摘要
背景新型冠状病毒肺炎(COVID-19)疫情已蔓延至全国乃至全球,但目前尚缺乏大规模的临床研究和循证医学证据来指导临床实践。目的分析COVID-19患者的临床特征。方法计算机检索PubMed、EMBase、中国知网(CNKI)、万方数据知识服务平台和维普网(VIP)等数据库筛选COVID-19患者临床特征的文献,采用Stata 12.0软件对患者性别分布、临床症状(包括发热、干咳、乏力、肌肉疼痛、头痛、腹泻、咳痰、呼吸困难、胸闷气促、恶心呕吐、咽痛、无症状)、实验室检查指标〔包括白细胞计数(WBC)、淋巴细胞分数、C反应蛋白(CRP)、降钙素原(PCT)、D-二聚体〕异常情况进行Meta分析。结果最终纳入30篇文献,共包含3290例COVID-19患者。Meta分析结果显示,COVID-19患者中男性占55.4%〔95%CI(52.0%,58.9%)〕,发热发生率为77.7%〔95%CI(69.7%,84.7%)〕、干咳发生率为60.7%〔95%CI(55.4%,65.9%)〕、乏力发生率为43.5%〔95%CI(34.9%,52.3%)〕、肌肉疼痛发生率为27.7%〔95%CI(21.3%,34.7%)〕、咳痰发生率为29.3%〔95%CI(21.9%,37.4%)〕、胸闷气促发生率为23.7%〔95%CI(16.8%,31.4%)〕、呼吸困难发生率为21.1%〔95%CI(12.7%,31.0%)〕,少数患者出现恶心呕吐(7.4%)、腹泻(8.8%)、头痛(14.2%)和咽痛(13.1%),而6.6%患者无临床症状;WBC正常者占比为62.9%〔95%CI(55.9%,69.6%)〕,CRP升高者占比66.6%〔95%CI(56.0%,72.9%)〕,淋巴细胞分数降低发生率为49.5%〔95%CI(40.8%,58.3%)〕,WBC降低发生率为23.7%〔95%CI(18.7%,29.0%)〕;少数患者D-二聚体(18.4%)和PCT(17.1%)升高。结论COVID-19患者以男性居多,常见的临床表现为发热、干咳和乏力,肌肉疼痛、咳痰、胸闷气促、呼吸困难也较常见,少数患者出现恶心呕吐、腹泻、头痛、咽痛等,部分患者无任何临床症状。另外,多数患者WBC正常、淋巴细胞分数降低、CRP升高,部分WBC降低,仅少数患者出现D-二聚体升高及PCT升高。
Background COVID-19 pandemic has spread to the entire China and the whole world,but there are no guidances from large-scale clinical trials and evidence-based medical practice for clinical management of COVID-19 patients.Objective To systematically analyse the clinical characteristics of COVID-19 patients.Methods Electronic databases of PubMed,EMBase,CNKI,WanFang Data and VIP were searched to collect studies about the clinical characteristics of COVID-19 patients.Stata 12.0 was used to conduct a meta-analysis of male prevalence,clinical manifestationsg〔including symptomatic(such as fever,dry cough,fatigue,muscle pain,headache,diarrhea,expectoration,dyspnea,chest tightness/shortness of breath,nausea,vomiting,pharyngalgia)and asymptomatic〕and laboratory abnormalities(involving WBC,leukocyte count,C-reactive protein,procalcitonin and D-dimer).Results A total of 30 studies involving 3290 cases were included.Meta-analysis showed that,the male prevalence of COVID-19 was 55.4%〔95%CI(52.0%,58.9%)〕.In symptomatic patients,the prevalence of fever,dry cough,fatigue,muscle pain,expectoration,chest tightness/shortness of breath,and dyspnea was 77.7%〔95%CI(69.7%,84.7%)〕,60.7%〔95%CI(55.4%,65.9%)〕,43.5%〔95%CI(34.9%,52.3%)〕,27.7%〔95%CI(21.3%,34.7%)〕,29.3%〔95%CI(21.9%,37.4%)〕,23.7%〔95%CI(16.8%,31.4%)〕,21.1%〔95%CI(12.7%,31.0%)〕,respectively.The prevalence of other symptoms,such as vomiting(7.4%),diarrhea(8.8%),headache(14.2%),and pharyngalgia(13.1%)was less.The prevalence of asymptomatic COVID-19 was 6.6%.In terms of laboratory findings,the prevalence of normal WBC was 62.9%〔95%CI(55.9%,69.6%)〕.The prevalence of elevated CRP,decreased lymphocyte fraction and decreased WBC was 66.6%〔95%CI(56.0%,72.9%)〕,49.5%〔95%CI(40.8%,58.3%)〕,and 23.7%〔95%CI(18.7%,29.0%)〕,respectively.The prevalence of elevated procalcitonin(17.1%)and D-dimer(18.4%)was less.Conclusion COVID-19 is more common in men,which is often manifested as fever,dry cough,fatigue,muscle pain,expectoration,chest tightness/shortness of breath and dyspnea.Nausea and vomiting,diarrhea,headache,pharyngalgia can also be found in a few patients.And a relatively small percentage of patients are asymptomatic.Most patients show normal WBC,decreased lymphocyte fraction and elevated CRP.Some may have decreased WBC,only a few have elevated D-dimer and procalcitonin.
作者
朱洁云
庞杰龙
钟枝梅
吉攀
李红园
何翠影
张剑锋
ZHU Jieyun;PANG Jielong;ZHONG Zhimei;JI Pan;LI Hongyuan;HE Cuiying;ZHANG Jianfeng(Department of Emergency,the Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China)
出处
《实用心脑肺血管病杂志》
2020年第6期6-12,共7页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
国家自然科学基金资助项目(81960343)
广西科技计划项目(AB20058002)。
