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中国・上海市におけるCOVID-19患者494人の症候性・無症候性感染症の観察
Observations about Symptomatic and Asymptomatic infections of 494 patients with COVID-19 in Shanghai,China.
PMID: 32645475 PMCID: PMC7336908. DOI: 10.1016/j.ajic.2020.06.221.
抄録
背景:
ヒトは一般的にSARS-CoV-2に感染しやすく、COVID-19の世界的なパンデミックを引き起こした。集団感染者のスクリーニングは、いまだに臨床症状に主に依存している。しかし、異なる集団、特に輸入症例における臨床症状の特徴についての研究は限られている。
BACKGROUND: Humans are generally susceptible to SARS-CoV-2, which has caused a global pandemic of COVID-19. The screening of infected people in the population still mainly depends on clinical symptoms. However, there is limited research on the characteristics of clinical symptoms in different populations, especially in imported cases.
方法:
2020年1月20日から2020年3月31日までに上海の指定病院に入院したCOVID-19確定患者494人の臨床データをレトロスペクティブに解析するため、COVID-19患者の異なる集団における臨床症状とその影響因子を比較した。
METHODS: To retrospectively analyze the clinical data of 494 confirmed COVID-19 patients admitted to a designated hospital in Shanghai from January 20, 2020, to March 31, 2020, we compared the clinical manifestations in different populations and their influencing factors in COVID-19 patients.
結果:
(1) 494人の患者のうち、入院時の症状が異なる453人（91.7％）、無症状の患者は39人（7.89％）であった。(2) 異なる層別に患者の症状を比較したところ、以下の結果が得られた：a. 呼吸困難の割合は、女性患者よりも男性患者の方が有意に高かった（P＜0.05）。b. 鼻づまり、咽頭痛、嗅覚・味覚障害の割合は小児で成人より有意に高かった（P＜0.05）。 c. 発熱、胸の張り、息切れ、倦怠感の割合は輸入例よりも局所例で有意に高かった。一方、鼻づまり、鼻づまり、喉の痛み、頭痛、嗅覚・味覚障害の割合は、輸入例の方が輸入例よりも有意に低かった（P＜0.05）。 d. 胸の張り、息切れ、呼吸困難の割合は、重症患者の方が軽症患者よりも有意に高かった（P＜0.05）。(3) 無症状患者31例は、症候群に比べて有意に若く、輸入症例の割合が高く、白血球（WBC）・リンパ球（LYM）数の値が高く、CT異常症例が少なかった（P＜0.05）。(4)症状が消失するのに必要な発症からの日数は，疫学的病歴（輸入例），咽頭スワブ核酸検査が陰性になるまでの日数，入院日数，発症からの日数，白血球（WBC）およびリンパ球（LYM）数値と関連していた（P＜0.05）．
RESULTS: (1) Of the 494 patients, 453 (91.7%) had different symptoms at admission, and 39 (7.89%) patients were asymptomatic. (2) We compared the symptoms of patients according to different stratifications and found the following results: a. The proportion of dyspnea was significantly higher in male patients than in female patients (P < 0.05). b. The proportions of a stuffy nose, sore throat, and olfactory and gustatory dysfunction were significantly higher in children than in adult patients (P < 0.05). c. The proportions of fever, chest tightness, shortness of breath, and fatigue were significantly higher in local cases than in imported cases. In comparison, the proportions of nasal congestion, stuffy nose, sore throat, headache, and olfactory and gustatory dysfunction were significantly lower in imported cases than in imported cases (P < 0.05). d. The proportions of chest tightness, shortness of breath, and dyspnea were significantly higher in severely ill patients than in those with mild symptoms (P < 0.05). (3) Thirty-one asymptomatic patients were significantly younger than symptomatic patients, and they had a higher proportion of imported cases, white blood cell (WBC) and lymphocyte (LYM) count levels, and fewer abnormal CT cases than the group of symptomatic patients (P < 0.05). (4) The number of days since the onset of the disease needed for the symptoms to disappear was associated with the epidemiological history (imported cases), the number of days until the pharyngeal swab nucleic acid test turned negative, the days of hospitalization, the days of onset, and the WBC and LYM count levels (P < 0.05).
結論:
COVID-19の大多数（91.7％）が初期症状を有していたのに対し，COVID-19では7.89％が無症状であった．若年者では上気道症状を中心に症状が少なく、病状は輸入患者に多く見られた穏やかなものであった。高齢の男性患者は入院時に重篤な症状を呈した。症状が消失するまでの日数は咽頭スワブ核酸検査が陰性になるまでの日数と密接に関連していた。
CONCLUSION: The majority of COVID-19 patients (91.7%) had early symptoms. whereas 7.89% of COVID-19 patients were asymptomatic. Younger patients had fewer symptoms, mainly the upper respiratory symptoms, and the illness condition was milder, which was more common in imported cases. Elderly male patients had severe symptoms when admitted. The number of days needed for the patient's symptoms to disappear was closely related to the number of days necessary for the pharyngeal swab nucleic acid test to turn negative.
Copyright © 2020. Published by Elsevier Inc.