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Summary of perioperative analgesia and sedation management of 19 lung transplant recipients 19例肺移植患者围手术期镇痛镇静处理总结
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2021.6013
R. Zhu, S. Yu, W. Gao, L. Zhan
Objective: To summarize and explore the management experience of postoperative analgesia and sedation in lung transplant recipients. Methods: A total of 19 cases of lung transplantation were performed in Renmin Hospital of Wuhan University from December 2016 to December 2020, and all of them were transferred back to intensive care unit after surgery, the clinical data were retrospectively analyzed. Results: Among the 19 patients, the main diagnoses were chronic obstructive pulmonary disease in 5 cases, idiopathic pulmonary fibrosis in 6 cases, bronchiectasis in 2 cases, pneumoconiosis in 4 cases, Kartagener syndrome in 1 case and COVID-19 pneumonia with advanced pulmonary fibrosis in 1 case. There were 12 cases of double lung transplantation, and 7 cases of unilateral lung transplantation in (4 cases of left single lung transplantation and 3 cases of right single lung transplantation). Nine patients used ECMO to complete the operation, and 5 cases took ECMO back to the intensive care unit. All patients were treated with opioid analgesia, mainly sufentanil at a dose of 0.2-0.3 μg/(kg•h), midazolam and propofol are mainly used as sedatives at doses of 0.02-0.1 mg/(kg•h) and 0.3-0.4 mg/(kg•h), respectively, and the Richmond agitation sedation scale was -3.01±1.32 within 24 hours after operation. The main postoperative adverse events were delirium (1 case) and respiratory depression (1 case). There were 6 deaths during the perioperative period. One case died of multi-drug resistant bacteria infection, 1 case died of circulatory failure caused by active thoracic hemorrhage post-operation, the third case died of intraoperative cardiac arrest, and the other 3 cases were given up because of multiple organs failure. Conclusion: Analgesia and sedation is an important treatment for patients after lung transplantation. Choosing the depth of sedation according to the functional state of organs of lung transplant recipients and implementing the sedation strategy aiming at organ function protection is helpful to maintain the stability of cardiopulmonary function after lung transplantation. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:总结和探讨肺移植术后镇痛镇静的管理经验。方法:对2016年12月至2020年12月在武汉大学人民医院行肺移植手术的19例患者进行回顾性分析,所有患者术后均转回重症监护病房。结果:19例患者中,主要诊断为慢性阻塞性肺疾病5例,特发性肺纤维化6例,支气管扩张2例,尘肺病4例,Kartagener综合征1例,COVID-19肺炎合并晚期肺纤维化1例。双肺移植12例,单侧肺移植7例(左单肺移植4例,右单肺移植3例)。9例患者采用ECMO完成手术,5例患者采用ECMO返回重症监护病房。所有患者均给予阿片类镇痛,以舒芬太尼为主,剂量为0.2 ~ 0.3 μg/(kg•h),镇静以咪达唑仑和异丙酚为主,剂量分别为0.02 ~ 0.1 mg/(kg•h)和0.3 ~ 0.4 mg/(kg•h),术后24 h内Richmond搅拌镇静评分为-3.01±1.32。术后主要不良事件为谵妄(1例)和呼吸抑制(1例)。围手术期死亡6例。1例死于多重耐药菌感染,1例死于术后胸腔活动性出血导致循环衰竭,3例死于术中心脏骤停,其余3例因多脏器衰竭而放弃手术。结论:镇痛镇静是肺移植术后患者的重要治疗手段。根据肺移植受者器官功能状态选择镇静深度,实施以器官功能保护为目标的镇静策略,有助于维持肺移植术后心肺功能的稳定。©2021,武汉大学医学杂志编辑委员会。版权所有。
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引用次数: 0
Influencing factors of occupational stress of front⁃line medical workers under the epidemic of COVID‑19 新冠肺炎疫情下前线医务人员职业应激影响因素分析
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2020.0288
H. Lin, H. Ai, X. Guo, X. Wu, B. Chen
Objective: To understand the influencing factors of occupational stress of front‑line medical workers and provide scientific decision‑making basis for health management departments, and to avoid post‑epidemic stress disorders of medical workers. Methods: Using the method of random sampling, the electronic questionnaire was sent in the forms of Wechat link and picture QR code. Results: Frequent night shift, frequent headache and tiredness, fear of COVID‑19, anxiety and tension caused by overwork, job burnout and self‑remorse due to the death of patients were the influencing factors of self‑stress perception of front‑line medical workers. Conclusion: The occupational pressure of anti‑epidemic front‑line medical workers is great, and measures such as psychological counseling and reasonable shift arrangement should be taken. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:了解一线医务人员职业应激的影响因素,为卫生管理部门提供科学的决策依据,避免医务人员出现流行后应激障碍。方法:采用随机抽样的方法,以微信链接和图片二维码的形式发送电子问卷。结果:频繁上夜班、频繁头痛疲倦、对新冠病毒的恐惧、过度劳累引起的焦虑和紧张、工作倦怠和因患者死亡而产生的自责是一线医务人员自我压力感知的影响因素。结论:抗疫一线医务人员职业压力大,应采取心理疏导、合理排班等措施。©2021,武汉大学医学杂志编辑委员会。版权所有。
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引用次数: 0
Application of extracorporeal membrane oxygenation in the perioperative period of lung transplantation 体外膜氧合在肺移植围手术期的应用
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2021.6011
C. Ma, J. Bai, M. Wu, X. Du
Objective: To investigate the application of extracorporeal membrane oxygenation (ECMO) in the perioperative period of lung transplantation, and summarize the experience. Methods: The clinical data of 19 patients receiving lung transplantation operation in Renmin Hospital of Wuhan University from December 2016 to December 2020 were retrospectively analyzed. Patients were divided into groups according to whether ECMO support was used, and their clinical data were compared. Results: Among the 19 patients, there were 5 cases of chronic obstructive pulmonary disease, 3 cases of bronchiectasis, 4 cases of pneumoconiosis, 4 cases of idiopathic pulmonary fibrosis, 1 case of connective tissue disease interstitial pulmonary fibrosis, 1 case of Kartagener syndrome, and 1 case of COVID-19 with advanced pulmonary fibrosis. Among the 10 patients in the non-ECMO group, 1 died during the operation, 1 died after abandoning treatment, and 1 was discharged after abandoning treatment. There were 9 patients in the ECMO group, 2 patients received ECMO bridged treatment before surgery, and the remaining 7 patients received ECMO adjuvant treatment after anesthesia. In the ECMO group, 1 patient died, 1 patient was discharged after abandoning treatment, and the rest patients were all improved and discharged after successful weaning of ECMO. The two groups only differed in the way of preoperative respiratory support (P=0.033). There were no significant differences in gender, age, preoperative assessment, surgical process, length of hospital stay, ICU stay, postoperative multi-drug resistant organism infection, and outcome. Conclusion: ECMO is an important auxiliary tool during the perioperative period of lung transplantation. The use of ECMO did not increase the risk of postoperative infection with multidrug-resistant bacteria, nor did it lead to an increase in mortality. In the other hand, the choice of preoperative respiratory support method has reference for perioperative patients whether to use ECMO. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:探讨体外膜氧合(ECMO)在肺移植围手术期的应用,总结经验。方法:回顾性分析2016年12月至2020年12月武汉大学人民医院19例肺移植手术患者的临床资料。根据是否使用ECMO支持将患者分为两组,比较两组患者的临床资料。结果:19例患者中,慢性阻塞性肺疾病5例,支气管扩张3例,尘肺病4例,特发性肺纤维化4例,结缔组织病间质性肺纤维化1例,Kartagener综合征1例,COVID-19合并晚期肺纤维化1例。非ecmo组10例患者,术中死亡1例,放弃治疗后死亡1例,放弃治疗后出院1例。ECMO组9例,2例术前接受ECMO桥接治疗,其余7例麻醉后接受ECMO辅助治疗。ECMO组1例死亡,1例放弃治疗出院,其余患者均好转,成功脱机后出院。两组仅在术前呼吸支持方式上有差异(P=0.033)。性别、年龄、术前评估、手术过程、住院时间、ICU住院时间、术后多药耐药菌感染和结局无显著差异。结论:ECMO是肺移植围手术期重要的辅助工具。ECMO的使用没有增加术后多药耐药菌感染的风险,也没有导致死亡率的增加。另一方面,术前呼吸支持方式的选择对围手术期患者是否采用ECMO有参考意义。©2021,武汉大学医学杂志编辑委员会。版权所有。
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引用次数: 0
Factors related to viral clearance time in patients with critical COVID‑19 危重型COVID - 19患者病毒清除时间的相关因素
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2020.0499
L. Li, B. He, S. Zhang, S. Wang, M. Zhang, Q. Zhao
Objective: To evaluate the related factors to virus clearance time in patients with critical COVID‑19. Methods: A total of 63 patients with critical COVID‑19 who had viral clearance were enrolled from Feb 1 to Mar 20, 2020, in Renmin Hospital of Wuhan University. Univariate analyses were used to compare the related factors between groups with different viral clearance time (≤30 days viral clearance group versus >30 days viral clearance group). COX regression analysis was also used to evaluate the factors related to virus clearance time. Results: A total of 63 critical patients with COVID‑19 who had viral clearance were collected, including 35 male and 28 female. The mean age was (63.65±14.06) years, range from 29 to 89 years. The median viral clearance time was 27 days ( IQR, 21~36 days). In univariate analysis, the following factors had significant differences between ≤30 days viral clearance group and >30 days viral clearance group (all P 70 years old, COPD, WBC>9.5×109/L, LYM 50 mg/L, D‑dimer>5 mg/L, CK>200 U/L, LDH>300 U/L, CD4+ T‑cell 70 years old ( HR : 0.207, 95% CI : 0.090‑0.479), LYM 5 mg/L ( HR : 0.243, 95% CI : 0.105‑0.563), and ALT>50 U/L ( HR : 0.483, 95% CI : 0.239‑0.973) were inconducive to the elimination of the virus. Conclusion: Critical COVID‑19 patients have longer hospital stays and significantly different virus clearance time. There are many factors that affect viral clearance time. As adverse factors, age>70 years old, LYM 5 mg/L and ALT>50 U/L may prolong the viral clearance time. Early detection of related factors and timely treatment are beneficial to shorten the time of viral clearance and improve the prognosis of the disease. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:探讨影响COVID - 19危重患者病毒清除时间的相关因素。方法:选取武汉大学人民医院2020年2月1日至3月20日病毒清除的危重型COVID - 19患者63例。采用单因素分析比较不同病毒清除时间组(≤30天的病毒清除组与≤30天的病毒清除组)的相关因素。采用COX回归分析评价与病毒清除时间相关的因素。结果:共收集到63例病毒清除的COVID - 19危重患者,其中男性35例,女性28例。年龄29 ~ 89岁,平均(63.65±14.06)岁。中位病毒清除时间为27天(IQR, 21~36天)。在单变量分析中,下列因素之间有显著差异≤30天病毒清除组和病毒清除> 30天组(所有P 70岁,慢性阻塞性肺病,白细胞> 9.5×109 / L, LYM 50 mg / L、D -二聚体> 5 mg / L, CK > 200 U / L, LDH > 300 U / L, CD4 + T细胞- 70岁(人力资源:0.207,95%置信区间CI: 0.090 - 0.479), LYM 5 mg / L(人力资源:0.243,95%置信区间CI: 0.105 - 0.563),和ALT > 50 U / L(人力资源:0.483,95%置信区间CI: 0.239 - 0.973)是病毒的消除无益的。结论:COVID - 19危重患者住院时间更长,病毒清除时间差异显著。影响病毒清除时间的因素有很多。年龄70岁、LYM 5 mg/L、ALT 50 U/L等不利因素可延长病毒清除时间。早期发现相关因素,及时治疗,有利于缩短病毒清除时间,改善疾病预后。©2021,武汉大学医学杂志编辑委员会。版权所有。
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引用次数: 0
Clinical characteristics of COVID‑19 complicated with pleural and pericardial effusion in 10 patients COVID - 19合并胸膜和心包积液10例临床特点
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2020.0559
Y. Guo, L. Zhang, R. Li, S. Tian, W. Dong
Objective: To retrospectively analyze the clinical characteristics of corona virus disease 2019 (COVID‑19) patients with pleural and pericardial effusion. Methods: We retrospectively reviewed and compared data of 60 COVID‑19 inpatients including 10 patients with pleural effusion (PLE) and pericardial effusion (PCE) and 50 cases without PLE/PCE, from January 20, 2020 to March 23, 2020 in Renmin Hospital of Wuhan University. The patients' medical history, clinical features, physical findings, laboratory test results, and chest tomographic imaging were recorded and analyzed. Statistical significance was determined using the chi‑square test, Fisher's exact test, and the Mann‑Whitney U‑test. Results: COVID‑19 patients with PLE and PCE had a higher temperature (P<0.001), a higher incidence of breath shortness (P=0.024) and faster respiratory frequency (P=0.004) than those without PLE and PCE. Laboratory findings showed that patients with PLE and PCE had higher levels of C‑reactive protein (CRP,P=0.039) and D‑dimer (P=0.038), and lower levels of lymphocytes (P=0.024), hemoglobin (P=0.003), CD4+T cell counts (P=0.016), and oxygen saturation (P=0.037). Meanwhile, patients with PLE and PCE had higher incidence of severe or critical illness and mortality rates as compared with those without PLE and PCE (all P<0.05). Conclusion: PLE and PCE were indicators for severe inflammation and poor clinical outcomes, and might be independent risk factors for critical type in COVID‑19 patients. It suggests that the treatment for the COVID‑19 patients with PLE and PCE should be more active and timely. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:回顾性分析2019冠状病毒病(COVID - 19)合并胸膜和心包积液患者的临床特点。方法:回顾性分析武汉大学人民医院2020年1月20日至2020年3月23日收治的60例新冠肺炎住院患者的资料,其中合并胸腔积液(PLE)和心包积液(PCE)的患者10例,未合并胸腔积液/心包积液的患者50例。记录和分析患者的病史、临床特征、体格检查、实验室检查结果和胸部断层成像。统计显著性采用卡方检验、Fisher精确检验和Mann - Whitney U检验确定。结果:合并PLE和PCE的COVID - 19患者比未合并PLE和PCE的患者体温升高(P<0.001),呼吸急促发生率(P=0.024)和呼吸频率加快(P=0.004),实验室结果显示,合并PLE和PCE的患者C反应蛋白(CRP,P=0.039)和D -二聚体(P=0.038)水平较高,淋巴细胞(P=0.024)、血红蛋白(P=0.003)、CD4+T细胞计数(P=0.016)和血氧饱和度(P=0.037)水平较低。合并PLE、PCE患者的重症、危重症发生率及病死率均高于未合并PLE、PCE患者(P<0.05)。结论:PLE和PCE是严重炎症和不良临床结局的指标,可能是COVID - 19危重型患者的独立危险因素。提示对新冠肺炎合并PLE和PCE患者的治疗应更加积极和及时。©2021,武汉大学医学杂志编辑委员会。版权所有。
{"title":"Clinical characteristics of COVID‑19 complicated with pleural and pericardial effusion in 10 patients","authors":"Y. Guo, L. Zhang, R. Li, S. Tian, W. Dong","doi":"10.14188/j.1671-8852.2020.0559","DOIUrl":"https://doi.org/10.14188/j.1671-8852.2020.0559","url":null,"abstract":"Objective: To retrospectively analyze the clinical characteristics of corona virus disease 2019 (COVID‑19) patients with pleural and pericardial effusion. Methods: We retrospectively reviewed and compared data of 60 COVID‑19 inpatients including 10 patients with pleural effusion (PLE) and pericardial effusion (PCE) and 50 cases without PLE/PCE, from January 20, 2020 to March 23, 2020 in Renmin Hospital of Wuhan University. The patients' medical history, clinical features, physical findings, laboratory test results, and chest tomographic imaging were recorded and analyzed. Statistical significance was determined using the chi‑square test, Fisher's exact test, and the Mann‑Whitney U‑test. Results: COVID‑19 patients with PLE and PCE had a higher temperature (P<0.001), a higher incidence of breath shortness (P=0.024) and faster respiratory frequency (P=0.004) than those without PLE and PCE. Laboratory findings showed that patients with PLE and PCE had higher levels of C‑reactive protein (CRP,P=0.039) and D‑dimer (P=0.038), and lower levels of lymphocytes (P=0.024), hemoglobin (P=0.003), CD4+T cell counts (P=0.016), and oxygen saturation (P=0.037). Meanwhile, patients with PLE and PCE had higher incidence of severe or critical illness and mortality rates as compared with those without PLE and PCE (all P<0.05). Conclusion: PLE and PCE were indicators for severe inflammation and poor clinical outcomes, and might be independent risk factors for critical type in COVID‑19 patients. It suggests that the treatment for the COVID‑19 patients with PLE and PCE should be more active and timely. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.","PeriodicalId":35402,"journal":{"name":"Medical Journal of Wuhan University","volume":"42 1","pages":"878-883"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66657087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Application of remote fetal heart rate monitoring during the pandemic of COVID‑19 远程胎儿心率监测在COVID - 19大流行期间的应用
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2021.0006
Y. Xu, F. Huang
Objective: To explore the application of remote fetal heart rate monitoring during the pandemic of COVID‑19. Methods: The rate of cesarean section, the incidence of neonatal asphyxia, the times of self‑care, the false positive rate, and the degree of anxiety were compared between the remote fetal heart rate monitoring group and control group. Results: There was no significant difference in cesarean section rate and neonatal asphyxia rate between the two groups( P >0.05). The frequency of self‑care and the incidence of false positive in the remote fetal heart monitoring group were better than in control group( P <0.01). Compared with the remote fetal heart rate monitoring group, the control group were more likely to be anxious( P <0.01). Conclusion: Remote fetal heart rate monitoring is suitable as an effective supplement for hospital prenatal examination during the epidemic period, and it has good application prospects. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:探讨远程胎儿心率监测在COVID - 19大流行期间的应用。方法:比较远程胎心监测组与对照组的剖宫产率、新生儿窒息发生率、自我护理次数、假阳性率、焦虑程度。结果:两组剖宫产率、新生儿窒息率比较,差异均无统计学意义(P < 0.05)。远程胎心监护组自我护理频次和假阳性发生率均优于对照组(P <0.01)。与远程胎心监测组相比,对照组出现焦虑的可能性更大(P <0.01)。结论:远程胎心监测适合作为流行期医院产前检查的有效补充,具有良好的应用前景。©2021,武汉大学医学杂志编辑委员会。版权所有。
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引用次数: 0
Risk factors analysisi for COVID‑19 in the elderly 老年人COVID - 19危险因素分析
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2021.0064
Z. Wang, H. Wang, Q. Yin, J. Peng, Y. Wang, H. Ye
Objective: To analyze the clinical characteristics and prognosis of the coronavirus disease 2019 (COVID‑19) in the elderly(aged 60 or above), and to explore the high risk factors of severe disease progression for early identification and prevention. Methods: Novel coronavirus pneumonia patients aged 60 or above diagnosed in Hubei Veterans Hospital from January 20 to February 29 in year 2020 were collected. According to the degrees of disease, the patients were divided into mild and severe groups, and their clinical features, laboratory examination, chest CT features, treatment, and outcome were compared. Results: A total of 108 patients were included, including 69 in mild group and 39 in severe group. The average age of the severe group was higher than that of the mild group ( P <0.001). The clinical symptoms of fever, expectoration, dyspnea, fatigue and diarrhea in the severe group were severer and more common than those in the mild group (all P <0.001). The proportion of hypertension ( P <0.05), respiratory system diseases (such as chronic bronchitis and COPD) ( P <0.05), and hypoproteinemia ( P <0.001) combined with COVID⁃19 were higher in severe groupthe severe group. Leukocyte count (WBC), neutrophil count (NEUT), CRP and SAA in the severe group were significantly higher ( P <0.05), while lymphocyte count (LY) and eosinophil count (EOS) were lower than those in the mild group ( P <0.05). Lung CT images showed that patients in the severe group had more bilateral lung involvements and pleural effusion than those in the mild group ( P <0.05). Among the 108 cases, 96 (88.9%) were cured and improved, 12 (11.1%) died. Conclusion: Age, basic comorbidities, decreasing in lymphocytes and acidophilic granulocytes, and multiple bacterial infections are risk factors for severe COVID‑19. Hypoalbuminemia may be a potential and independent adverse prognostic indicator for the elderly COVID‑19. Symptoms of dyspnea and diarrhea, bilateral lung involvements, the pleural effusion are high risk signs for the elderly COVID‑19 patients progressing to severe. These findings are valuable for the early recognition, early diagnosis and treatment for COVID⁃19. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:分析老年人(60岁及以上)新型冠状病毒病2019 (COVID - 19)的临床特点及预后,探讨疾病严重进展的高危因素,以便及早发现和预防。方法:收集2020年1月20日至2月29日在湖北省退役军人医院确诊的60岁及以上的新型冠状病毒肺炎患者。根据病情程度将患者分为轻、重度两组,比较其临床特征、实验室检查、胸部CT表现、治疗及转归。结果:共纳入108例患者,其中轻度组69例,重度组39例。重度组的平均年龄高于轻度组(P <0.001)。重症组患者发热、咳痰、呼吸困难、乏力、腹泻等临床症状较轻症组更严重、更常见(均P <0.001)。重症组合并高血压(P <0.05)、呼吸系统疾病(如慢性支气管炎、慢性阻塞性肺病)(P <0.05)、低蛋白血症(P <0.001)合并COVID⁃19的比例高于重症组。重症组白细胞计数(WBC)、中性粒细胞计数(NEUT)、CRP、SAA显著高于轻度组(P <0.05),淋巴细胞计数(LY)、嗜酸性粒细胞计数(EOS)显著低于轻度组(P <0.05)。肺部CT图像显示,重型组患者双侧肺受累及胸腔积液明显多于轻型组(P <0.05)。108例中治愈好转96例(88.9%),死亡12例(11.1%)。结论:年龄、基本合并症、淋巴细胞和嗜酸粒细胞减少、多种细菌感染是重症COVID - 19的危险因素。低白蛋白血症可能是老年COVID - 19的一个潜在且独立的不良预后指标。呼吸困难和腹泻、双侧肺受累、胸腔积液等症状是老年COVID - 19患者病情恶化的高危体征。这些发现对COVID⁃19的早期识别、早期诊断和治疗具有重要意义。©2021,武汉大学医学杂志编辑委员会。版权所有。
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引用次数: 0
Changes of antibodies in COVID‑19 patients: A 10‑month prospective study COVID - 19患者抗体变化:一项为期10个月的前瞻性研究
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2021.0357
M. Jia, L. Liu, X. Cai, X. Wu
Objective: To explore the law of antibody changes in patients diagnosed with COVID‑19 after the onset of the disease. Methods: A total of 215 patients who were diagnosed with COVID‑19 by RT‑PCR in Wuchang District, Wuhan City, Hubei Province were recruited as the research subjects. The rapid colloidal gold immunochromatography assay was performed on every newly diagnosed patient at the time points of (10±3) d, (100±3) d, (190±3) d, and (280±3) d after the onset of the disease. Results: In terms of antibody types, among the 215 patients,the positive rate of IgM antibodies was 36.7% at (10±3) d. The antibody levels were 22.5%, 5.0%, and 4.7% at (100±3) d, (190±3) d, and (280±3) d respectively. In general, the levels of IgG antibody were high. The positive rate of antibody within (10±3) days was 87.0%, and the rate decreased to 80.8% at (100±3) d, 49.7% and 46.5% at (190±3) d and (280±3) d, respectively. The number of IgM and IgG antibodies homo‑positive samples gradually decreased over time. At the meantime, the proportion of IgM+IgG antibodies both negative samples gradually increases. According to the clinical classification, in the early stage of the disease, the positive rate of IgM antibody was different in patients with different severity of clinical symptoms. The more severe the clinical symptoms, the higher the positive rate of IgM antibodies. Around 190 days after the onset of symptoms, the positive rate of IgG antibodies decreased more slowly in mild and common patients. At the 280‑day during follow‑up, IgM antibodies showed a higher positive rate in severe and critical patients. From the trend of antibody changes in the same patient within 10 months, among the 70 patients, only 55 cases (32.4%) showed continuous positive in IgG antibody, with 77 cases (45.3%) in the IgG antibody positive‑to‑negative group,and 21 cases (12.4%) in the IgG antibody positive‑to‑negative‑to‑positive group. Three cases (1.8%) showed IgG antibody negative converting to positive. However, there were 14 cases (8.2%) remaining with negative IgG antibody. For IgM antibodies, 97 cases (57.1%) were persistently negative, wth 5 cases (2.9%) in the negative‑to‑positive group, and 65 cases (38.2%) in the positive‑to‑negative group. IgM antibody continued to be positive within 10 months has not been observed yet, and there were 3 cases (1.8%) in the IgM antibody positive‑to‑negative‑to‑positive group. Conclusion: After the new coronavirus infection, the serological response is unstable. In the early stage of the disease, antibody detection has important auxiliary value for the diagnosis of the disease;but in the late stage, the diagnostic value is not great. The antibody response may be positively correlated with the severity of the disease. Nearly 50% of patients can remain positive for IgG antibodies within 10 months, which indicates that nearly half of patients recovering from COVID‑19 can obtain longer‑lasting immunity. However, IgG antibodies in some patients contin
目的:探讨确诊COVID - 19患者发病后抗体变化规律。方法:选取湖北省武汉市武昌区经RT - PCR诊断为COVID - 19的215例患者作为研究对象。在发病后(10±3)d、(100±3)d、(190±3)d、(280±3)d对每例新确诊患者进行快速胶体金免疫层析分析。结果:从抗体类型来看,215例患者(10±3)d时IgM抗体阳性率为36.7%,(100±3)d、(190±3)d和(280±3)d时抗体水平分别为22.5%、5.0%和4.7%。总体而言,IgG抗体水平较高。(10±3)d抗体阳性率为87.0%,(100±3)d抗体阳性率为80.8%,(190±3)d抗体阳性率为49.7%,(280±3)d抗体阳性率为46.5%。随着时间的推移,IgM和IgG抗体阳性样本的数量逐渐减少。同时,IgM+IgG抗体双阴性样本所占比例逐渐增加。根据临床分类,在疾病早期,不同临床症状严重程度的患者IgM抗体阳性率不同。临床症状越严重,IgM抗体阳性率越高。出现症状后190天左右,轻、普通患者IgG抗体阳性率下降较慢。随访280天,重症和危重症患者IgM抗体阳性率较高。从同一患者10个月内抗体变化趋势看,70例患者中IgG抗体持续阳性的只有55例(32.4%),其中IgG抗体由阳性转为阴性组77例(45.3%),IgG抗体由阳性转为阴性转为阳性组21例(12.4%)。IgG抗体阴性转阳性3例(1.8%)。但仍有14例(8.2%)IgG抗体阴性。IgM抗体持续阴性97例(57.1%),阴性转阳性组5例(2.9%),阳性转阴性组65例(38.2%)。未见IgM抗体持续10个月呈阳性,IgM抗体阳性-阴性-阳性组有3例(1.8%)。结论:新型冠状病毒感染后,血清学反应不稳定。在疾病的早期,抗体检测对疾病的诊断有重要的辅助价值,但到了晚期,诊断价值就不大了。抗体反应可能与疾病的严重程度呈正相关。近50%的患者可以在10个月内保持IgG抗体阳性,这表明近一半从COVID - 19恢复的患者可以获得更持久的免疫力。然而,一些患者的IgG抗体持续或最终变为阴性。这类患者能否获得免疫还有待观察和研究。©2021,武汉大学医学杂志编辑委员会。版权所有。
{"title":"Changes of antibodies in COVID‑19 patients: A 10‑month prospective study","authors":"M. Jia, L. Liu, X. Cai, X. Wu","doi":"10.14188/j.1671-8852.2021.0357","DOIUrl":"https://doi.org/10.14188/j.1671-8852.2021.0357","url":null,"abstract":"Objective: To explore the law of antibody changes in patients diagnosed with COVID‑19 after the onset of the disease. Methods: A total of 215 patients who were diagnosed with COVID‑19 by RT‑PCR in Wuchang District, Wuhan City, Hubei Province were recruited as the research subjects. The rapid colloidal gold immunochromatography assay was performed on every newly diagnosed patient at the time points of (10±3) d, (100±3) d, (190±3) d, and (280±3) d after the onset of the disease. Results: In terms of antibody types, among the 215 patients,the positive rate of IgM antibodies was 36.7% at (10±3) d. The antibody levels were 22.5%, 5.0%, and 4.7% at (100±3) d, (190±3) d, and (280±3) d respectively. In general, the levels of IgG antibody were high. The positive rate of antibody within (10±3) days was 87.0%, and the rate decreased to 80.8% at (100±3) d, 49.7% and 46.5% at (190±3) d and (280±3) d, respectively. The number of IgM and IgG antibodies homo‑positive samples gradually decreased over time. At the meantime, the proportion of IgM+IgG antibodies both negative samples gradually increases. According to the clinical classification, in the early stage of the disease, the positive rate of IgM antibody was different in patients with different severity of clinical symptoms. The more severe the clinical symptoms, the higher the positive rate of IgM antibodies. Around 190 days after the onset of symptoms, the positive rate of IgG antibodies decreased more slowly in mild and common patients. At the 280‑day during follow‑up, IgM antibodies showed a higher positive rate in severe and critical patients. From the trend of antibody changes in the same patient within 10 months, among the 70 patients, only 55 cases (32.4%) showed continuous positive in IgG antibody, with 77 cases (45.3%) in the IgG antibody positive‑to‑negative group,and 21 cases (12.4%) in the IgG antibody positive‑to‑negative‑to‑positive group. Three cases (1.8%) showed IgG antibody negative converting to positive. However, there were 14 cases (8.2%) remaining with negative IgG antibody. For IgM antibodies, 97 cases (57.1%) were persistently negative, wth 5 cases (2.9%) in the negative‑to‑positive group, and 65 cases (38.2%) in the positive‑to‑negative group. IgM antibody continued to be positive within 10 months has not been observed yet, and there were 3 cases (1.8%) in the IgM antibody positive‑to‑negative‑to‑positive group. Conclusion: After the new coronavirus infection, the serological response is unstable. In the early stage of the disease, antibody detection has important auxiliary value for the diagnosis of the disease;but in the late stage, the diagnostic value is not great. The antibody response may be positively correlated with the severity of the disease. Nearly 50% of patients can remain positive for IgG antibodies within 10 months, which indicates that nearly half of patients recovering from COVID‑19 can obtain longer‑lasting immunity. However, IgG antibodies in some patients contin","PeriodicalId":35402,"journal":{"name":"Medical Journal of Wuhan University","volume":"42 1","pages":"861-866"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66656805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Clinical efficacy of Lopinavir-Ritonavir combined with interferon alpha in COVID-19 洛匹那韦-利托那韦联合α干扰素治疗COVID-19的临床疗效观察
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2020.0400
Y. Wang, T. Suo, H. Fan, K. Zhao, J. Zou, D. Wu, G. Tang, G. Chen
Objective: To evaluate the clinical efficacy of Lopinavir-Ritonavir combined with interferon alpha on coronavirus disease 2019 (COVID-19). Methods: A prospective and real-world observational clinical research was conducted on COVID-19 cases who were admitted to the Renmin Hospital of Wuhan University from January 25, 2020 to February 12, 2020. Of the 109 cases involved, 58 cases were treated with interferon alpha (group A), while 58 cases were treated with Lopinavir-Ritonavir combined with interferon alpha (group B). The recent outcomes were compared between the two groups by Kruskal Wallis test or Chi square test. Results: The baseline data of the two groups were basically the same. On the 7th day after treatment, the lung inflammation in group B was higher than in group A, and the leukocyte count and neutrophil count in the normal range increased as compared with the baseline value in group B. On the 14th day after treatment, the leukocyte count, lymphocyte count, CD4/CD8 cell count increased as compared with the baseline value, while CRP decreased from baseline in the B group, with statistically significant differnce. Conclusion: Lopinavir-Ritonavir combined with interferon alpha can accelerate the improvement of pulmonary inflammation, and increase the levels of immune cells in COVID-19 patients. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:评价洛匹那韦-利托那韦联合干扰素治疗冠状病毒病2019 (COVID-19)的临床疗效。方法:对2020年1月25日至2020年2月12日武汉大学人民医院收治的新冠肺炎病例进行前瞻性和现实观察性临床研究。109例患者中,干扰素治疗组58例(A组),洛匹那韦-利托那韦联合干扰素治疗组58例(B组)。采用Kruskal Wallis检验或卡方检验比较两组近期疗效。结果:两组患者基线资料基本相同。治疗后第7天,B组肺部炎症程度高于A组,正常范围内白细胞计数、中性粒细胞计数较B组基线值升高。治疗后第14天,B组白细胞计数、淋巴细胞计数、CD4/CD8细胞计数较基线值升高,CRP较基线值下降,差异均有统计学意义。结论:洛匹那韦-利托那韦联合干扰素可加速COVID-19患者肺部炎症的改善,提高免疫细胞水平。©2021,武汉大学医学杂志编辑委员会。版权所有。
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引用次数: 2
Clinical characteristics of twenty children with COVID⁃19 20例儿童COVID⁃19的临床特征分析
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.14188/j.1671-8852.2020.0502
Y. Xu, X. Song, A. Zhang, W. Lu, Q. Yuan, X. Peng, B. Yao
Objective: To investigate the characteristics of disease transmission, diagnosis, and treatment of COVID‑19 in children. Methods: We retrospectively studied 20 children with COVID‑19 from 4 medical centers in Hubei, China. Results: Among the 20 children, 18 (90.0%) were contaminated by close contact and characterized by family clustering. Seven cases (35.0%) had all family members infected, and 11 cases (55.0%) were confirmed by either of the parents infected. Twelve cases (60.0%) had fever, which was the primary symptom in 10 cases (50.0%). Only one child was in severe degree and combined with severe underlying disease (congenital heart disease). Seven cases (35.0%) presented typical ground‑glass opacity in CT. All patients were confirmed to be infected with SARS‑CoV‑2. Eleven cases (55.0%) had normal white blood cell counts, and one case (5.0%) with severe COVID‑19 showed a continuous decline in T cells subsets. Conclusion: COVID‑19 in children is transmitted by close contact and characterized by family clustering. Fever is the most common symptom or initial symptom. However, the sustained low levels of T cells and underlying diseases are risk factors for severe COVID‑19 children. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.
目的:探讨儿童COVID - 19的疾病传播、诊断和治疗特点。方法:我们回顾性研究了来自中国湖北省4个医疗中心的20名COVID - 19患儿。结果:20例儿童中有18例(90.0%)为密切接触感染,呈家庭聚集性;家庭成员全部感染7例(35.0%),父母一方确诊11例(55.0%)。发热12例(60.0%),发热为首发症状10例(50.0%)。仅有1例患儿重度合并严重基础疾病(先天性心脏病)。7例(35.0%)CT表现为典型的磨玻璃样混浊。所有患者均确诊为SARS - CoV - 2感染。11例(55.0%)白细胞计数正常,1例(5.0%)重症COVID - 19患者T细胞亚群持续下降。结论:儿童COVID - 19通过密切接触传播,具有家庭聚集性特征。发烧是最常见的症状或最初症状。然而,持续的低水平T细胞和潜在疾病是严重COVID - 19儿童的危险因素。©2021,武汉大学医学杂志编辑委员会。版权所有。
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引用次数: 0
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武汉大学学报(医学版)
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