附属瑞金医院瞿介明教授团队新冠肺炎重要发现,在呼吸领域最顶级期刊发表!

时间:2020-04-20 来源:上海交通大学医学院作者: 点击:518次

  近日,附属瑞金医院瞿介明教授团队在呼吸领域最顶级期刊《American Journal Of Respiratory and Critical Care Medicine》(IF=16.494)在线发表题为“COVID-19 with different severity: a multi-center study of clinical features”的新型冠状病毒病(COVID-19)多中心临床研究。

  文章通讯作者为瞿介明教授、周敏教授及上海公共卫生临床中心卢洪洲教授,第一作者包括冯耘副主任医师、谢雨桑博士、上海公共卫生临床中心凌云副主任医师和武汉金银潭医院柏涛主治医师。研究系统比较了不同严重程度新型冠状病毒肺炎患者的临床表现,影像学特征,重要检验指标变化特点及差异。

  研究发现重型和危重型患者各器官功能障碍和免疫功能受损更加严重,多肺叶浸润及胸腔积液比例增高。合并高血压的普通型患者中使用ACEI/ARB的比例高于重型及危重型患者。高龄是造成COVID-19死亡的危险因素。阐明了不同严重程度新型冠状病毒肺炎的特点,为优化临床诊治提供了重要参考。



【Abstract】

RATIONALE: COVID-19 pandemic is now a global health concern.

OBJECTIVES: We compared the clinical characteristics, laboratory examinations, CT images and treatment of COVID-19 patients from three different cities in China.


METHODS:476 patients were recruited from Jan 1 to Feb 15, 2020 at three hospitals in Wuhan, Shanghai and Anhui. Patients were divided into four groups according to age and into three groups (moderate, severe, and critical group) according to the fifth version of the guidelines issued by the National Health Commission of China on Diagnosis and Treatment of COVID-19.


MEASUREMENTS AND MAIN RESULTS: Compared with moderate group (37.8%), the incidence of comorbidities was higher in severe (46.3%) and critical groups (67.1%). Compared with severe and critical groups, there were more patients taking ACEI/ARB in moderate group. More patients had multiple lung lobe involvement and pleural effusion in the critical group as compared to moderate group. Compared with the moderate group, more patients received antiviral agents within first 4 days than in severe group, and more patients received antibiotics and corticosteriods in critical and severe groups. Patients over 75 years old had significantly lower survival rate than the younger patients.


CONCLUSION: Multiple organ dysfunction and impaired immune function were the typical characteristics of severe and critical patients. There was a significant difference in angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers usage among patients with different severities. Involvement of multiple lung lobes and pleural effusion were associated with the severity of COVID-19. Advanced age (≥75 years) was a risk factor for mortality.


【中文摘要】

     目的:新型冠状病毒病(COVID-19)肆虐全球,构成大流行。比较中国不同严重程度的COVID-19患者临床特征及合并症、相关重要检查指标差异、治疗及预后和胸部影像学表现。

     方法:我们收集了2020年1月1日至2020年2月15日间收住于上海市公共卫生临床中心、湖北省武汉市金银潭医院及安徽省铜陵市人民医院,经核酸检测确诊的476名新冠肺炎患者。按照年龄分为四组,依照我国《新型冠状病毒感染的肺炎诊疗方案(第五版)》中临床分型将纳入的患者分为三组:普通型、重型、危重型。

     结果:和普通型患者(37.8%)相比,更多的重症(46.3%)和危重症患者(67.1%)存在合并症。在普通型患者中使用血管紧张素转换酶抑制剂(ACEI)/血管紧张素II受体拮抗剂(ARB)的高血压患者比例高于其他两组。此外,危重症患者中多肺叶累及和胸腔积液的比例高于普通型患者。与普通型患者比较,危重症患者在入院4天内接受抗病毒治疗,抗生素和激素治疗的比例更高。年龄≥75岁的高龄患者生存率显著低于年轻患者。

结论:COVID-19重型和危重型患者各器官功能障碍和免疫功能受损更加严重。合并高血压的普通型患者中使用ACEI/ARB比例高于重症及危重症组。多肺叶浸润及胸腔积液与疾病进展有关。此外,高龄(≥75岁)是造成COVID-19死亡的危险因素。


作者介绍

瞿介明:上海交通大学医学院附属瑞金医院呼吸与危重症医学科,主任医师,教授,博士生导师;上海交通大学医学院附属瑞金医院党委书记;中华医学会呼吸分会主任委员。研究方向:肺部感染


周敏:上海交通大学医学院附属瑞金医院呼吸与危重症医学科,主任医师,教授,博士生导师,科副主任。研究方向:慢性阻塞性肺病和肺部感染


冯耘:上海交通大学医学院附属瑞金医院呼吸与危重症医学科,副主任医师,上海交通大学医学院副研究员。研究方向:呼吸危重症和肺恶性肿瘤


谢雨桑:上海交通大学医学院附属瑞金医院呼吸与危重症医学科瞿介明教授二年级博士生





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