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Clinical characteristics of gastrointestinal symptoms and liver function injury in patients with coronavirus disease 2019 2019冠状病毒病患者胃肠道症状及肝功能损伤的临床特征
Pub Date : 2020-04-13 DOI: 10.3760/CMA.J.CN311367-20200316-00148
Feng-hua Xu, X. Qin, Lei Zhang, Fei Wu, Yu Jin, Yan Xu, Caiyuan Liu, Yilin Xiong, Gangping Li, X. Xiang, Yudong Jiang, T. Bai, X. Hou, Jun Song
Objective To analyze the clinical characteristics of gastrointestinal symptoms and liver function injury in patients with coronavirus disease 2019 (COVID-19). Methods From January 23, 2020 to February 29, 2020, medical records of 251 patients with COVID-19 admitted to the West Campus of the Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, were collected. The proportion of the patients with gastrointestinal symptoms including anorexia, nausea and vomit, diarrhea and abdominal pain were analyzed respectively. The patients were divided into common type (76 cases), severe type (65 cases) and critical type (110 cases). The incidence of liver function injury and index of liver function such as total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGT), lactate dehydrogenase (LDH) and albumin of the patients with different clinical types and with or without gastrointestinal symptoms were analyzed. Student t test, Chi square test and Fisher's exact test were performed for statistical analysis. Results The main gastrointestinal symptoms of patients with COVID-19 were anorexia (33.9%, 85/251), diarrhea (12.0%, 30/251), nausea and vomit (7.6%, 19/251) and abdominal pain (1.2%, 3/251). 143 patients (57.0%) had liver function injury, the rate of liver function injury in critical type patients was 75.5% (83/110), which was higher than that of common type (40.8%, 31/76) and severe type patients (44.6%, 29/65), and the differences were statistically significant (χ2=22.765 and 16.865, both P 0.05). The proportion of liver function injury of patients with gastrointestinal symptoms was 57.8% (67/116), compared with that of liver function injury of patients without gastrointestinal symptoms (56.3%, 76/135), the difference was not statistically significant (P>0.05). The median value of TBil, DBil, ALT, AST, ALP, GGT, LDH and globulin level of critical type patients was 13.5 μmol/L, 4.9 μmol/L, 44.5 U/L and 50.0 U/L, 64.0 U/L, 41.0 U/L, 527.0 U/L and 33.6 g/L respectively. The proportion of critical type patients with TBil level > 34.2 μmol, DBil >13.6 μmol, ALT> 80 U/L and AST> 80 U/L was 7.3% (8/110), 7.3% (8/110), 17.3% (19/110) and 17.3% (19/110), respectively. These results were all higher than those of common type patients (9.5 μmol/L, 2.9 μmol/L, 28.5 U/L, 28.5 U/L, 54.0 U/L, 25.5 U/L, 225.5 U/L and 30.1 g/L, 0, 0, 6.6% (5/76), 2.6% (2/76) ) and severe type patients (10.4 μmol/L, 3.4 μmol/L, 30.0 U/L, 31.0 U/L, 49.0 U/L, 25.0 U/L, 284.0 U/L and 30.7 g/L, 0, 0, 6.2% (4/65), 1.5% (1/65) ), and the differences were statistically significant (Z=-4.264, -5.507,-4.000, -6.558, -3.112, -4.333, -4.858, -3.873, Fisher's exact test, Fisher's exact test, χ2=4.574, 9.620; Z=-3.060, -3.850, -3.923, -5.005, -9.495, -7.651, -3.853, -2.725, Fisher's exact test, Fisher's exact test, χ2=4.425, 10.169; all P 20.0
目的分析2019冠状病毒病(COVID-19)患者胃肠道症状及肝功能损伤的临床特点。方法收集2020年1月23日至2020年2月29日华中科技大学同济医学院协和医院西校区收治的新冠肺炎患者病历251例。分别分析患者出现厌食、恶心呕吐、腹泻、腹痛等胃肠道症状的比例。患者分为普通型(76例)、重症(65例)和危重型(110例)。分析不同临床类型、有无胃肠道症状患者肝功能损伤发生率及肝功能指标如总胆红素(TBil)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(GGT)、乳酸脱氢酶(LDH)、白蛋白。采用学生t检验、卡方检验和Fisher精确检验进行统计分析。结果新冠肺炎患者的主要胃肠道症状为厌食(33.9%,85/251)、腹泻(12.0%,30/251)、恶心呕吐(7.6%,19/251)和腹痛(1.2%,3/251)。143例(57.0%)患者出现肝功能损伤,危重型患者肝功能损伤率为75.5%(83/110),高于普通型(40.8%,31/76)和重症(44.6%,29/65),差异均有统计学意义(χ2=22.765、16.865,P均为0.05)。有胃肠道症状患者肝功能损伤比例为57.8%(67/116),无胃肠道症状患者肝功能损伤比例为56.3%(76/135),差异无统计学意义(P>0.05)。危重型患者TBil、DBil、ALT、AST、ALP、GGT、LDH及球蛋白水平中位数分别为13.5 μmol/L、4.9 μmol/L、44.5 μmol/L、50.0 μmol/L、64.0 U/L、41.0 U/L、527.0 U/L、33.6 g/L。TBil > 34.2 μmol、DBil >13.6 μmol、ALT> 80 U/L、AST> 80 U/L的危重型患者比例分别为7.3%(8/110)、7.3%(8/110)、17.3%(19/110)、17.3%(19/110)。这些结果都高于常见病人(9.5μ摩尔/升,2.9μmol / L, 28.5 U / L, 28.5 U / L, 54.0 U / L, 25.5 U / L, 225.5 U / L和30.1 g / L, 0, 0, 6.6%(5/76), 2.6%(2/76))和严重类型的病人(10.4μ摩尔/升,3.4μmol / L, 30.0 U / L, 31.0 U / L, 49.0 U / L, 25.0 U / L, 284.0 U / L和30.7 g / L, 0, 0, 6.2%(4/65), 1.5%(1/65),差异具有统计学意义(Z = -4.264, -5.507, -4.000, -6.558, -3.112, -4.333, -4.858, -3.873,确切概率法,确切概率法,χ2 = 4.574,9.620;Z=-3.060, -3.850, -3.923, -5.005, -9.495, -7.651, -3.853, -2.725,费雪精确检验,χ2=4.425, 10.169;腹泻患者P 20.0 ~ 34.2 μmol/L均高于非腹泻患者(70.0%,21/30 vs 10.9%, 24/221),差异有统计学意义(Z = -2.182, P = 0.029;χ2 = 62.788, p <0.01)。结论厌食是新冠肺炎患者最常见的消化系统症状,腹泻、恶心呕吐、腹痛发生率较低。危重型患者肝功能损伤发生率高。胃肠道症状与肝功能损伤无明显相关性。腹泻患者白蛋白水平较低。关键词:2019冠状病毒病;腹泻;胃肠道症状;肝功能;白蛋白
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引用次数: 3
Clinical characteristics of 70 patients with coronavirus disease 2019 accompanied with diarrhea 70例冠状病毒病伴腹泻患者临床特征分析
Pub Date : 2020-03-30 DOI: 10.3760/CMA.J.CN311367-20200315-00141
Yuanmei Guo, Jixiang Zhang, Qiutang Xiong, Jiao Li, Mengyao Ji, P. An, Xiaoguang Lyu, Fei Liao, Wenhao Su, W. Dong
Objective To retrospectively analyze the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) accompanied with diarrhea. Methods From January 11 to February 6 in 2020, the clinical data of 663 patients diagnosed with COVID-19 admitted to Renmin Hospital of Wuhan University were collected. According to whether with diarrhea, the patients were divided into with diarrhea group and without diarrhea group. The differences in general condition, clinical manifestation, chest computed tomography (CT), laboratory findings, disease severity and death situation between two groups were compared. Chi-square test, Fisher exact test and Mann-Whitney U test were performed for statistical analysis. Results Among 663 COVID-19 patients, 70 (10.6%) patients accompanied with diarrhea. The ratio of fatigue and increased lactate dehydrogenase (LDH) of with diarrhea group were higher than those of without diarrhea group (58.6%, 41/70 vs. 28.2%, 167/593; and 64.2%, 43/67 vs. 50.4%, 277/550), and the differences were statistically significant (χ2=26.891 and 4.566, both P 0.05). There were no statistically significant differences in the ratio of mild and normal type, severe type and critical type between diarrhea group and without diarrhea group (35.7%, 25/70 vs. 38.6%, 229/593; 50.0%, 35/70 vs. 47.2%, 280/593; and 14.3%, 10/70 vs. 14.2%, 84/593, respectively) (χ2=0.240, P=0.887). There were no statistically significant differences in the ratio of death of each corresponding mild and normal type, severe type and critical type between diarrhea group and without diarrhea group (0 vs. 0.5%, 3/593; 0 vs 0 and 1.4%, 1/70 vs. 3.5%, 21/593) (Fisher exact test, all P>0.05). Conclusions Patients with COVID-19 accompanied with diarrhea are more likely to have fatigue and increased LDH. Diarrhea is not significantly correlated with the disease severity of patients with COVID-19. Key words: COVID-19; Diarrhea; Clinical characteristics; Disease severity
目的回顾性分析2019冠状病毒病(COVID-19)合并腹泻患者的临床特点。方法收集2020年1月11日至2月6日武汉大学人民医院收治的663例新冠肺炎确诊患者的临床资料。根据有无腹泻分为有腹泻组和无腹泻组。比较两组患者一般情况、临床表现、胸部CT、实验室检查、病情严重程度及死亡情况的差异。采用卡方检验、Fisher精确检验和Mann-Whitney U检验进行统计学分析。结果663例新冠肺炎患者中有70例(10.6%)伴有腹泻。腹泻组的疲劳率和乳酸脱氢酶(LDH)升高率高于未腹泻组(58.6%,41/70比28.2%,167/593;64.2%(43/67比50.4%,277/550),差异有统计学意义(χ2=26.891、4.566,P均为0.05)。轻度型与正常型、重度型与危重型的比例,腹泻组与无腹泻组比较差异无统计学意义(35.7%,25/70比38.6%,229/593;50.0%, 35/70 vs. 47.2%, 280/593;14.3%, 10/70比14.2%,84/593)(χ2=0.240, P=0.887)。腹泻组与无腹泻组各对应轻、正常型、重度、危重型的死亡率比较,差异均无统计学意义(0比0.5%,3/593;0比0和1.4%,1/70比3.5%,21/593)(Fisher精确检验,P均>0.05)。结论COVID-19合并腹泻患者更容易出现疲劳和LDH升高。腹泻与COVID-19患者病情严重程度无显著相关性。关键词:COVID-19;腹泻;临床特点;疾病严重程度
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引用次数: 1
Pay attention to the etiological analysis and management of 2019 coronavirus disease associated liver injury 注意2019冠状病毒病相关肝损伤的病因分析和处理
Pub Date : 2020-03-27 DOI: 10.3760/CMA.J.CN311367-20200317-00152
Ling Yang, Weifen Xie
2019 coronavirus disease(COVID-19) as a novel infectious respiratory disease, has become pandemic worldwide. The clinical manifestation of COVID-19 is complicated and varied. In addition to lung injury, liver is also one of the important organs to be affected. Abnormal liver function is common in the various stage of COVID-19. It is urgent to pay attention to the role of hypoxic-ischemia-reperfusion injury and drug-induced liver injury. Careful differentiation and precise management of COVID-19 associated liver injury are critical to reduce the incidence rate, improve the survival rate and shorten hospital stays. In the future to strengthen the pathophysiologic, therapeutic and prognostic research of COVID-19 associated liver injury is also required. Key words: 2019 coronavirus disease; Liver injury; Hepatic hypoxic-ischemia-reperfusion injury; Drug-induced liver injury
2019冠状病毒病(COVID-19)作为一种新型呼吸道传染病,已在全球范围内流行。新冠肺炎的临床表现复杂多样。除肺损伤外,肝脏也是重要的受累器官之一。肝功能异常在新冠肺炎的各个阶段都很常见。缺氧-缺血-再灌注损伤和药物性肝损伤的作用亟待重视。仔细鉴别和精准治疗新冠肺炎相关肝损伤对降低发病率、提高生存率和缩短住院时间至关重要。未来还需要加强COVID-19相关肝损伤的病理生理、治疗和预后研究。关键词:2019冠状病毒病;肝损伤;肝脏缺氧-缺血-再灌注损伤;药物性肝损伤
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引用次数: 1
Mechanisms and potential treatments for gastrointestinal symptoms in coronavirus disease 2019, severe acute respiratory syndrome, and Middle East respiratory syndrome 2019冠状病毒病、严重急性呼吸综合征和中东呼吸综合征胃肠道症状的机制和潜在治疗方法
Pub Date : 2020-03-15 DOI: 10.3760/CMA.J.ISSN.0254-1432.2020.03.008
Cao Li, Teng Liu, Shanshan Guo
新型冠状病毒肺炎(COVID-19)以肺部表现为主,同时感染胃肠道,引起包括恶心、呕吐、腹泻等消化系统症状。现结合现有指南和国内外文献资料,探讨了COVID-19、严重急性呼吸综合征、中东呼吸综合征伴发胃肠道症状的临床特点、流行病学特征和发病机制,以及抗菌药物、微生态制剂、血管紧张素转换酶2抑制剂在COVID-19肠道损害治疗中的作用机制和潜在价值,以期为临床工作者预防和治疗COVID-19肠道损害提供参考。
新型冠状病毒肺炎(COVID-19)以肺部表现为主,同时感染胃肠道,引起包括恶心、呕吐、腹泻等消化系统症状。现结合现有指南和国内外文献资料,探讨了COVID-19、严重急性呼吸综合征、中东呼吸综合征伴发胃肠道症状的临床特点、流行病学特征和发病机制,以及抗菌药物、微生态制剂、血管紧张素转换酶2抑制剂在COVID-19肠道损害治疗中的作用机制和潜在价值,以期为临床工作者预防和治疗COVID-19肠道损害提供参考。
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引用次数: 1
Considerations and suggestions on clinical research for coronavirus disease 2019 对2019冠状病毒病临床研究的思考与建议
Pub Date : 2020-03-15 DOI: 10.3760/CMA.J.ISSN.0254-1432.2020.03.002
Xu Jin
新型冠状病毒肺炎(COVID-19)疫情之下迫切需要找到有效的治疗手段来对抗这种疾病。一系列候选治疗已经进入临床试验或正处于准备阶段。鉴于找到有效药物的紧迫性,在循证医学临床研究设计规范与准则的基础上,提出除了临床随机对照试验外,可以采用实验性的整群随机对照试验、阶梯设计,以及观察性的病例-时间-对照研究等设计类型,开展COVID-19治疗药物的临床研究,并且强调顶层科学设计、有序规范开展,避免重复研究,阻止低效或设计方案存在偏倚的临床研究。呼吁构建标准统一的信息系统,设立明确的COVID-19临床数据标准和数据收集模式,以在常规医疗环境下形成COVID-19的病例队列,开展比较效果研究,切实解决并促进临床研究人员更好地共享、交换信息,提高研究效率。
新型冠状病毒肺炎(COVID-19)疫情之下迫切需要找到有效的治疗手段来对抗这种疾病。一系列候选治疗已经进入临床试验或正处于准备阶段。鉴于找到有效药物的紧迫性,在循证医学临床研究设计规范与准则的基础上,提出除了临床随机对照试验外,可以采用实验性的整群随机对照试验、阶梯设计,以及观察性的病例-时间-对照研究等设计类型,开展COVID-19治疗药物的临床研究,并且强调顶层科学设计、有序规范开展,避免重复研究,阻止低效或设计方案存在偏倚的临床研究。呼吁构建标准统一的信息系统,设立明确的COVID-19临床数据标准和数据收集模式,以在常规医疗环境下形成COVID-19的病例队列,开展比较效果研究,切实解决并促进临床研究人员更好地共享、交换信息,提高研究效率。
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引用次数: 0
Psychoanalysis of 300 patients with chronic gastritis 300例慢性胃炎患者精神分析
Pub Date : 2020-03-15 DOI: 10.3760/CMA.J.ISSN.0254-1432.2020.03.010
Jie Liu, Chuan Han, Jian Zhang, Xianmin Xue, Y. Nie, Yongquan Shi
Objective To analyze the difference of psychosocial characteristics in patients with chronic gastritis. Methods From June to December 2018, a total of 300 patients with chronic gastritis visited Xijing Hospital were consecutively enrolled. The patients were divided into chronic non-atrophic gastritis (CNAG) group, chronic atrophic gastritis (CAG) group and CAG with intestinal metaplasia group, with 100 cases in each group. Hamilton anxiety scale (HAMA), Hamilton depression scale (HAMD), living events scale (LES) and Eysenck personality questionnaire (EPQ) were used for evaluation and analysis. Chi square test, analysis of variance, nonparametric rank sum test and Kruskal Wallis H test were used for statistical analysis. Results The incidences of anxiety of the CAG group and the CAG with intestinal metaplasia group were both significantly higher than that of the CNAG group (64.0%, 64/100; 53.0%, 53/100; and 34.0%, 34/100; respectively), and the differences were statistically significant (χ2=0.007 and 0.001, both P 56.7) of etraversion or introversion and concealment in CAG group and the CAG with intestinal metaplasia group were higher than those in the CNAG group (48.0%, 48/100; 23.0%, 23/100; 4.0%, 4/100 and 46.0%, 46/100; 21.0%, 21/100 and 7.0%, 7/100, respectively), and the differences were statistically significant (χ2=0.001, 0.001, 0.001 and 0.004, all P<0.01). Conclusions Anxiety is associated with CAG and intestinal metaplasia, while depression is associated with intestinal metaplasia. In male patients and patients under 50 years old, depression, negative event and high psychiatric stress are more significantly related to intestinal metaplasia. The mental characteristics of extroversion, emotional instability, psychoticism and concealment are closely associated with CAG. Key words: Chronic gastritis; Atrophy; Intestinal metaplasia; Psychological characteristic; Mental characteristic
目的分析慢性胃炎患者心理社会特征的差异。方法选取2018年6月至12月在西京医院就诊的慢性胃炎患者300例为研究对象。将患者分为慢性非萎缩性胃炎(CNAG)组、慢性萎缩性胃炎(CAG)组和慢性萎缩性胃炎合并肠化生组,每组100例。采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、生活事件量表(LES)和艾森克人格问卷(EPQ)进行评价和分析。采用卡方检验、方差分析、非参数秩和检验和Kruskal Wallis H检验进行统计分析。结果CAG组和CAG合并肠化生组的焦虑发生率均显著高于CNAG组(64.0%,64/100;53.0%, 53/100;34.0%, 34/100;CAG组、CAG合并肠化生组的外向性、内向性、隐匿性均高于CNAG组(48.0%,48/100;23.0%, 23/100;4.0%, 4/100; 46.0%, 46/100;分别为21.0%、21/100和7.0%、7/100),差异有统计学意义(χ2=0.001、0.001、0.001、0.004,P均<0.01)。结论焦虑与CAG和肠化生相关,抑郁与肠化生相关。在男性和50岁以下患者中,抑郁、负面事件和高精神压力与肠化生的关系更为显著。外倾性、情绪不稳定性、精神病性和隐蔽性等心理特征与CAG密切相关。关键词:慢性胃炎;萎缩;肠上皮化生;心理特征;心理特征
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引用次数: 1
Digestive system manifestations and analysis of disease severity in 54 patients with coronavirus disease 2019 54例2019冠状病毒病患者消化系统表现及病情严重程度分析
Pub Date : 2020-03-15 DOI: 10.3760/CMA.J.ISSN.0254-1432.2020.03.006
Jihua Shi, Yiran Wang, Wenbin Li, Rui Gang, Xiao Liu, L. Xu
本研究通过回顾性分析2020年2月9至29日华中科技大学附属同济医院中法新城院区隔离病房北京医院国家援鄂抗疫医疗队收治的54例新型冠状病毒肺炎(COVID-19)患者的临床资料,比较不同临床分型患者的基本临床特征、入院时外周血生物化学指标检测结果,以及炎症指标如IL-6、超敏C-反应蛋白(HsCRP)和铁蛋白水平。结果发现COVID-19患者的消化系统症状并不少见,以腹泻(22.2%)和恶心(14.8%)为主,普通型患者的腹泻比例更是高达26.3%(10/38),仅次于常见症状发热、乏力和咳嗽;患者外周血LDH、D-二聚体水平和炎症指标IL-6、HsCRP水平均与临床疾病分型相关,能够提示COVID-19的严重程度。
本研究通过回顾性分析2020年2月9至29日华中科技大学附属同济医院中法新城院区隔离病房北京医院国家援鄂抗疫医疗队收治的54例新型冠状病毒肺炎(COVID-19)患者的临床资料,比较不同临床分型患者的基本临床特征、入院时外周血生物化学指标检测结果,以及炎症指标如IL-6、超敏C-反应蛋白(HsCRP)和铁蛋白水平。结果发现COVID-19患者的消化系统症状并不少见,以腹泻(22.2%)和恶心(14.8%)为主,普通型患者的腹泻比例更是高达26.3%(10/38),仅次于常见症状发热、乏力和咳嗽;患者外周血LDH、D-二聚体水平和炎症指标IL-6、HsCRP水平均与临床疾病分型相关,能够提示COVID-19的严重程度。
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引用次数: 6
Expert recommendations on pathological diagnosis of inflammatory bowel disease 炎性肠病病理诊断的专家建议
Pub Date : 2020-03-15 DOI: 10.3760/CMA.J.ISSN.0254-1432.2020.03.009
Shuyuan Xiao, Z. Ye, Min Chen, Weixun Zhou, Xueying Shi, Ze Li, Fei Yuan, Zhinong Jiang, Jing Sun, Xinying Wang
病理在IBD诊断和鉴别诊断中的作用受到广泛关注,但仍存在观念、认识和实践上的问题和误区。本专家建议强调肠道炎症性疾病的病理诊断思路应从识别病变模式出发,每种模式提示一类可能的鉴别诊断。慢性肠炎是IBD的组织学模式,但IBD的诊断必须建立在慢性肠炎模式结合临床和系统性规范活组织检查的基础上。针对病理医师在IBD诊断和鉴别诊断中常引起困惑的问题提出专家建议,包括CD与UC、CD与肠结核、CD与肠道血管疾病,以及IBD与感染性肠炎之间的鉴别,也建议病理医师通过对诊断的病例主动随访反馈,在实践中不断积累诊断经验。
病理在IBD诊断和鉴别诊断中的作用受到广泛关注,但仍存在观念、认识和实践上的问题和误区。本专家建议强调肠道炎症性疾病的病理诊断思路应从识别病变模式出发,每种模式提示一类可能的鉴别诊断。慢性肠炎是IBD的组织学模式,但IBD的诊断必须建立在慢性肠炎模式结合临床和系统性规范活组织检查的基础上。针对病理医师在IBD诊断和鉴别诊断中常引起困惑的问题提出专家建议,包括CD与UC、CD与肠结核、CD与肠道血管疾病,以及IBD与感染性肠炎之间的鉴别,也建议病理医师通过对诊断的病例主动随访反馈,在实践中不断积累诊断经验。
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引用次数: 1
Manifestations of digestive system of hospitalized patients with coronavirus disease 2019 in Wuhan, China: a single-center descriptive study 武汉2019冠状病毒病住院患者消化系统表现:单中心描述性研究
Pub Date : 2020-03-15 DOI: 10.3760/CMA.J.ISSN.0254-1432.2020.03.003
Dan Fang, Jingdong Ma, Jia-Lun Guan, Mu-ru Wang, Yang Song, D. Tian, Pei-Yuan Li
Objective To study the manifestations of digestive system of hospitalized patients with coronavirus disease 2019 (COVID-19) in Wuhan, China, and to provide a reference for disease control and treatment. Methods The data of hospitalized patients with COVID-19 in the Sino-French Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 27 to February 14, 2020 were retrospectively analyzed, which included general information, positive rate of nucleic acid test, severity of disease, incubation period, initial symptoms and manifestations of digestive system. The general information, positive rate of nucleic acid detection, and manifestations of digestive system were compared between critical patients who required non-invasive or invasive assisted ventilation (critical group) and non-critical patients without assisted ventilation (non-critical group). Continuous corrected Chi-square test and independent sample median Chi-square test were used for statistical analysis. Results Among the 305 patients, there were 146 males (47.9%) and 159 females (52.1%), and the median age was 57 years old. Nucleic acid assay of nasopharyngeal swabs or pharyngeal swabs were positive in 84.1% (228/271) patients including 46 patients (15.1%) of critical group and 259 patients (84.9%) of non-critical group. The incubation period was one to fifteen days, and the median period was six days. The initial symptoms were mainly fever (81.1%, 163/201), cough (39.3%, 79/201), fatigue (54.7%, 110/201), and loss of appetite (50.2%, 101/201). In one to ten days after the disease onset, 79.1% (159/201) of patients developed gastrointestinal symptoms including nausea (29.4%, 59/201), vomiting (15.9%, 32/201), or abdominal pain (6.0%, 12/201). 49.5% (146/295) of patients had diarrhea, with a median time of 3.3 days, (3.3±1.6) times per day, and a duration of (4.1±2.5) days. After excluding possible drug-related diarrhea, the incidence of diarrhea was still 22.2%. Only 6.9% (4/58) of patients had positive fecal leukocytes or fecal occult blood test. Alanine aminotrans ferase (ALT), aspartate aminotransferase (AST), or total bilirubin (TBil) increased in 39.1% (119/304) of patients on admission. Patients with ALT or AST ≥ 80 U/L only accounted for 7.9% (24/304) and 6.3% (19/304), respectively. About 2.0% (6/304) of patients also had increased TBil level, and the average level was (37.4±21.1) μmol/L. The median age of critical group was older than that of non-critical group (65 years vs. 56 years), the proportion of patients with abnormal liver function and slightly increased AST (40- 0.05). Conclusions The manifestation of digestive system of hospitalized COVID-19 patients in Wuhan is significant, the proportion of patients with diarrhea and abnormal aminotransferase level is high. And on admission the proportion of patients with abnormal liver function of critical group is higher than that of non-critical group, which w
目的了解武汉市新型冠状病毒病2019 (COVID-19)住院患者的消化系统表现,为疾病控制和治疗提供参考。方法回顾性分析华中科技大学同济医学院同济医院中法分院2020年1月27日至2月14日收治的新型冠状病毒肺炎住院患者的一般资料、核酸检测阳性率、病情严重程度、潜伏期、首发症状及消化系统表现。比较需要无创或有创辅助通气的危重患者(危重组)与不需要辅助通气的非危重患者(非危重组)的一般信息、核酸检测阳性率及消化系统表现。采用连续校正卡方检验和独立样本中位数卡方检验进行统计分析。结果305例患者中,男性146例(47.9%),女性159例(52.1%),中位年龄57岁。84.1%(228/271)患者鼻咽拭子或咽拭子核酸检测阳性,其中危重组46例(15.1%),非危重组259例(84.9%)。潜伏期为1至15天,中位期为6天。首发症状主要为发热(81.1%,163/201)、咳嗽(39.3%,79/201)、乏力(54.7%,110/201)、食欲减退(50.2%,101/201)。发病后1 ~ 10天,79.1%(159/201)的患者出现恶心(29.4%,59/201)、呕吐(15.9%,32/201)、腹痛(6.0%,12/201)等胃肠道症状。49.5%(146/295)的患者出现腹泻,平均时间3.3天,每天(3.3±1.6)次,持续时间(4.1±2.5)天。排除可能的药物相关性腹泻后,腹泻发生率仍为22.2%。仅6.9%(4/58)的患者粪便白细胞或粪便潜血试验阳性。入院时丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)或总胆红素(TBil)升高的患者占39.1%(119/304)。ALT或AST≥80u /L的患者分别占7.9%(24/304)和6.3%(19/304)。约2.0%(6/304)患者TBil水平升高,平均为(37.4±21.1)μmol/L。危重组的中位年龄大于非危重组(65岁比56岁),肝功能异常、AST轻度升高的患者比例(40- 0.05)。结论武汉市住院COVID-19患者消化系统表现明显,腹泻和转氨酶水平异常的患者比例较高。入院时危重组肝功能异常患者比例高于非危重组,为COVID-19的防治提供参考。关键词:新型冠状病毒;COVID-19;腹泻;肝功能;胃肠道
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引用次数: 26
Clinical characteristics and risk factors of gastrointestinal symptoms in patients with coronavirus disease 2019 in Xinyang, Henan Province, China 河南省信阳市2019年冠状病毒病患者胃肠道症状临床特征及危险因素分析
Pub Date : 2020-03-15 DOI: 10.3760/CMA.J.ISSN.0254-1432.2020.03.007
Ye-ting Zhao, S. Zhong, Fang Li, Gang Liu, Xinfang Wang
回顾性分析信阳市第五人民医院106例成人新型冠状病毒肺炎(COVID-19)患者的临床特征,了解河南省信阳地区COVID-19患者消化道症状临床特征和危险因素。筛选合并消化道症状8例患者为病例组,无消化道症状16例患者为对照组,结果发现病例组与对照组的临床症状、基础疾病和流行病学特征比较差异均无统计学意义(P均>0.05)。病例组中性粒细胞计数、CRP、DBil和肌红蛋白水平均高于对照组,差异均有统计学意义[OR(95%CI)分别为2.021(1.012~2.123)、1.015(1.002~1.028)、1.062(1.008~1.357)和1.091(1.000~1.921),P均<0.05]。CRP水平升高是COVID-19患者出现消化道症状的独立危险因素(P < 0.05)。COVID-19患者合并消化道症状发生率为7.55%(8/106),有消化道症状者炎症活动和器官受累情况比无消化道症状者更严重。
回顾性分析信阳市第五人民医院106例成人新型冠状病毒肺炎(COVID-19)患者的临床特征,了解河南省信阳地区COVID-19患者消化道症状临床特征和危险因素。筛选合并消化道症状8例患者为病例组,无消化道症状16例患者为对照组,结果发现病例组与对照组的临床症状、基础疾病和流行病学特征比较差异均无统计学意义(P均>0.05)。病例组中性粒细胞计数、CRP、DBil和肌红蛋白水平均高于对照组,差异均有统计学意义[OR(95%CI)分别为2.021(1.012~2.123)、1.015(1.002~1.028)、1.062(1.008~1.357)和1.091(1.000~1.921),P均<0.05]。CRP水平升高是COVID-19患者出现消化道症状的独立危险因素(P < 0.05)。COVID-19患者合并消化道症状发生率为7.55%(8/106),有消化道症状者炎症活动和器官受累情况比无消化道症状者更严重。
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引用次数: 0
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中华消化杂志
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