福建省COVID-19患者重症危险因素病例对照研究

陈光敏; 蓝梅芳; 陈晓红; 谢剑锋; 欧剑鸣; 郑奎城

doi:10.16462/j.cnki.zhjbkz.2021.11.016

福建省COVID-19患者重症危险因素病例对照研究

doi: 10.16462/j.cnki.zhjbkz.2021.11.016

陈光敏^{1, 2, 3},
蓝梅芳^{1, 2, 3},
陈晓红^{1, 2, 3},
谢剑锋^{1, 2, 3},
欧剑鸣^{1, 2, 3},
郑奎城^4, ,

1.
350001 福州，福建医科大学公共卫生学院教学基地
2.
350001 福州，福建省疾病预防控制中心
3.
350001 福州，福建省人兽共患病研究重点实验室
4.
50001 福州，福州肺科医院呼吸科

陈光敏与蓝梅芳为共同第一作者

基金项目: 福建省自然科学基金(2021R0111, 2020J01094); 中央引导地方科技发展项目(2021L3018); 福建省卫生健康科技计划项目(2020GGB019); 福建省科技创新平台建设项目(2019Y2001)

详细信息

通讯作者:
郑奎城，E-mail: kingdadi9909@126.com

中图分类号: R181.3
计量
- 文章访问数: 523
- HTML全文浏览量: 298
- PDF下载量: 65
- 被引次数: 0
出版历程
- 收稿日期: 2021-05-24
- 修回日期: 2021-08-10
- 网络出版日期: 2021-12-04
- 刊出日期: 2021-11-10

Case-control study on severe risk factors in COVID-19 patients in Fujian Province

CHEN Guang-min^{1, 2, 3},
LAN Mei-fang^{1, 2, 3},
CHEN Xiao-hong^{1, 2, 3},
XIE Jian-feng^{1, 2, 3},
OU Jian-ming^{1, 2, 3},
ZHENG Kui-cheng^{4
, ,}

1.
Teaching Base of the School of Public Health of Fujian Medical University, Fuzhou 350001, China
2.
Fujian Center for Disease Control and Prevention, Fuzhou 350001, China
3.
Fujian Key Laboratory of Human and Animal Disease Research, Fuzhou 350001, China
4.
Respiratory Department of Fuzhou Pulmonary Hospital, Fuzhou 350001, China

Funds: Fujian Provincial Natural Science Foundation Project (2021R0111, 2020J01094); Special Project of the Central Government Guiding Local Science and Technology Development (2021L3018); Fujian Science and Technology Innovation Platform Construction Project (2019Y2001)

More Information

Corresponding author: ZHENG Kui-cheng, E-mail: kingdadi9909@126.com

摘要

摘要: 目的分析福建省COVID-19患者的流行病学特征和实验室检查等指标，探讨其进展为重症的危险因素。方法收集福建省2020年1月22日-3月7日已出现临床最终结局(含痊愈出院、死亡等)的COVID-19确诊病例231例，运用单因素和多因素Logistic回归分析模型分析重症化的危险因素。结果 2020年1月22日-3月7日出院的231例COVID-19患者中，重症和危重症患者占16.88%(39/231)。单因素分析显示，重症组患者多合并有基础疾病(71.80%)，高于非重症组(34.40%)(χ² =18.808, P＜0.001)；其中患高血压、心血管疾病、肺部疾病、其他慢性病等因素在两组间差异均有统计学意义(均有P < 0.05)。两组间多项血液学检测指标差异均有统计学意义(均有P＜0.05)。多因素Logistic回归分析模型分析显示：年龄≥65岁(OR=17.067, 95% CI: 2.640~110.327)、淋巴细胞偏低(OR=4.731, 95% CI: 1.175~19.046)、肝功能异常(OR=12.458, 95% CI: 2.559~60.649)、降钙素偏高(OR=3.577, 95% CI: 1.733~7.384)和C反应蛋白偏高(OR=2.354, 95% CI: 1.012~5.478)是COVID-19患者进展为重症的危险因素。得到的回归方程对训练样本拟合优度良好(AUC=0.941)。结论淋巴细胞偏低、肝功能异常、降钙素偏高、C反应蛋白偏高可作为重症COVID-19患者的早期预警指标。对于年龄≥65岁老年患者以及有上述实验室检查指标异常的患者应多加关注并及时采取有效的治疗措施。
- COVID-19 /
- 重症 /
- 危险因素 /
- 病例对照研究
Abstract: Objective To analyze the epidemiological characteristics and laboratory tests of coronavirus diseases 2019(COVID-19) cases in Fujian province and to explore the risk factors for their progression to severe cases. Methods The clinical and epidemiological data of COVID-19 confirmed patients with clinical final outcome (including recovery death, etc.) from January 22 to March 7 in 2020 in Fujian were collected. The risk factors of the severe cases were analyzed by univariate and multivariate Logistic regression. Results Up to March 7, 2020, a total of 231 patients were collected in Fujian province, among which, 39(16.88%) were severe and critical cases. The univariate analysis showed that most patients in the severe group had underlying diseases (71.80%), which was significantly higher than that in the non-severe group (34.40%) (χ² =18.808, P < 0.001). Among them, hypertension, cardiovascular disease, lung disease, other chronic diseases and other factors were statistically different between the two groups (all P < 0.05).Then, numbers of hematological tests were statistical differences between the two groups. Multivariate Logistic regression analysis revealed that age≥65 years old (OR=17.067, 95%CI: 2.640-110.327), low level of lymphocyte (OR=4.731, 95%CI: 1.175-19.046), liver dysfunction (OR=12.458, 95%CI: 2.559-60.649), high level of calcitonin (OR=3.577, 95%CI: 1.733-7.384) and high level of C-reaction protein (OR=2.354, 95%CI: 1.012-5.478) were risk factors for the progression of COVID-19 patients to severe illness. The obtained regression equation fits the training sample well (AUC=0.941). Conclusions Low level of lymphocyte, liver dysfunction, high level of calcitonin and high level of C-reaction protein could be used as the early warning indicators for severe cases. More attention should be paid to elderly patients age≥65 years old and patients with the above laboratory test abnormality and timely and effective treatment should be taken.
- COVID-19 /
- Severecase /
- Risk factors /
- Case control study

HTML全文

表 1 福建省COVID-19非重症组和重症组人口学特征和基础病史情况[n (%)]

Table 1. Demographic characteristics and history of underlying diseases of COVID-19 in Fujian Province between non-severe groupand severe group [n (%)]

因素	非重症组 (n=192)	重症组 (n=39)	χ²值	P值
性别			2.996	0.083
女	88(45.8)	12(30.8)
男	104(54.2)	27(69.2)
年龄(岁)			45.431	< 0.001
< 65	178(92.7)	20(51.3)
≥65	14(7.3)	19(48.7)
孕妇			-	1.000 ^a
否	191(99.5)	39(100.0)
是	1(0.5)	0(0.0)
BMI(kg/m²)			3.423	0.309 ^b
< 18.5	11(5.7)	1(2.6)
18.5~＜24.0	107(55.7)	17(43.6)
24.0~＜28.0	59(30.7)	16(41.0)
≥28	15(7.8)	5(12.8)
吸烟情况			0.492	0.483 ^b
现在吸烟	15(7.8)	5(12.8)
不吸烟(含已戒烟)	177(92.2)	34(87.2)
患基础疾病			18.808	< 0.001
否	126(65.6)	11(28.2)
是	66(34.4)	28(71.8)
注: ^a表示使用连续性校正χ²；^b表示使用Fisher确切概率法。

下载: 导出CSV

表 2 福建省COVID-19非重症和重症患者诊疗情况单因素分析[n (%)]

Table 2. Univariate analysis of diagnosis and treatment of non-severe and severe COVID-19 patients in Fujian Province[n (%)]

因素	非重症组 (n=192)	重症组 (n=39)	χ²值	P值
首次就诊医院级别			0.783	0.376 ^a
县级以下	22(12.1)	5(12.8)
县级及以上	160(87.9)	34(87.2)
白细胞			18.271	< 0.001
正常	137(72.9)	22(57.9)
偏低	47(25.0)	9(23.7)
偏高	4(2.1)	7(18.4)
血小板			8.395	0.013 ^a
正常	156(83.4)	28(75.7)
偏低	6(3.2)	6(16.2)
偏高	25(13.4)	3(8.1)
中性粒细胞			30.065	< 0.001
正常	139(74.3)	13(34.2)
偏低	11(5.9)	1(2.6)
偏高	37(19.8)	24(63.2)
淋巴细胞			31.903	< 0.001 ^a
正常	164(87.2)	17(44.7)
偏低	20(10.6)	20(52.6)
偏高	4(2.1)	1(2.6)
血红蛋白			10.799	0.008 ^a
正常	139(75.5)	25(65.8)
偏低	16(8.7)	1(2.6)
偏高	26(14.1)	7(18.4)
白蛋白			37.730	< 0.001
正常	143(78.1)	11(28.2)
偏低	40(21.9)	28(71.8)
肝功能			23.050	< 0.001
正常	137(73.3)	13(33.3)
异常	50(26.7)	26(66.7)
ALT			13.666	< 0.001
正常	138(73.8)	17(43.6)
偏高	49(26.2)	22(56.4)
AST			21.343	< 0.001
正常	168(90.3)	24(61.5)
偏高	18(9.7)	15(38.5)
心肌酶异常			50.551	< 0.001
正常	147(78.6)	8(20.5)
异常	40(21.4)	31(79.5)
C反应蛋白			33.663	< 0.001
正常	122(65.2)	5(13.5)
偏高	65(34.8)	32(86.5)
降钙素			42.924	< 0.001
正常	118(88.7)	13(37.1)
偏高	15(11.3)	22(62.9)
肌钙蛋白			32.270	< 0.001
正常	50(100.0)	10(41.7)
偏高	0(0.0)	14(58.3)
D-二聚体			16.253	< 0.001
正常	106(76.3)	16(42.1)
偏高	33(23.7)	22(57.9)
TG			6.531	0.011
正常	75(40.5)	18(66.7)
偏高	110(59.5)	9(33.3)
尿素氮			27.321	< 0.001 ^a
正常	177(97.3)	28(71.8)
偏高	5(2.7)	11(28.2)
出现并发症			27.660	< 0.001^a
否	179(93.2)	24(61.5)
是	13(6.8)	15(38.5)
注: ^a表示使用连续性校正χ²。

下载: 导出CSV

表 3 福建省COVID-19患者重症化多因素Logistic回归分析模型分析

Table 3. Analysis of severe multivariate Logistic regression analysis model for COVID-19 patients in Fujian Province

变量		β值	s_x	Wald值	OR(95% CI)值	P值
常数项		-5.593	1.072	27.220	0.004	< 0.001
X1	年龄≥65岁	2.837	0.952	8.878	17.067(2.640~110.327)	0.003
X2	淋巴细胞偏低	1.554	0.711	4.783	4.731(1.175~19.046)	0.029
X3	肝功能异常	2.522	0.808	9.756	12.458(2.559~60.649)	0.002
X4	降钙素偏高	1.275	0.370	11.881	3.577(1.733~7.384)	0.001
X5	C反应蛋白偏高	0.856	0.431	3.948	2.354(1.012~5.478)	0.047

下载: 导出CSV

参考文献(17)

[1]	Huang CL, Wang YM, Li XW, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J]. Lancet, 2020, 395(10223): 497-506. DOI: 10.1016/s0140-6736(20)30183-5.
[2]	World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard[EB/OL]. (2021-05-09)[2021-05-09]. https://covid19.who.int/.
[3]	凌云, 徐水宝, 林逸骁, 等. 新型冠状病毒肺炎患者重症化危险因素的临床分析[J]. 上海医药, 2020, 41(S1): 58-59. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY2020S1025.htm Ling Y, Xu SB, Lin YX, et al. Clinical analysis of risk factors for severe patients with corona virus disease 2019[J]. Shanghai Med Pharm J, 2020, 41(S1): 58-59. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY2020S1025.htm
[4]	中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室. 新型冠状病毒肺炎诊疗方案(试行第七版)[J]. 江苏中国医药, 2020, 52(4): 1-6. DOI: 10.19844/j.cnki.1672-397x.2020.04.001. General Office of the National Health Commission of the People 's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment protocol for COVID-19 trial version 7[J]. Jiangsu J Tradit Chin Med, 2020, 52(4): 1-6. DOI: 10.19844/j.cnki.1672-397x.2020.04.001.
[5]	何权瀛, 高莹慧. 关于吸烟问题若干名词定义[J]. 中华结核和呼吸杂志, 2009, 32(1): 56. DOI: 10.3760/cma.j.issn.1001-0939.2009.01.008. He QY, Gao YH. Definitions of several terms on smoking[J]. Chin J Tuberc Respir Dis, 2009, 32(1): 56. DOI: 10.3760/cma.j.issn.1001-0939.2009.01.008.
[6]	中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室. 新型冠状病毒肺炎诊疗方案(试行第八版)[J]. 中国医药, 2020, 15(10): 1494-1499. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202010002.htm General Office of the National Health Commission of the People 's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of Corona virus disease-19 (8th trial edition)[J]. China Med, 2020, 15(10): 1494-1499. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202010002.htm
[7]	Liu XQ, Xue S, Xu JQ, et al. Clinical characteristics and related risk factors of disease severity in 101 COVID-19 patients hospitalized in Wuhan, China[J]. Acta Pharmacol Sin, 2021: 1-12. DOI: 10.1038/s41401-021-00627-2.
[8]	Yang XB, Yu Y, Xu JQ, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study[J]. Lancet Respir Med, 2020, 8(5): 475-481. DOI: 10.1016/s2213-2600(20)30079-5.
[9]	彭志行, 陈旭峰, 胡钦勇, 等. 新型冠状病毒肺炎患者重症转归风险预测[J]. 中华流行病学杂志, 2020, 41(10): 1595-1600. DOI: 10.3760/cmaj.cn112338-20200331-00479. Peng ZX, Chen XF, Hu QY, et al. Prediction of severe outcomes of patients with COVID-19[J]. Chin J Epidemiol, 2020, 41(10): 1595-1600. DOI: 10.3760/cmaj.cn112338-20200331-00479.
[10]	中华预防医学会新型冠状病毒肺炎防控专家组. 新型冠状病毒肺炎流行病学特征的最新认识[J]. 中国病毒病杂志, 2020, 10(2): 86-92. DOI: 10.16505/j.2095-0136.2020.0015. Special Expert Group for Control of the Epidemic of Novel Corona virus Pneumonia, An update on the epidemiological characteristics of novel coronavirus pneumonia (COVID-19)[J]. Chin J Viral Dis, 2020, 10(2): 86-92. DOI: 10.16505/j.2095-0136.2020.0015.
[11]	曾旻敏, 田克卿, 刘天, 等. 新型冠状病毒肺炎病例重症化影响因素及早期临床特征[J]. 中华疾病控制杂志, 2020, 24(7): 835-839. DOI: 10.16462/j.cnki.zhjbkz.2020.07.017. Zeng MM, Tian KQ, Liu T, et al. Analysis of influencing factors and early clinical features of severe cases of COVID-19[J]. Chin J Dis Control Prev, 2020, 24(7): 835-839. DOI: 10.16462/j.cnki.zhjbkz.2020.07.017.
[12]	孙昼, 陈珺芳, 杨旭辉, 等. 43例新型冠状病毒肺炎重症患者的危险因素分析[J]. 中国病毒病杂志, 2020, 10(6): 455-457. DOI: 10.16505/j.2095-0136.2020.0035. Sun Z, Chen JF, Yang XH, et al. Retrospective study of risk factors of 43 patients with severe coronavirus disease 2019 pneumonia[J]. Chin J Viral Dis, 2020, 10(6): 455-457. DOI: 10.16505/j.2095-0136.2020.0035.
[13]	Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China[J]. N Engl J Med, 2020, 382(18): 1708-1720. DOI: 10.1056/nejmoa2002032.
[14]	Xie JY, Wang Q, Xu YY, et al. Clinical characteristics, laboratory abnormalities and CT findings of COVID-19 patients and risk factors of severe disease: a systematic review and meta-analysis[J]. Ann Palliat Med, 2021, 10(2): 1928-1949. DOI: 10.21037/apm-20-1863.
[15]	倪力, 邓雪梅, 黄勉, 等. 新型冠状病毒肺炎严重程度的危险因素分析[J]. 临床肺科杂志, 2021, 26(1): 139-140, 146. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFK202101031.htm Ni L, Deng XM, Huang M, et al. Risk factors for disease severity of COVID-19[J]. J Clin Pulm Med, 2021, 26(1): 139-140, 146. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFK202101031.htm
[16]	Li Q, Xie Y, Cui Z, et al. Analysis of peripheral blood IL-6 and leukocyte characteristics in 364 COVID-19 patients of Wuhan[J]. Front Immunol, 2020, 11: 559716. DOI: 10.3389/fimmu.2020.559716.
[17]	Cai QX, Huang DL, Yu H, et al. COVID-19: Abnormal liver function tests[J]. J Hepatol, 2020, 73(3): 566-574. DOI: 10.1016/j.jhep.2020.04.006.