2019[J].Acad J Sec Mil Med Univ,2020,41(4):371-377   [点击复制]
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重型新型冠状病毒肺炎早期治疗效果的影响因素分析
郑楷炼1,2△,宁方政3△,徐莹4,陈怡1,5,赵志越3,孔祥毓1,6,董宇超1,7,赵峰1,8,万小健1,9*
0
(1. 湖北省武汉市火神山医院, 武汉 430100;
2. 海军军医大学(第二军医大学)长海医院普通外科, 上海 200433;
3. 海军军医大学(第二军医大学)基础医学院, 上海 200433;
4. 湖北省武汉市汉口医院消化科, 武汉 430014;
5. 海军军医大学(第二军医大学)长海医院感染科, 上海 200433;
6. 海军军医大学(第二军医大学)长海医院消化内科, 上海 200433;
7. 海军军医大学(第二军医大学)长海医院呼吸与危重症医学科, 上海 200433;
8. 海军军医大学(第二军医大学)长海医院心血管内科, 上海 200433;
9. 海军军医大学(第二军医大学)长海医院麻醉学部, 上海 200433
共同第一作者
*通信作者)
摘要:
目的 探讨影响重型新型冠状病毒肺炎(COVID-19)早期治疗效果的相关危险因素。方法 回顾性分析2020年1月至2月在湖北省武汉市汉口医院住院的71例严重急性呼吸综合征冠状病毒2(SARS-CoV-2)核酸检测阳性的重型COVID-19患者资料。收集患者入院早期生命体征、临床表现、静息状态下脉搏氧饱和度、血常规、肝功能、肾功能、血生物化学、电解质、超敏肌钙蛋白T、凝血功能、脑钠肽前体、肺部CT表现、序贯器官功能衰竭评分(SOFA),以及治疗方式和早期治疗转归等资料。根据治疗2周后的治疗效果分为临床改善组和临床进展组,比较两组患者各项指标的差异,分析影响早期治疗效果的危险因素。结果 临床缓解组患者43例,经治疗后均转为普通型;临床进展组患者28例,10例死亡,15例进展至危重型,3例治疗后无明显改善。两组患者发病前均存在武汉疫区居住史。临床进展组患者中吸烟者所占比例(75.0%,21/28)高于临床缓解组患者(46.5%,20/43),差异有统计学意义(P=0.033)。与临床缓解组患者相比,临床进展组患者淋巴细胞计数[0.80(0.70,0.90)×109/L vs 0.70(0.60,0.70)×109/L]、血小板计数[222(174,310)×109/L vs 193(152,232)×109/L]、纤维蛋白原水平[4.22(3.71,4.80)g/L vs 3.81(2.96,4.38)g/L]降低,差异均有统计学意义(P均<0.05)。两组患者常见临床症状、生命体征、静息状态下脉搏氧饱和度、其余实验室检查指标、SOFA评分、治疗方式等差异均无统计学意义(P均>0.05)。多因素logistic回归分析结果显示,吸烟(OR=4.88,95% CI 1.33~25.00,P=0.020)、白细胞计数≤3.5×109/L(OR=10.00,95% CI 1.47~100.00,P=0.008)、淋巴细胞计数<0.1×109/L(OR=16.67,95% CI 3.33~100.00,P<0.001)是影响患者早期治疗效果的危险因素。结论 有吸烟史、白细胞计数≤3.5×109/L及淋巴细胞计数<0.1×109/L的重型COVID-19患者早期治疗效果不佳的风险较高,建议临床上对有上述危险因素的重型COVID-19患者进行重点诊疗,及早采取有效治疗措施进行干预,以改善预后。
关键词:  新型冠状病毒肺炎  重型肺炎  治疗效果  危险因素
DOI:10.16781/j.0258-879x.2020.04.0371
投稿时间:2020-03-21修订日期:2020-04-11
基金项目:
Risk factors affecting the early treatment effect of patients with severe coronavirus disease 2019
ZHENG Kai-lian1,2△,NING Fang-zheng3△,XU Ying4,CHEN Yi1,5,ZHAO Zhi-yue3,KONG Xiang-yu1,6,DONG Yu-chao1,7,ZHAO Feng1,8,WAN Xiao-jian1,9*
(1. Huoshenshan Hospital, Wuhan 430100, Hubei, China;
2. Department of General Surgery, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
3. College of Basic Medical Sciences, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
4. Department of Gastroenterology, Hankou Hospital, Wuhan 430014, Hubei, China;
5. Department of Infectious Disease, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
6. Department of Gastroenterology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
7. Department of Respiratory and Critical Care Medicine, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
8. Department of Cardiovasology, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
9. Department of Anesthesia, Changhai Hospital, Naval Medical University (Second Military Medical University), Shanghai 200433, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To explore the relevant risk factors that affect the early treatment effect of severe coronavirus disease 2019 (COVID-19). Methods A retrospective analysis was performed on the data of 71 severe COVID-19 patients who were admitted to Hankou Hospital, Wuhan, Hubei from Jan. to Feb. 2020 with positive in nucleic acid test of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The early vital signs, clinical manifestations, resting oxygen saturation, blood routine, liver function, blood biochemistry, electrolyte, high-sensitivity troponin, coagulation function, pro-brain natriuretic peptide, lung CT manifestations and sequential organ failure assessment (SOFA) at admission, as well as treatment regimens and early treatment outcomes were collected. According to the treatment effect after 2 weeks, the patients were divided into clinical remission group and clinical deterioration group. The differences of each index between the two groups were compared, and the risk factors affecting the early treatment effect were analyzed. Results Forty-three patients in the clinical remission group turned into non-severe cases after treatment. Among the 28 patients in the clinical deterioration group, 10 died, 15 had disease progression to critically ill status, and three had no significant improvement after treatment. The patients in both groups had a history of staying in Wuhan before the onset of the disease. The proportion of smokers in the clinical deterioration group was significantly higher than that in the clinical remission group (75.0% [21/28] vs 46.5% [20/43], P=0.033). Compared with the patients in the clinical remission group, the patients in the clinical deterioration group were more likely to have different degrees of reductions in lymphocyte counts (0.80 [0.70, 0.90]×109/L vs 0.70 [0.60, 0.70]×109/L), platelet counts (222 [174, 310]×109/L vs 193 [152, 232]×109/L) and fibrinogen level (4.22 [3.71, 4.80] g/L vs 3.81 [2.96, 4.38] g/L) (all P<0.05). There were no significant differences in common clinical symptoms, vital signs, resting oxygen saturation, other laboratory indicators, SOFA score, or treatment regimens between the two groups (all P>0.05). Multivariate logistic regression analysis revealed that smoking (odds ratio [OR]=4.88, 95% confidence interval [CI] 1.33-25.00, P=0.020), white blood cell (WBC) count ≤3.5×109/L (OR=10.00, 95% CI 1.47-100.00, P=0.008), and lymphocyte count <0.1×109/L (OR=16.67, 95% CI 3.33-100.00, P<0.001), were the independent risk factors affecting the early treatment effect of severe COVID-19 patients. Conclusion The severe COVID-19 patients with smoking history, WBC count ≤3.5×109/L or lymphocyte count<0.1×109/L have a higher risk of poor early treatment, and more attention should be paid in clinical diagnosis and treatment of these patients to improve the prognosis.
Key words:  coronavirus disease 2019  severe pneumonia  treatment effect  risk factors