中国2019新型冠状病毒感染的临床特征
2020年2 月 9 日，钟南山院士团队在 medrxiv 以预印本的形式，发表一篇题为《中国 2019 新型冠状病毒感染的临床特征》（Clinical characteristics of 2019 novel coronavirus infection in China）的重磅论文。
据了解，这是继 Nature、NEJM、柳叶刀、JAMA 等顶尖期刊发表多篇新冠病毒研究论文之后，钟南山院士及其团队的首篇重磅论文，也是迄今为止涉及最大临床样本规模的分析成果。
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在这篇最新论文中，钟南山院士及其团队分析了截至 1 月 29 日来自全国 31 个省（市、自治区）552 家医院的 1099 病例患者样本，分析数据包括患者近期接触史、临床症状和体征，以及实验室检查结果。
除了分析样本量规模最大外，这篇论文的结果也很重磅，其中主要结论包括：
患者中 2.09% 是医疗工作者，仅 1.18% 有野生动物接触史，31.30% 近期到过武汉，71.80% 有接触过武汉人；
患者中位潜伏期为 3.0 天，最短为 0 天，最长可达 24 天；
患者感染新冠病毒早期，只有 43.8% 出现了发热症状，因此早期筛查不能过分侧重于是否发烧；
住院期间，发烧 (87.9%) 和咳嗽 (67.7%) 是最常见的症状，而腹泻 (3.7%) 和呕吐 (5.0%) 比较少见；
重症病例和轻微症状的病例中分别有 23.9% 和 5.2% 在最初的表现中没有发现放射异常，因此仅靠 CT 确诊新冠病毒感染准确率只有 76.4%；
住院期间最常见的并发症是肺炎 (79.1%)，其次是 ARDS(3.37%) 和休克 (1.00%)。
在一些患者的粪便以及胃肠道、唾液或尿液、食道侵蚀出血部位中检测到新冠病毒，因此应考虑到通过胃肠道分泌物的传播和粪口传播；
不能排除「超级传播者」已经出现。
Clinical characteristics of 2019 novel coronavirus infection in China
Wei-jie Guan, Zheng-yi Ni, Yu Hu, Wen-hua Liang, Chun-quan Ou, Jian-xing He, Lei Liu, Hong Shan, Chun-liang Lei, David SC Hui, Bin Du, Lan-juan Li, Guang Zeng, Kowk-Yung Yuen, Ru-chong Chen, Chun-li Tang, Tao Wang, Ping-yan Chen, Jie Xiang, Shi-yue Li, Jin-lin Wang, Zi-jing Liang, Yi-xiang Peng, Li Wei, Yong Liu, Ya-hua Hu, Peng Peng, Jian-ming Wang, Ji-yang Liu, Zhong Chen, Gang Li, Zhi-jian Zheng, Shao-qin Qiu, Jie Luo, Chang-jiang Ye, Shao-yong Zhu, Nan-shan Zhong
Background: Since December 2019, acute respiratory disease (ARD) due to 2019 novel coronavirus (2019-nCoV) emerged in Wuhan city and rapidly spread throughout China. We sought to delineate the clinical characteristics of these cases. Methods: We extracted the data on 1,099 patients with laboratory-confirmed 2019-nCoV ARD from 552 hospitals in 31 provinces/provincial municipalities through January 29th, 2020. Results: The median age was 47.0 years, and 41.90% were females. Only 1.18% of patients had a direct contact with wildlife, whereas 31.30% had been to Wuhan and 71.80% had contacted with people from Wuhan. Fever (87.9%) and cough (67.7%) were the most common symptoms. Diarrhea is uncommon. The median incubation period was 3.0 days (range, 0 to 24.0 days). On admission, ground-glass opacity was the typical radiological finding on chest computed tomography (50.00%). Significantly more severe cases were diagnosed by symptoms plus reverse-transcriptase polymerase-chain-reaction without abnormal radiological findings than non-severe cases (23.87% vs. 5.20%, P<0.001). Lymphopenia was observed in 82.1% of patients. 55 patients (5.00%) were admitted to intensive care unit and 15 (1.36%) succumbed. Severe pneumonia was independently associated with either the admission to intensive care unit, mechanical ventilation, or death in multivariate competing-risk model (sub-distribution hazards ratio, 9.80; 95% confidence interval, 4.06 to 23.67). Conclusions: The 2019-nCoV epidemic spreads rapidly by human-to-human transmission. Normal radiologic findings are present among some patients with 2019-nCoV infection. The disease severity (including oxygen saturation, respiratory rate, blood leukocyte/lymphocyte count and chest X-ray/CT manifestations) predict poor clinical outcomes.
Competing Interest Statement
The authors have declared no competing interest.
Clinical Trial
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Funding Statement
Supported by Ministry of Science and Technology, National Health Commission, National Natural Science Foundation, Department of Science and Technology of Guangdong Province.
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