武汉市以外13例新型冠状病毒感染的流行病学和临床特征

StephenW

[email protected]

6:40 AM (11 hours ago)

[tr][/tr][/table][table]
to hiv, HCV/HIV, undefined, Natap

www.natap.org
February 7, 2020
                                Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China
In December 2019, cases of pneumonia appeared in Wuhan, China. The etiology of these infections was a novel coronavirus (2019-nCoV),1,2 possibly connected to zoonotic or environmental exposure from the seafood market in Wuhan. Human-to-human transmission has accounted for most of the infections, including among health care workers.3,4 The virus has spread to different parts of China and at least 26 other countries.1 A high number of men have been infected, and the reported mortality rate has been approximately 2%, which is lower than that reported from other coronavirus epidemics including severe acute respiratory syndrome (SARS; mortality rate, >40% in patients aged >60 years)5 and Middle East respiratory syndrome (MERS; mortality rate, 30%).6 However, little is known about the clinical manifestations of 2019-nCoV in healthy populations or cases outside Wuhan. We report early clinical features of 13 patients with confirmed 2019-nCoV infection admitted to hospitals in Beijing.
The median age of the patients was 34 years (25th-75th percentile, 34-48 years); 2 patients were children (aged 2 years and 15 years), and 10 (77%) were male. Twelve patients either visited Wuhan, including a family (parents and son), or had family members (grandparents of the 2-year-old child) who visited Wuhan after the onset of the 2019-nCoV epidemic (mean stay, 2.5 days). One patient did not have any known contact with Wuhan.
            Twelve patients reported fever (mean, 1.6 days) before hospitalization. Symptoms included cough (46.3%), upper airway congestion (61.5%), myalgia (23.1%), and headache (23.1%) (Table). No patient required respiratory support before being transferred to the specialty hospital after a mean of 2 days. The youngest patient (aged 2 years) had intermittent fever for 1 week and persistent cough for 13 days before 2019-nCoV diagnosis. Levels of inflammatory markers such as C-reactive protein were elevated, and numbers of lymphocytes were marginally elevated (Table).
Four patients had chest radiographs and 9 had computed tomography. Five images did not demonstrate any consolidation or scarring. One chest radiograph demonstrated scattered opacities in the left lower lung; in 6 patients, ground glass opacity was observed in the right or both lungs (Figure). As of February 4, 2020, all the patients recovered, but 12 were still being quarantined in the hospital.

The current coronavirus outbreak in China is the third epidemic caused by coronavirus in the 21st century, already surpassing SARS and MERS in the number of individuals infected.1 The higher number of infections may be attributable to late identification of the etiologic agent and the ability of the host to shed the infection while asymptomatic, rather than to greater infectivity of the virus compared with SARS.3



-------------------------

            Original Investigation
                Caring for the Critically Ill Patient
        
        February 7, 2020


This report, to our knowledge, is the largest case series to date of hospitalized patients with NCIP. As of February 3, 2020, of the 138 patients included in this study, 26% required ICU care, 34.1% were discharged, 6 died (4.3%), and 61.6% remain hospitalized. For those who were discharged (n = 47), the hospital stay was 10 days (IQR, 7.0-14.0). The time from onset to dyspnea was 5.0 days, 7.0 days to hospital admission, and 8.0 days to ARDS. Common symptoms at onset of illness were fever, dry cough, myalgia, fatigue, dyspnea, and anorexia. However, a significant proportion of patients presented initially with atypical symptoms, such as diarrhea and nausea. Major complications during hospitalization included ARDS, arrhythmia, and shock. Bilateral distribution of patchy shadows and ground glass opacity was a typical hallmark of CT scan for NCIP. Most critical ill patients were older and had more underlying conditions than patients not admitted to the ICU. Most patients required oxygen therapy and a minority of the patients needed invasive ventilation or even extracorporeal membrane oxygenation.
                                Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China                    
            



                    JAMA.  Published online February 7, 2020. doi:10.1001/jama.2020.1585        


     
               

Key PointsQuestion     What are the clinical characteristics of hospitalized patients with 2019 novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) in Wuhan, China?
Findings     In this single-center case series involving 138 patients with NCIP, 26% of patients required admission to the intensive care unit and 4.3% died. Presumed human-to-human hospital-associated transmission of 2019-nCoV was suspected in 41% of patients.
Meaning     In this case series in Wuhan, China, NCIP was frequently associated with presumed hospital-related transmission, 26% of patients required intensive care unit treatment, and mortality was 4.3%.
            
                                                            Abstract                           
                        
Importance     In December 2019, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
Objective     To describe the epidemiological and clinical characteristics of NCIP.
Design, Setting, and Participants     Retrospective, single-center case series of the 138 consecutive hospitalized patients with confirmed NCIP at Zhongnan Hospital of Wuhan University in Wuhan, China, from January 1 to January 28, 2020; final date of follow-up was February 3, 2020.
Exposures     Documented NCIP.
Main Outcomes and Measures     Epidemiological, demographic, clinical, laboratory, radiological, and treatment data were collected and analyzed. Outcomes of critically ill patients and noncritically ill patients were compared. Presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalized patients in the same wards became infected and a possible source of infection could be tracked.
Results     Of 138 hospitalized patients with NCIP, the median age was 56 years (interquartile range, 42-68; range, 22-92 years) and 75 (54.3%) were men.
Hospital-associated transmission was suspected as the presumed mechanism of infection for affected health professionals (40 [29%]) and hospitalized patients (17 [12.3%]).
Common symptoms included fever (136 [98.6%]), fatigue (96 [69.6%]), and dry cough (82 [59.4%]). Lymphopenia (lymphocyte count, 0.8 × 109/L [interquartile range {IQR}, 0.6-1.1]) occurred in 97 patients (70.3%), prolonged prothrombin time (13.0 seconds [IQR, 12.3-13.7]) in 80 patients (58%), and elevated lactate dehydrogenase (261 U/L [IQR, 182-403]) in 55 patients (39.9%).
Chest computed tomographic scans showed bilateral patchy shadows or ground glass opacity in the lungs of all patients. Most patients received antiviral therapy (oseltamivir, 124 [89.9%]), and many received antibacterial therapy (moxifloxacin, 89 [64.4%]; ceftriaxone, 34 [24.6%]; azithromycin, 25 [18.1%]) and glucocorticoid therapy (62 [44.9%]). Thirty-six patients (26.1%) were transferred to the intensive care unit (ICU) because of complications, including acute respiratory distress syndrome (22 [61.1%]), arrhythmia (16 [44.4%]), and shock (11 [30.6%]). The median time from first symptom to dyspnea was 5.0 days, to hospital admission was 7.0 days, and to ARDS was 8.0 days. Patients treated in the ICU (n = 36), compared with patients not treated in the ICU (n = 102), were older (median age, 66 years vs 51 years), were more likely to have underlying comorbidities (26 [72.2%] vs 38 [37.3%]), and were more likely to have dyspnea (23 [63.9%] vs 20 [19.6%]), and anorexia (24 [66.7%] vs 31 [30.4%]). Of the 36 cases in the ICU, 4 (11.1%) received high-flow oxygen therapy, 15 (41.7%) received noninvasive ventilation, and 17 (47.2%) received invasive ventilation (4 were switched to extracorporeal membrane oxygenation). As of February 3, 47 patients (34.1%) were discharged and 6 died (overall mortality, 4.3%), but the remaining patients are still hospitalized. Among those discharged alive (n = 47), the median hospital stay was 10 days (IQR, 7.0-14.0).
Conclusions and Relevance     In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.
                                                             Introduction                           
                        
            In December 2019, a cluster of acute respiratory illness, now known as novel coronavirus–infected pneumonia (NCIP), occurred in Wuhan, Hubei Province, China.1-5 The disease has rapidly spread from Wuhan to other areas. As of January 31, 2020, a total of 9692 NCIP cases in China have been confirmed. Internationally, cases have been reported in 24 countries and 5 continents.6 On January 3, 2020, the 2019 novel coronavirus (2019-nCoV) was identified in samples of bronchoalveolar lavage fluid from a patient in Wuhan and was confirmed as the cause of the NCIP.7 Full-genome sequencing and phylogenic analysis indicated that 2019-nCoV is a distinct clade from the betacoronaviruses associated with human severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).7 The 2019-nCoV has features typical of the coronavirus family and was classified in the betacoronavirus 2b lineage. The 2019-nCoV has close similarity to bat coronaviruses, and it has been postulated that bats are the primary source. While the origin of the 2019-nCoV is still being investigated, current evidence suggests spread to humans occurred via transmission from wild animals illegally sold in the Huanan Seafood Wholesale Market.8
            Huang et al9 first reported 41 cases of NCIP in which most patients had a history of exposure to Huanan Seafood Wholesale Market. Patients’ clinical manifestations included fever, nonproductive cough, dyspnea, myalgia, fatigue, normal or decreased leukocyte counts, and radiographic evidence of pneumonia. Organ dysfunction (eg, shock, acute respiratory distress syndrome [ARDS], acute cardiac injury, and acute kidney injury) and death can occur in severe cases.9 Subsequently, Chen et al8 reported findings from 99 cases of NCIP from the same hospital and the results suggested that the 2019-nCoV infection clustered within groups of humans in close contact, was more likely to affect older men with comorbidities, and could result in ARDS. However, the difference in clinical characteristics between severe and nonsevere cases was not reported. Case reports confirmed human-to-human transmission of NCIP.10,11 At present, there are no effective therapies or vaccines for NCIP. The objective of this case series was to describe the clinical characteristics of 138 hospitalized patients with NCIP and to compare severe cases who received intensive care unit (ICU) care with nonsevere cases who did not receive ICU care.
                                                             Discussion                           
                        
            This report, to our knowledge, is the largest case series to date of hospitalized patients with NCIP. As of February 3, 2020, of the 138 patients included in this study, 26% required ICU care, 34.1% were discharged, 6 died (4.3%), and 61.6% remain hospitalized. For those who were discharged (n = 47), the hospital stay was 10 days (IQR, 7.0-14.0). The time from onset to dyspnea was 5.0 days, 7.0 days to hospital admission, and 8.0 days to ARDS. Common symptoms at onset of illness were fever, dry cough, myalgia, fatigue, dyspnea, and anorexia. However, a significant proportion of patients presented initially with atypical symptoms, such as diarrhea and nausea. Major complications during hospitalization included ARDS, arrhythmia, and shock. Bilateral distribution of patchy shadows and ground glass opacity was a typical hallmark of CT scan for NCIP. Most critical ill patients were older and had more underlying conditions than patients not admitted to the ICU. Most patients required oxygen therapy and a minority of the patients needed invasive ventilation or even extracorporeal membrane oxygenation.
            The data in this study suggest rapid person-to-person transmission of 2019-nCoV may have occurred. The main reason is derived from the estimation of the basic reproductive number (R0) based on a previous study.15 R0 indicates how contagious an infectious disease is. As an infection spreads to new people, it reproduces itself; R0 indicates the average number of additional individuals that one affected case infects during the course of their illness and specifically applies to a population of people who were previously free of infection and have not been vaccinated. Based on the report, R0 from nCoV is 2.2, which estimated that, on average, each patient has been spreading infection to 2.2 other people.15 One reason for the rapid spread may be related to the atypical symptoms in the early stage in some patients infected with nCoV.
            A recent study showed that nCoV was detected in stool samples of patients with abdominal symptoms.16 However, it is difficult to differentiate and screen patients with atypical symptoms. Nevertheless, the rapid human-to-human transmission among close contacts is an important feature in nCoV pneumonia.10,11,15
            The patients admitted to the ICU were older and had a greater number of comorbid conditions than those not admitted to the ICU. This suggests that age and comorbidity may be risk factors for poor outcome. However, there was no difference in the proportion of men and women between ICU patients and non-ICU patients. These data differ from the recent report that showed 2019-nCoV infection is more likely to affect males.8 The possible explanation is that the nCoV infection in patients in the previous report was related to exposure associated with the Huanan Seafood Wholesale Market, and most of the affected patients were male workers. Compared with symptoms in non-ICU patients, symptoms were more common in critically ill patients, including dyspnea, abdominal pain, and anorexia. The onset of symptoms may help physicians identify the patients with poor prognosis. In this cohort, the overall rates of severe hypoxia and invasive ventilation were higher than those in the previous study,9 likely because the cases in the previous study were from the early epidemic stage of the NCIP, and the current cases are from the stage of outbreak.
            The most common laboratory abnormalities observed in this study were depressed total lymphocytes, prolonged prothrombin time, and elevated lactate dehydrogenase. Compared with non-ICU patients, patients who received ICU care had numerous laboratory abnormalities. These abnormalities suggest that 2019-nCoV infection may be associated with cellular immune deficiency, coagulation activation, myocardia injury, hepatic injury, and kidney injury. These laboratory abnormalities are similar to those previously observed in patients with MERS-CoV and SARS-CoV infection.
            The dynamic profile of laboratory findings was tracked in 33 patients with NCIP (5 nonsurvivors and 28 survivors). In the nonsurvivors, the neutrophil count, D-dimer, blood urea, and creatinine levels continued to increase, and the lymphocyte counts continued to decrease until death occurred. Neutrophilia may be related to cytokine storm induced by virus invasion, coagulation activation could have been related to sustained inflammatory response, and acute kidney injury could have been related to direct effects of the virus, hypoxia, and shock. The 3 pathologic mechanisms may be associated with the death of patients with NCIP.
            Until now, no specific treatment has been recommended for coronavirus infection except for meticulous supportive care.17 Currently, the approach to this disease is to control the source of infection; use of personal protection precaution to reduce the risk of transmission; and early diagnosis, isolation, and supportive treatments for affected patients. Antibacterial agents are ineffective. In addition, no antiviral agents have been found to provide benefit for treating SARS and MERS. All of the patients in this study received antibacterial agents, 90% received antiviral therapy, and 45% received methylprednisolone. The dose of oseltamivir and methylprednisolone varied depending on disease severity. However, no effective outcomes were observed.
            This study has several limitations. First, respiratory tract specimens were used to diagnose NCIP through RT-PCR. The serum of patients was not obtained to evaluate the viremia. The viral load is a potentially useful marker associated with disease severity of coronavirus infection, and this should be determined in NCIP. Second, hospital-related transmission/infection could not be definitively proven but was suspected and presumed based on timing and patterns of exposure to infected patients and subsequent development of infection. Third, among the 138 cases, most patients are still hospitalized at the time of manuscript submission. Therefore, it is difficult to assess risk factors for poor outcome, and continued observations of the natural history of the disease are needed.
                                                                                                Conclusions                           
                        
            In this single-center case series of 138 hospitalized patients with confirmed NCIP in Wuhan, China, presumed hospital-related transmission of 2019-nCoV was suspected in 41% of patients, 26% of patients received ICU care, and mortality was 4.3%.

StephenW

[email protected]
牧场
Attachments6：40 AM（11小时前）
牧场
艾滋病毒，HCV / HIV（未定义），纳塔普
www.natap.org

2020年2月7日
武汉市以外13例新型冠状病毒感染的流行病学和临床特征
2019年12月，中国武汉出现了肺炎病例。这些感染的病因是一种新型冠状病毒（2019-nCoV），1,2可能与武汉市海鲜市场的人畜共患或环境暴露有关。人与人之间的传播占大多数感染的原因，包括在医护人员中。 3,4病毒已传播到中国不同地区和至少26个其他国家。 1大量男性被感染，报告的死亡率约为2％，低于其他冠状病毒流行病（包括严重急性呼吸系统综合症（SARS）的死亡率；在60岁以上的患者中死亡率> 40％） 5年和中东呼吸综合征（MERS;死亡率，30％）.6然而，对健康人群或武汉以外地区2019-nCoV的临床表现知之甚少。我们报告了北京医院收治的13例确诊为2019-nCoV感染的患者的早期临床特征。

患者的中位年龄为34岁（25-75％，34-48岁）；儿童2例（2岁和15岁），男性10例（77％）。 2019年nCoV流行后（平均住院时间为2.5天），有12名患者或者访问了武汉，包括一个家庭（父母和儿子），或者有家人（2岁孩子的祖父母）访问了武汉。一名患者与武汉没有任何已知的接触。

十二名患者报告住院前发烧（平均1.6天）。症状包括咳嗽（46.3％），上呼吸道充血（61.5％），肌痛（23.1％）和头痛（23.1％）（表）。平均2天后，没有患者需要呼吸支持才能转入专科医院。最年轻的患者（2岁）在2019-nCoV诊断之前间歇性发烧1周，持续咳嗽13天。炎症标记物（如C反应蛋白）水平升高，淋巴细胞数量略有升高（表）。
4名患者进行了胸部X光片检查，而9名进行了计算机断层扫描。五张图像未显示出任何巩固或疤痕。一张胸部X光片显示左下肺散在混浊。在6例患者中，在右肺或双肺中均观察到毛玻璃样混浊（图）。截至2020年2月4日，所有患者均康复，但仍有12名患者在医院被隔离。
当前在中国爆发的冠状病毒是21世纪第三次由冠状病毒引起的流行病，感染人数已超过SARS和MERS。 1感染数量较高的原因可能是病原体的识别较晚以及宿主在无症状的情况下摆脱感染的能力，而不是与SARS相比，病毒的感染性更高。 3

-------------------------

原始调查
照顾重病患者
2020年2月7日

据我们所知，该报告是迄今为止住院的NCIP患者的最大病例系列。截至2020年2月3日，本研究纳入的138例患者中，需要ICU护理的占26％，出院34.1％，死亡6例（占4.3％），并且住院率仍为61.6％。对于那些出院（n = 47）的患者，住院时间为10天（IQR，7.0-14.0）。从发病到呼吸困难的时间分别为5.0天，入院7.0天和ARDS 8.0天。发病时的常见症状是发烧，干咳，肌痛，疲劳，呼吸困难和厌食。但是，很大一部分患者最初出现典型症状，例如腹泻和恶心。住院期间的主要并发症包括ARDS，心律不齐和休克。斑片状阴影和毛玻璃不透明的双边分布是NCIP CT扫描的典型特征。与未入住ICU的患者相比，大多数重症患者年龄较大且有更多潜在疾病。大多数患者需要进行氧气治疗，而少数患者需要进行有创通气甚至体外膜氧合。
武汉市138例2019年新型冠状病毒感染肺炎住院患者的临床特征
贾玛在线发布于2020年2月7日。doi：10.1001 / jama.2020.1585

关键点

问题中国武汉市2019年新型冠状病毒（2019-nCoV）感染的肺炎（NCIP）住院患者的临床特征是什么？

调查结果在涉及138名NCIP患者的单中心病例系列中，有26％的患者需要重症监护病房入院，而4.3％的患者死亡。在41％的患者中怀疑与人对人的医院相关的2019-nCoV传播。
含义在此案例系列中，中国武汉市的NCIP经常与推测的医院相关传播相关，26％的患者需要重症监护病房治疗，死亡率为4.3％。
抽象

重要性2019年12月，新型冠状病毒（2019-nCoV）感染的肺炎（NCIP）在中国武汉发生。病例数迅速增加，但是有关受影响患者临床特征的信息有限。

目的描述NCIP的流行病学和临床特征。

设计，背景和参与者2020年1月1日至1月28日在中国武汉市武汉大学中南医院接受138例确诊NCIP的连续住院患者的回顾性单中心病例研究；随访的最后日期是2020年2月3日。

暴露记录在案的NCIP。

主要结果和措施收集并分析了流行病学，人口统计学，临床，实验室，放射学和治疗数据。比较危重患者和非危重患者的结果。如果同一病房中的一群医疗专业人员或住院患者被感染，并且可以追踪到可能的感染源，则怀疑与医院相关的传播。

结果138例住院的NCIP患者中位年龄为56岁（四分位间距为42-68岁；范围为22-92岁），其中男性为75岁（54.3％）。

怀疑与医院相关的传播是受影响的卫生专业人员（40 [29％]）和住院患者（17 [12.3％]）的推测感染机制。

常见症状包括发烧（136 [98.6％]），疲劳（96 [69.6％]）和干咳（82 [59.4％]）。 97名患者（70.3％）发生了淋巴细胞减少症（淋巴细胞计数，0.8××109 / L [四分位间距{IQR}，0.6-1.1]），80名患者（58）延长了凝血酶原时间（13.0秒[IQR，12.3-13.7]）。 ％）和55位患者（39.9％）的乳酸脱氢酶升高（261 U / L [IQR，182-403]）。

胸部计算机断层扫描显示，所有患者的肺部都有双侧斑片状阴影或毛玻璃片混浊。大多数患者接受抗病毒治疗（奥司他韦，124 [89.9％]），许多患者接受抗菌治疗（莫西沙星，89 [64.4％]；头孢曲松钠，34 [24.6％]；阿奇霉素，25 [18.1％]）和糖皮质激素治疗（62）。 [44.9％]。由于并发症，包括急性呼吸窘迫综合征（22 [61.1％]），心律不齐（16 [44.4％]）和休克（11 [30.6]）将三十六名患者（26.1％）转移到重症监护病房（ICU）。 ％]）。从首次出现症状到呼吸困难的中位时间为5.0天，入院时间为7.0天，ARDS时间为8.0天。与未在重症监护室中接受治疗的患者（n = 102）相比，在重症监护室中接受治疗的患者（n =（36）年龄更大（中位年龄为66岁vs 51岁），更可能患有合并症（26 [72.2％ ] vs 38 [37.3％]），更容易出现呼吸困难（23 [63.9％] vs 20 [19.6％]）和厌食（24 [66.7％] vs 31 [30.4％]）。在ICU的36例患者中，有4例（11.1％）接受了高流量氧疗，有15例（41.7％）接受了无创通气，有17例（47.2％）接受了有创通气（4例转为体外膜氧合）。截至2月3日，47例患者（34.1％）出院，6例死亡（总死亡率为4.3％），但其余患者仍在住院治疗。在那些活着出院的患者中（n = 47），中位住院时间为10天（IQR，7.0-14.0）。

结论与相关性在此单中心病例系列中，中国武汉市138例确诊NCIP的住院患者中，41％的患者怀疑与医院相关的2019-nCoV传播，26％的患者接受了ICU护理，死亡率为4.3％。
                                 介绍

2019年12月，中国湖北省武汉市发生了一系列急性呼吸道疾病，现称为新型冠状病毒感染的肺炎。1-5该疾病已从武汉迅速传播到其他地区。截至2020年1月31日，中国共确诊9692例NCIP病例。在国际上，已在24个国家和5大洲报告了病例。62020年1月3日，在武汉市一名患者的支气管肺泡灌洗液样本中鉴定出2019年新型冠状病毒（2019-nCoV），并被确认为造成这种疾病的原因。 NCIP.7全基因组测序和系统发育分析表明，2019-nCoV是与人类严重急性呼吸综合征（SARS）和中东呼吸综合征（MERS）相关的β冠状病毒的独特分支.7 2019-nCoV具有以下特征：冠状病毒家族，并被归类于beta冠状病毒2b谱系。 2019-nCoV与蝙蝠冠状病毒非常相似，据推测蝙蝠是主要来源。虽然仍在调查2019-nCoV的起源，但目前的证据表明，通过在华南海鲜批发市场非法出售的野生动物的传播，传播到人类是8
Huang等[9]首先报道了41例NCIP病例，其中大多数患者有接触华南海鲜批发市场的历史。患者的临床表现包括发烧，非生产性咳嗽，呼吸困难，肌痛，疲劳，白细胞计数正常或下降以及肺炎的影像学证据。严重的情况下会发生器官功能障碍（例如休克，急性呼吸窘迫综合征[ARDS]，急性心脏损伤和急性肾损伤）9。随后，Chen等[8]报道了同一家医院和医院的99例NCIP的发现。结果表明，2019-nCoV感染聚集在密切接触的人群中，更可能影响合并症的老年男性，并可能导致ARDS。但是，没有报道严重和不严重病例之间的临床特征差异。病例报告证实了NCIP的人际传播。10,11目前，尚无有效的NCIP治疗方法或疫苗。本病例系列的目的是描述138例NCIP住院患者的临床特征，并将接受重症监护病房（ICU）护理的严重病例与未接受ICU护理的非严重病例进行比较。
                                 讨论区

据我们所知，该报告是迄今为止住院的NCIP患者的最大病例系列。截至2020年2月3日，本研究纳入的138例患者中，需要ICU护理的占26％，出院34.1％，死亡6例（4.3％），并且仍有61.6％住院。对于那些出院（n = 47）的患者，住院时间为10天（IQR，7.0-14.0）。从发病到呼吸困难的时间分别为5.0天，入院7.0天和ARDS 8.0天。发病时的常见症状是发烧，干咳，肌痛，疲劳，呼吸困难和厌食。但是，很大一部分患者最初表现出非典型症状，例如腹泻和恶心。住院期间的主要并发症包括ARDS，心律不齐和休克。斑片状阴影和毛玻璃不透明的双边分布是NCIP CT扫描的典型特征。与未入住ICU的患者相比，大多数重症患者年龄较大且有更多潜在疾病。大多数患者需要氧气疗法，而少数患者需要有创通气甚至体外膜氧合。

这项研究中的数据表明，可能已经发生了2019-nCoV的快速人际传播。主要原因是根据先前的研究估计基本生殖数（R0）得出的。15R0表示传染病的传染性。当感染传播到新人们时，它会自我繁殖。 R0表示一个患病病例在病程中感染的其他平均人数，特别适用于以前没有感染且尚未接种疫苗的人群。根据该报告，nCoV的R0为2.2，这估计平均每位患者已将感染传播给其他2.2个人。15迅速传播的原因可能与某些患者早期的非典型症状有关。被nCoV感染。

最近的一项研究表明，在腹部症状患者的粪便样本中检测到nCoV。16但是，很难区分和筛查具有非典型症状的患者。然而，nCoV肺炎的一个重要特征是人与人之间的密切人际快速传播。10,11,15

与未入住重症监护病房的患者相比，入住重症监护病房的患者年龄更大，合并症更多。这表明年龄和合并症可能是不良结局的危险因素。但是，ICU患者和非ICU患者之间男女比例没有差异。这些数据与最近的报告不同，后者显示2019-nCoV感染更可能影响男性.8可能的解释是，上一份报告中患者的nCoV感染与华南海鲜批发市场相关的暴露有关，并且大多数受影响的患者是男性工人。与非ICU患者的症状相比，重症患者的症状更为常见，包括呼吸困难，腹痛和厌食。症状的发作可能有助于医生识别预后不良的患者。在该队列中，严重缺氧和有创通气的总体发生率高于先前的研究，9可能是因为先前的研究病例来自NCIP的早期流行阶段，而当前病例来自暴发。
在这项研究中观察到的最常见的实验室异常是总淋巴细胞减少，凝血酶原时间延长和乳酸脱氢酶升高。与非ICU患者相比，接受ICU护理的患者有许多实验室异常。这些异常现象表明2019-nCoV感染可能与细胞免疫缺陷，凝血激活，心肌损伤，肝损伤和肾损伤有关。这些实验室异常与以前在MERS-CoV和SARS-CoV感染患者中观察到的异常相似。

对33名NCIP患者（5名非幸存者和28名幸存者）的实验室检查结果进行了动态追踪。在非幸存者中，中性粒细胞计数，D-二聚体，血尿素和肌酐水平持续增加，淋巴细胞计数持续减少直至死亡。中性粒细胞增多可能与病毒入侵引起的细胞因子风暴有关，凝血激活可能与持续的炎症反应有关，急性肾脏损伤可能与病毒，缺氧和休克的直接作用有关。这三种病理机制可能与NCIP患者的死亡有关。

迄今为止，除进行细致的支持治疗外，尚未建议针对冠状病毒感染的特异性治疗。17目前，该疾病的治疗方法是控制感染源。使用个人防护措施以减少传播的风险；以及对受影响患者的早期诊断，隔离和支持治疗。抗菌剂无效。另外，未发现抗病毒剂可提供治疗SARS和MERS的益处。该研究中的所有患者均接受了抗菌药物，90％接受了抗病毒治疗，45％接受了甲基泼尼松龙。奥司他韦和甲基泼尼松龙的剂量根据疾病的严重程度而变化。但是，没有观察到有效的结果。

这项研究有几个局限性。首先，使用呼吸道标本通过RT-PCR诊断NCIP。未获得患者血清以评估病毒血症。病毒载量是与冠状病毒感染的疾病严重程度相关的潜在有用标记，应在NCIP中确定。其次，与医院相关的传播/感染尚不能得到确定的证明，但根据与受感染患者接触的时间和方式以及随后的感染发展情况，是可以怀疑和推测的。第三，在138例病例中，大多数患者在投稿时仍在住院。因此，很难评估不良预后的危险因素，并且需要继续观察该疾病的自然病史。
结论

在此单中心病例系列中，中国武汉有138例已确诊NCIP的住院患者中，怀疑有与医院相关的2019-nCoV传播是在41％的患者中怀疑的，其中26％的患者接受了ICU护理，死亡率为4.3％。

newchinabok

政府那些官老爷们平时懒政，不作为。出了事问责，就会说，我很内疚，很自责。乙肝八九十年代为什么这么流行？