中国・北京市のコロナウイルス病2019年患者の臨床的特徴

Clinical characteristics of Coronavirus Disease 2019 patients in Beijing, China.

• Zhenhuan Cao
• Tongzeng Li
• Lianchun Liang
• Haibo Wang
• Feili Wei
• Sha Meng
• Miaotian Cai
• Yulong Zhang
• Hui Xu
• Jiaying Zhang
• Ronghua Jin

抄録

武漢で発生したコロナウイルス病（COVID-19）は、世界250以上の国と地域に影響を及ぼしている。しかし、臨床研究のほとんどは武漢に焦点を当てたものであり、中国の武漢以外の地域での発症についてはほとんど知られていない。今回のレトロスペクティブコホート研究では、北京市内の病院に入院したCOVID-19患者80人の初期臨床特徴を報告した。その結果、27人（33.8％）の患者が重症であった。6例（7.5％）がICUに入院し、3例（3.8％）が死亡した。患者の48％（39/80）は武漢での生活・旅行歴があった。重症患者は非重症患者に比べて有意に高齢で（平均年齢71歳、44歳）、痰（59.3％、34.0％）、息切れ（92.6％、9.4％）、食欲不振（51.9％、18.9％）、錯乱（18.5％、0％）の発生率が高かった。収縮期血圧（中央値130mmHg vs 120mmHg）は非重症患者に比べて高く，酸素飽和度（中央値98.3％ vs 92.0％）は重症患者で有意に低かった。また、ミオグロビン（中央値56.0ng/mL vs 35.0ng/mL）、トロポニンI（中央値0.02pg/mL vs 0.01pg/mL）、C反応性蛋白（中央値69.7mg/L vs 12.9mg/L）、好中球（中央値3.3×109/L vs 2．2×109/L）が有意に増加し，リンパ球（中央値0.8×109/L vs 1.2×109/L），アルブミン（平均32.8g/L vs 36.8g/L），クレアチニンクリアランス率（中央値91.2 vs 108.2ml/min/1.73m2）は重症患者で有意に減少していた．我々の研究では、C反応性蛋白、ミオグロビン、トロポニンI、好中球の値が高く、収縮期血圧が高く、リンパ球、アルブミンの値が低く、クレアチニンクリアランス率と酸素飽和度が低い高齢者では、重症化しやすいことが明らかになった。

The outbreak of Coronavirus Disease (COVID-19) in Wuhan have affected more than 250 countries and regions worldwide. However, most of the clinical studies have been focused on Wuhan, and little is known about the disease outside of Wuhan in China. In this retrospective cohort study, we report the early clinical features of 80 patients with COVID-19 admitted to the hospital in Beijing. The results show that 27 (33.8%) patients had severe illness. Six (7.5%) patients were admitted to the ICU, and 3 (3.8%) patients died. Forty-eight percent (39/80) of the patients had a history of living/traveling in Wuhan. Patients with severe- illness were significantly older (average age, 71 years old vs 44 years old) and had a high incidence of expectoration (59.3% vs 34.0%), shortness of breath (92.6% vs 9.4%), anorexia (51.9% vs 18.9%) and confusion(18.5% vs 0%) compared with nonsevere patients. The systolic blood pressure (median, 130 mmHg vs 120 mmHg) was higher and the oxygen saturation (median, 98.3% vs 92.0%) was significantly lower in severe patients than nonsevere patients. In addition, myoglobin (median, 56.0 ng/mL vs 35.0 ng/mL), troponin I (median, 0.02 pg/mL vs 0.01 pg/mL), C-reactive protein (median, 69.7 mg/L vs 12.9 mg/L) and neutrophils (median, 3.3×109/L vs 2.2×109/L) were significantly increased, while lymphocytes (median, 0.8×109/L vs 1.2×109/L), albumin (mean, 32.8 g/L vs 36.8 g/L) and the creatinine clearance rate (median, 91.2 vs 108.2 ml/min/1.73m2) were significantly decreased among severe patients. Our study revealed that older patients with high levels of C-reactive protein, myoglobin, troponin I, and neutrophil and high systolic blood pressure as well as low levels of lymphocytes, and albumin and a low creatinine clearance rate and oxygen saturation were more likely to have severe disease.