武漢でCOVID-19を発症した超高齢者の臨床観察

Clinical observations in the very elderly patients with COVID-19 in Wuhan.

• Li Rui
• Li Sirui
• Du Xuebei
• Ye Xujun
• Wang Yanggan

抄録

背景:

2019年12月、武漢でコロナウイルス疾患2019（COVID-19）のアウトブレイクが始まり、現在世界的なパンデミックを引き起こしている。しかし、超高齢者患者での経験は非常に限られており、医療・保健機関における院内感染のサーベイランスに重要な意味を持つ。

BACKGROUND: In December 2019, the outbreak of coronavirus disease 2019 (COVID-19) was initiated in Wuhan, now causing a worldwide pandemic. However, the experience in the very elderly patients is very limited, which has important implications for the surveillances of hospital infection in medical and health institutions.

方法:

武漢大学中南病院老年科で COVID-19 感染が確認された 7 名の患者を対象とした．臨床データをレトロスペクティブに収集し、分析した。COVID-19 感染前と感染後の患者の臨床検査と胸部 CT 画像を比較した．

METHODS: Seven patients with confirmed COVID-19 infection in the Department of Geriatrics at Zhongnan Hospital of Wuhan University were included. Clinical data were retrospectively collected and analyzed. The laboratory test and chest CT images from the patients before and after the COVID-19 infection were compared.

結果:

患者の年齢中央値は 91 歳（87 歳から 96 歳）であった．6人の患者が過去6ヵ月間に肺炎を発症していた。発症から64時間後に1人の患者に呼吸困難が発生した。残りの6例は微熱を伴う軽度の倦怠感のみであった。発症前と比較してリンパ球減少と血漿グロブリン値の有意な低下が認められた。初期段階で典型的な胸部CTの表現型を示した患者は、前述の重症患者で「白色肺」を呈して死亡した患者を除き、いずれも典型的な胸部CTの表現型を示していなかった。1人は以前の低静脈性肺炎と比較して炎症の吸収が認められた。

RESULTS: The median age of patients was 91 years old (from 87 to 96). Six patients had pneumonia in the last six months. Dyspnea occurred in one patient 64 hours after the onset of the disease. The rest six patients only manifested minor fatigue with low fever. Lymphopenia and a significant reduction in plasma globulin level has been observed compared to the levels before the onset of the disease. None had typical chest CT phenotypes at the early stage, except the mentioned critically ill patient who had a "white lung" development and died. One even showed an absorption of inflammation compared with previous hypostatic pneumonia.

結論:

非常に高齢のCOVID-19感染者における致死例の割合は、免疫反応が低いためか、非高齢者の患者で報告されたものよりも高くはない。しかし、高齢者患者では軽度の臨床症状や胸部CT画像の非定型変化が認められ、通常は誤診や診断の遅延につながることが多い。

CONCLUSIONS: The ratio of fatal cases in the very elderly COVID-19 infected patients is not higher to that reported in the non-elderly patients, probably due to low immune response. The elderly patients, however, manifested minor clinical symptoms and atypical changes in chest CT images, which usually lead to misdiagnosis or delayed diagnosis.

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