以腹泻为首发症状的新型冠状病毒肺炎患者临床特征和病情严重程度及其影响因素研究

doi:10.12114/j.issn.1007-9572.2021.00.435

摘要/Abstract

摘要： 背景　部分新型冠状病毒肺炎（COVID-19）患者存在胃肠道症状，但目前关于以腹泻为首发症状的COVID-19患者临床特征及预后的研究报道较少见。目的　分析以腹泻为首发症状的COVID-19患者的临床特征、病情严重程度及其影响因素。方法　北京大学援鄂医疗队于2020-01-28至2020-02-28共接管华中科技大学同济医学院附属同济医院中法新城院区隔离病房中鼻咽拭子样本2019新型冠状病毒（SARS-CoV-2）RNA检测结果为阳性的COVID-19患者207例，选取其中由北京大学第三医院医疗分队接管的以腹泻为首发症状者17例作为观察组，未以腹泻为首发症状者34例作为对照组。比较两组患者一般资料、临床症状、血常规检查结果、肝功能指标、血脂指标、肌酐、凝血功能指标、炎性指标、降钙素原、心肌损伤指标、胸部CT检查结果、临床分型、最高体温、治疗情况、并发症发生情况、生存情况、发病至治疗时间、住院时间；COVID-19患者病情严重程度的影响因素分析采用单因素及多因素Logistic分析。结果　观察组患者咳痰发生率、D-二聚体、降钙素原异常率、临床分型为重型及危重型者所占比例低于对照组，乏力发生率、白蛋白高于对照组，凝血酶原时间、住院时间短于对照组（P<0.05）。多因素Logistic回归分析结果显示，白蛋白〔OR=0.739，95%CI（0.569，0.960）〕是COVID-19患者病情严重程度的保护因素，而降钙素原〔OR=7.349，95%CI（1.213，44.513）〕是危险因素（P<0.05）。结论　以腹泻为首发症状的COVID-19患者呼吸道症状及病情严重程度较轻、乏力发生率较高、临床分型以普通型为主、同等治疗情况下住院时间较短；白蛋白是COVID-19患者病情严重程度的保护因素，而降钙素原是危险因素，临床应注意加强对白蛋白及降钙素原的监测。

关键词: 肺炎, 病毒性；新型冠状病毒肺炎；新型冠状病毒；疾病特征；腹泻；危险因素；回顾性研究

Abstract: Background　There are gastrointestinal symptoms in some patients with COVID-19，but there are few reports about the clinical characteristics and prognosis in COVID-19 patients with diarrhea as the initial symptom.Objective　To analyze the clinical characteristics，severity of illness and its influencing factors in COVID-19 patients with diarrhea as the initial symptom.Methods　A total of 207 COVID-19 patients with positive RNA test results of nasopharyngeal swabs were taken over by Peking University Medical Team for Hubei from 2020-01-28 to 2020-02-28，who were hospitalized in isolated wards in Tongji Hospital Zhongfa New Town Branch Affiliated to Tongji Medical College，Huazhong University of Science and Technology，17 cases with diarrhea as the initial symptom charged by Medical Team of Peking University Third Hospital were selected as observation group，34 cases without diarrhea as the initial symptom were selected as control group.General information，clinical symptoms，blood routine test results，liver function index，blood lipid indices，creatinine，coagulation function indicators，inflammatory indicators，PCT，myocardial injury indicators，chest CT findings，clinical classification，maximum body temperature，therapeutic protocols，incidence of complications，survival status，duration from onset to treatment and hospital stays were compared between the two groups；univariate and multivariate Logistic regression analysis were used to analyze the influencing factors of severity of illness in patients with COVID-19.Results　Incidence of expectoration，D-dimer，abnormal rate of PCT and proportion of patients with severe and critical clinical classification types in observation group were significantly lower than control group，incidence of debilitation and albumin in observation group were significantly higher than control group，prothrombin time and hospital stays in observation group were significantly shorter than control group（P<0.05）.Multivariate Logistic regression analysis results showed that，albumin〔OR=0.739，95%CI（0.569，0.960）〕was the protective factor of severity of illness in patients with COVID-19，but PCT〔OR=7.349，95%CI（1.213，44.513）〕was the risk factor（P<0.05）.Conclusion　In COVID-19 patients with diarrhea as the initial symptom，the respiratory symptom and severity of illness are relatively mild，incidence of debilitation is relatively high，clinical classification is mainly common type，and hospital stays is relatively short；albumin is the protective factor of severity of illness in patients with COVID-19，but PCT is the risk factor.

Key words: Pneumonia, viral；Coronavirus disease 2019；SARS-CoV-2；Disease attribute；Diarrhea；Risk factors；Retrospective studies

俎明,石岩岩,宁静,等. 以腹泻为首发症状的新型冠状病毒肺炎患者临床特征和病情严重程度及其影响因素研究[J]. 中国全科医学, 2021, 24(15): 1874-1882. DOI: 10.12114/j.issn.1007-9572.2021.00.435.
ZU Ming,SHI Yanyan,NING Jing, et al. Clinical Characteristics，Severity of Illness and Its Influencing Factors in COVID-19 Patients with Diarrhea as the Initial Symptom　[J]. Chinese General Practice, 2021, 24(15): 1874-1882. DOI: 10.12114/j.issn.1007-9572.2021.00.435.

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