钟南山团队首篇NCP论文:半数以上NCP患者早期无发热,小心无症状感染者!

     

2020年2月9日,由钟南山院士领衔,由武汉市金银潭医院、武汉市中心医院、黄冈市主要医院等全国 31 个省市、共 552 家医院协同参与完成的最大样本的临床回顾性研究成果(纳入了从发病到1月29号共计1099例确诊的2019-nCoV感染NCP患者)在医学预印本平台 medRxiv上发表。

下图:大医编coco曾在非典期间与钟院士的合影

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最新研究得出以下结论:

1. 暴露史:

在本次研究纳入的1099名NCP患者中,武汉之外地区近三成(26.0%)无武汉旅居史,或者未与来自武汉的人有过接触史

原文: 26.0% of patients outside of Wuhan did not have a recent travel to Wuhan or contact with people from Wuhan.

同时,我们也应当关注:七成以上的病例为2、3代病例,仅31.30%的患者去过武汉,直接接触过野生动物的患者更是仅有1.18%。确诊病例的暴露史提示我们:家族聚集性发病、无症状感染者传播、3阶段爆发模式确实存在,同时不排除“超级传播者”的存在

 

2. 人口学特征:

患者中位年龄为47.0岁,女性占41.90%。新冠肺炎可发生在整个年龄段,其中0.9%的患者在15岁以下。

原文:The median age was 47.0 years (IQR, 35.0 to 58.0), and 41.9% were females. 2019-nCoV ARD was diagnosed throughout the whole spectrum of age. 0.9% of patients were aged below 15 years.

 

3. 潜伏期和临床症状:

中位潜伏期为3.0天,最长潜伏期可达24天

原文:The median incubation period was 3.0 days (range, 0 to 24.0).

 

发热(87.9%)和咳嗽(67.7%)是最常见的症状,但就诊时有发热症状的患者不足一半(43.8%)。腹泻(3.7%)和呕吐(5.0%)少见。

原文: Notably, fever occurred in only 43.8% of patients on initial presentation and developed in 87.9% following hospitalization. Absence of fever in 2019-nCoV ARD is more frequent than in SARS-CoV (1%) and MERS-CoV infection (2%)and such patients may be missed if the surveillance case definition focused heavily on fever detection.

这意味着我们如果还把可疑病例主要定义为发烧群体,就会漏诊一大批无发烧症状的NCP患者!

 

4. 影像学和实验室研究发现:

研究结果显示:入院时接受胸部X线断层扫描的840名患者中,有76.4%表现为肺炎。最常见的CT发现是:毛玻璃样混浊(50.0%)和双侧斑片状阴影(46.0%)

 

原文:the radiologic and laboratory findings on admission. Of 840 patients who underwent chest computed tomography on admission, 76.4% manifested as pneumonia. The most common

patterns on chest computed tomography were ground-glass opacity (50.0%) and bilateral patchy

shadowing (46.0%).

 

同时,82.1%的患者出现淋巴细胞减少,36.2%的患者血小板减少。总体而言,在33.7%的患者中观察到白细胞减少症。严重病例会有突出实验室异常,即白细胞减少症、淋巴细胞减少症、血小板减少症、C反应蛋白升高。

原文: On admission, 82.1% and 36.2% of patients had lymphopenia and thrombocytopenia, respectively. Overall, leukopenia was observed in 33.7% of patients. Most patients demonstrated

elevated levels of C-reactive protein, but elevated levels of alanine aminotransferase, aspartate aminotransferase, creatine kinase and D-dimer were less common. Severe cases had more prominent laboratory abnormalities (i.e., leukopenia, lymphopenia, thrombocytopenia, elevated C-reactive protein levels) as compared with non-severe cases (all P<0.05).  

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5. 治疗:

1099名患者整体而言,分别有38.0%,6.1%,57.5%和35.8%的患者接受了氧气疗法,机械通气,静脉内抗生素和奥司他韦这些治疗。

原文: Overall, oxygen therapy, mechanical ventilation, intravenous antibiotics and oseltamivir therapy were initiated in 38.0%, 6.1%, 57.5% and 35.8% of patients, respectively.

 

6. 预后:

进入ICU,需要有创通气和死亡的患者比例分别为5.00%,2.18%和1.36%。

原文:The percentages of patients being admitted to the ICU, requiring invasive ventilation and death were 5.00%, 2.18% and 1.36%, respectively.

 

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综上所述,钟南山院士所领衔的这项研究,不仅为NCP的人传人提供了更有力的证据,而且也提出了:最长潜伏期可达24天、不排除“超级传播者”、存在粪口途径传播·2019-nCov相较SARS传染性更强、致死率却更低等研究成果。愿NCP的增长速度慢下来,疫情早日得到控制!

 

参考文献:https://doi.org/10.1101/2020.02.06.20020974

         


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