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Article(id=1208106713664823781, tenantId=1146029695717560320, journalId=1189873630562394117, issueId=1208106710208717234, articleNumber=null, orderNo=null, doi=10.11855/j.issn.0577-7402.2022.04.0359, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1640620800000, receivedDateStr=2021-12-28, revisedDate=null, revisedDateStr=null, acceptedDate=1641657600000, acceptedDateStr=2022-01-09, onlineDate=1765964686075, onlineDateStr=2025-12-17, pubDate=1651075200000, pubDateStr=2022-04-28, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1765964686075, onlineIssueDateStr=2025-12-17, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1765964686075, creator=13701087609, updateTime=1765964686075, updator=13701087609, issue=Issue{id=1208106710208717234, tenantId=1146029695717560320, journalId=1189873630562394117, year='2022', volume='47', issue='4', pageStart='321', pageEnd='426', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1765964685250, creator=13701087609, updateTime=1765964685250, updator=13701087609, preIssue=null, nextIssue=null, ext=null, issueFiles=null}, startPage=359, endPage=366, ext={EN=ArticleExt(id=1208106714042311153, articleId=1208106713664823781, tenantId=1146029695717560320, journalId=1189873630562394117, language=EN, title=Epidemiological and clinical features of COVID-19 infected with SARS-CoV-2 Delta variant in Gansu Province, columnId=1190310109000602400, journalTitle=Medical Journal of Chinese People’s Liberation Army, columnName=Clinical Research, runingTitle=null, highlight=null, articleAbstract=

Objective To analyze the epidemiological and clinical features of coronavirus disease 2019 (COVID-19) infected with the Delta variant of SARS-CoV-2. Methods Retrospectively analyze the epidemiological and clinical features of 138 confirmed cases of COVID-19 infected with the Delta variant of SARS-CoV-2 from October 25, 2021 to November 19, 2021 in Yantan Branch of the Second People's Hospital of Lanzhou City. The epidemiological and demographic information, clinical symptoms, laboratory tests, chest CT, treatment and prognosis data were collected, with a final follow-up date of November 27,2021. Results As of November 19, 2021, a total of 144 confirmed cases of COVID-19 were reported in Gansu Province, of which 138 cases [65 males (47.1%) and 73 females (52.9%), aged 2-87 (42.7±21.0) years old, with the clinical classification of mainly common type (48.6%, 67/138)] were concentrically treated in the Yantan Branch of the Second People's Hospital of Lanzhou City. The transmission mode of the Delta variant of SARS-CoV-2 is mainly in confined spaces, with obvious tour group and family aggregation; screening the close contacts and community investigation are the main approaches of finding the infected persons; 86.2% (119/138) of confirmed patients have been vaccinated with the domestic inactivated COVID-19 vaccine. The most common clinical symptoms are cough (57.2%, 79/138), followed by sore throat (28.3%, 39/138), dry throat (24.6%, 34/138), and expectoration (21.0%, 29/138). Only 20.3% (28/138) of patients have fever, and 4 patients (2.9%) have decreased or lost sense of smell and taste. Laboratory tests showed that serum amyloid A and high-density lipoprotein cholesterol increased significantly.The Ct value of SARS-CoV-2 ORF1ab gene is 26.31±7.63, and N gene is 26.35±7.17. Chest CT fined that 71.3% (72/101) of confirmed patients showed bilateral lung lobes involvement, and the lesions are mostly located in the lower lobes of both lungs;the lesions are mainly flaky and patchy ground-glass opacities. All confirmed cases are treated with integrated traditional Chinese and Western medicine, mainly prone position ventilation and traditional Chinese medicine (TCM) treatment. The TCM treatment rate is 100% for severe cases. On the basis of respiratory support, nutritional support and anticoagulation, immunotherapy such as neutralizing antibodies are combined. Conclusions The main clinical features of COVID-19 infected by the Delta variant of SARS-CoV-2 in Gansu Province are low rate of fever, long time for viral nucleic acid turned to negative, low risk of severe illness after vaccination, the good therapeutic effect, no intubation, no extracorporeal membrane oxygenation (ECMO), and no deaths. "One person, one plan" personalized treatment with integrated Chinese and Western medicine can effectively control the progression of the disease and cure the disease.

, correspAuthors=Yi-Xin Wan, authorNote=null, correspAuthorsNote=
*E-mail:
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目的 分析新型冠状病毒(SARS-CoV-2) Delta变异株感染的新型冠状病毒肺炎(COVID-19)的流行病学及临床特征。方法 回顾性分析2021年10月25日－11月19日兰州市第二人民医院雁滩分院收治的SARS-CoV-2 Delta变异株感染的本土138例COVID-19确诊患者的流行病学和临床特征，采集流行病学及人口学信息、临床症状、实验室检查、胸部CT、治疗和预后数据，最终随访日期为2021年11月27日。结果 截至2021年11月19日，甘肃省此次疫情累计报告COVID-19确诊病例144例，其中兰州市第二人民医院雁滩分院集中收治138例，男65例(47.1%)，女73例(52.9%)，男女比例为1:1.12，年龄2~87(42.7±21.0)岁，临床分型以普通型(48.6%，67/138)为主。SARS-CoV-2 Delta变异株的传播方式以密闭空间为主，具有明显的旅行团聚集性和家庭聚集性；密切接触者筛查和社区排查是发现感染者的主要途径；86.2%(119/138)的确诊患者已接种国产COVID-19灭活疫苗；临床症状最常见的为咳嗽(57.2%，79/138)，其次为咽痛(28.3%，39/138)、咽干(24.6%，34/138)、咳痰(21.0%，29/138)等，有发热症状的患者仅占20.3%(28/138)，4例(2.9%)出现嗅觉、味觉减退或丧失。实验室检查血清淀粉样蛋白A和高密度脂蛋白胆固醇升高明显，SARS-CoV-2核酸检测ORF1ab基因Ct值为26.31±7.63，N基因为26.35±7.17；71.3%(72/101)的确诊患者胸部CT显示双侧肺叶受累，病灶位置以双肺下叶多见，病灶形态主要为片状、斑片状磨玻璃影。所有确诊患者均采用中西医结合治疗，以俯卧位通气和中医治疗为主，重症患者中医治疗率达100%，在呼吸支持、营养支持、抗凝的基础上配合中和抗体等免疫治疗。结论 甘肃省SARS-CoV-2 Delta变异株感染的COVID-19确诊患者主要临床特征为发热比例低、病毒核酸转阴时间长、疫苗接种后重症风险低、治疗效果好，无插管，无体外膜肺氧合(ECMO)，无死亡病例。“一人一方案”的中西医结合个性化治疗可有效控制病情进展，治愈疾病。

, correspAuthors=万毅新, authorNote=null, correspAuthorsNote=
万毅新，E-mail：
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周心怡，硕士研究生，主治医师，主要从事肺癌、呼吸系统感染性疾病的诊断与治疗研究

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周心怡，硕士研究生，主治医师，主要从事肺癌、呼吸系统感染性疾病的诊断与治疗研究

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周心怡，硕士研究生，主治医师，主要从事肺癌、呼吸系统感染性疾病的诊断与治疗研究

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A. 患者1，男，69岁，胸部CT提示双肺局部蜂窝状改变，散在斑片状密度增高影；B. 患者2，男，83岁，胸部CT提示双肺多发磨玻璃样密度增高影，双侧少量胸腔积液；C. 患者3，女，65岁，胸部CT提示右肺多发斑片状磨玻璃影；D. 患者4，女，26岁，胸部CT提示双肺胸膜下多个结节状磨玻璃样密度增高影；E. 患者5，女，79岁，胸部CT提示右肺上叶片状致密影，边界模糊，内可见空气支气管征；F. 患者6，女，77岁，胸部CT提示左肺上叶纤维索条影

, figureFileSmall=dcF+FnTiCToNGgDKhtdbEg==, figureFileBig=HnRvAAc4OlniwQW2MJQpqA==, tableContent=null), ArticleFig(id=1208435599044887064, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106713664823781, language=EN, label=Tab.1, caption=

The clinical manifestations of local confirmed cases in Gansu Province caused by SARS-CoV-2 Delta variant (n=138)

, figureFileSmall=null, figureFileBig=null, tableContent=
临床表现例数及占比[例(%)]
咳嗽79(57.2)
咽痛39(28.3)
咽干34(24.6)
咳痰29(21.0)
发热28(20.3)
鼻塞18(13.0)
乏力15(10.9)
咽痒15(10.9)
头痛10(7.2)
流涕9(6.5)
肌肉酸痛8(5.8)
嗅觉、味觉减退或丧失4(2.9)
气短4(2.9)
恶心4(2.9)
头晕3(2.2)
畏寒1(0.7)
声音嘶哑1(0.7)
一过性晕厥1(0.7)
), ArticleFig(id=1208435599107801626, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106713664823781, language=CN, label=表1, caption=

SARS-CoV-2 Delta变异株引起的甘肃省本土确诊病例临床表现分布(n=138)

, figureFileSmall=null, figureFileBig=null, tableContent=
临床表现例数及占比[例(%)]
咳嗽79(57.2)
咽痛39(28.3)
咽干34(24.6)
咳痰29(21.0)
发热28(20.3)
鼻塞18(13.0)
乏力15(10.9)
咽痒15(10.9)
头痛10(7.2)
流涕9(6.5)
肌肉酸痛8(5.8)
嗅觉、味觉减退或丧失4(2.9)
气短4(2.9)
恶心4(2.9)
头晕3(2.2)
畏寒1(0.7)
声音嘶哑1(0.7)
一过性晕厥1(0.7)
), ArticleFig(id=1208435599216853532, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106713664823781, language=EN, label=Tab.2, caption=

The basic diseases among confirmed local cases in Gansu Province caused by SARS-CoV-2 Delta variant (n=138)

, figureFileSmall=null, figureFileBig=null, tableContent=
基础疾病例数及占比[例(%)]
高血压病28(20.3)
2型糖尿病7(5.1)
冠状动脉粥样硬化性心脏病4(2.9)
脑梗死3(2.2)
慢性乙型病毒性肝炎3(2.2)
支气管扩张症2(1.4)
脑出血1(0.7)
慢性支气管炎1(0.7)
慢性阻塞性肺病1(0.7)
肺大泡1(0.7)
睡眠呼吸暂停低通气综合征1(0.7)
原发性甲状腺功能亢进症1(0.7)
原发性甲状腺功能减退症1(0.7)
胃恶性肿瘤1(0.7)
乳腺肿瘤1(0.7)
双相情感障碍1(0.7)
慢性肾功能不全1(0.7)
心力衰竭1(0.7)
癫癎1(0.7)
), ArticleFig(id=1208435599342682654, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106713664823781, language=CN, label=表2, caption=

SARS-CoV-2 Delta变异株引起的甘肃省本土确诊病例基础疾病分布(n=138)

, figureFileSmall=null, figureFileBig=null, tableContent=
基础疾病例数及占比[例(%)]
高血压病28(20.3)
2型糖尿病7(5.1)
冠状动脉粥样硬化性心脏病4(2.9)
脑梗死3(2.2)
慢性乙型病毒性肝炎3(2.2)
支气管扩张症2(1.4)
脑出血1(0.7)
慢性支气管炎1(0.7)
慢性阻塞性肺病1(0.7)
肺大泡1(0.7)
睡眠呼吸暂停低通气综合征1(0.7)
原发性甲状腺功能亢进症1(0.7)
原发性甲状腺功能减退症1(0.7)
胃恶性肿瘤1(0.7)
乳腺肿瘤1(0.7)
双相情感障碍1(0.7)
慢性肾功能不全1(0.7)
心力衰竭1(0.7)
癫癎1(0.7)
), ArticleFig(id=1208435599451734560, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106713664823781, language=EN, label=Tab.3, caption=

The laboratory test data of local confirmed cases in Gansu Province caused by SARS-CoV-2 Delta variant (n=138)

, figureFileSmall=null, figureFileBig=null, tableContent=
实验室检查构成[例(%)]检查结果($\bar{x}±s$) 参考范围
血常规(n=138)
 白细胞计数(×109/L) 5.3±1.64.0~10.0
  <4.029(21.0)
  4.0~10.0107(77.5)
  >10.02(1.5)
 中性粒细胞计数(×109/L) 3.4±1.42.0~7.0
  <2.019(13.8)
  2.0~7.0117(84.8)
  >7.02(1.4)
 淋巴细胞计数(×109/L) 1.4±0.60.8~4.0
  <0.818(13.0)
  0.8~4.0119(86.2)
  >4.01(0.7)
 中性粒细胞百分数(%) 63±1340~75
 淋巴细胞百分数(%) 27±1220~40
 血红蛋白(g/L) 137±17110~160
  <1105(3.6)
  110~160120(87.0)
  >16013(9.4)
 血小板计数(×109/L) 214±60100~300
  <1002(1.4)
  100~300124(89.9)
  >30012(8.7)
凝血指标
 凝血酶原时间(s, n=62) 12.12±0.669.0~14.0
 凝血酶原活动度(%, n=62) 100.10±18.8970.0~130.0
  70~13059(95.2)
  >1303(4.8)
 活化部分凝血活酶时间(s, n=62) 26.71±4.0225.0~40.0
  <2518(29.0)
  25~4044(71.0)
 纤维蛋白原(g/L, n=62) 3.01±2.272.00~4.00
  <210(16.1)
  2~443(69.4)
  >49(14.5)
 血浆D-二聚体(μg/ml, n=138) 0.55±1.660~0.55
  0~0.55119(86.2)
  >0.5519(13.8)
血生化
 谷丙转氨酶(U/L, n=135) 30±367~40
  7~40114(84.4)
  >4021(15.6)
 谷草转氨酶(U/L, n=138) 32±3015~35
  15~35109(79.0)
  >3529(21.0)
 结合胆红素(μmol/L, n=135) 4.6±2.00.0~6.8
  0.0~6.8122(90.4)
  >6.813(9.6)
 总蛋白(g/L, n=135) 73.4±6.565.0~85.0
  <6512(8.9)
  65.0~85.0117(86.7)
  >856(4.4)
 白蛋白(g/L, n=135) 43.0±4.635.0~55.0
  <356(4.4)
  35.0~55.0129(95.6)
 球蛋白(g/L, n=135) 30.2±4.720.0~35.0
  <201(0.7)
  20.0~35.0117(86.7)
  >3517(12.6)
 尿素(mmol/L, n=138) 4.8±1.33.1~8.8
  3.1~8.8137(99.3)
  >8.81(0.7)
 肌酐(μmol/L, n=138) 66±2141~81
  41~81111(80.4)
  >8127(19.6)
 高密度脂蛋白胆固醇(mmol/L, n=135) 1.14±0.30>1.04
  <1.0454(40.0)
  >1.0481(60.0)
 肌酸激酶(U/L, n=138) 110±11024~170
  24~170121(87.7)
  >17017(12.3)
 乳酸脱氢酶(U/L, n=138) 225±73109~245
  135~24595(68.8)
  >24543(31.2)
炎症指标
 CRP(mg/L, n=138) 9.57±22.350.00~5.00
  0.00~5.0076(55.1)
  >5.0062(44.9)
 PCT(ng/ml, n=138) 0.05±0.060.00~0.35
  0.00~0.35138(100.0)
  >0.350
 血清淀粉样蛋白A(mg/L, n=132) 43.18±69.550.00~10.00
  0.00~10.0060(45.5)
  >10.0072(54.5)
 IL-6(pg/ml, n=138) 6.96±13.810.00~10.00
  0.00~10.00114(82.6)
  >10.0024(17.4)
鼻咽拭子SARS-CoV-2核酸检测(n=138)
 ORF1ab基因 26.31±7.63>40
  <40122(88.4)
  >4016(11.6)
 N基因 26.35±7.17>40
  <40123(89.1)
  >4015(10.9)  
), ArticleFig(id=1208435599523037730, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106713664823781, language=CN, label=表3, caption=

SARS-CoV-2 Delta变异株引起的甘肃省本土确诊病例实验室检查数据分布(n=138)

, figureFileSmall=null, figureFileBig=null, tableContent=
实验室检查构成[例(%)]检查结果($\bar{x}±s$) 参考范围
血常规(n=138)
 白细胞计数(×109/L) 5.3±1.64.0~10.0
  <4.029(21.0)
  4.0~10.0107(77.5)
  >10.02(1.5)
 中性粒细胞计数(×109/L) 3.4±1.42.0~7.0
  <2.019(13.8)
  2.0~7.0117(84.8)
  >7.02(1.4)
 淋巴细胞计数(×109/L) 1.4±0.60.8~4.0
  <0.818(13.0)
  0.8~4.0119(86.2)
  >4.01(0.7)
 中性粒细胞百分数(%) 63±1340~75
 淋巴细胞百分数(%) 27±1220~40
 血红蛋白(g/L) 137±17110~160
  <1105(3.6)
  110~160120(87.0)
  >16013(9.4)
 血小板计数(×109/L) 214±60100~300
  <1002(1.4)
  100~300124(89.9)
  >30012(8.7)
凝血指标
 凝血酶原时间(s, n=62) 12.12±0.669.0~14.0
 凝血酶原活动度(%, n=62) 100.10±18.8970.0~130.0
  70~13059(95.2)
  >1303(4.8)
 活化部分凝血活酶时间(s, n=62) 26.71±4.0225.0~40.0
  <2518(29.0)
  25~4044(71.0)
 纤维蛋白原(g/L, n=62) 3.01±2.272.00~4.00
  <210(16.1)
  2~443(69.4)
  >49(14.5)
 血浆D-二聚体(μg/ml, n=138) 0.55±1.660~0.55
  0~0.55119(86.2)
  >0.5519(13.8)
血生化
 谷丙转氨酶(U/L, n=135) 30±367~40
  7~40114(84.4)
  >4021(15.6)
 谷草转氨酶(U/L, n=138) 32±3015~35
  15~35109(79.0)
  >3529(21.0)
 结合胆红素(μmol/L, n=135) 4.6±2.00.0~6.8
  0.0~6.8122(90.4)
  >6.813(9.6)
 总蛋白(g/L, n=135) 73.4±6.565.0~85.0
  <6512(8.9)
  65.0~85.0117(86.7)
  >856(4.4)
 白蛋白(g/L, n=135) 43.0±4.635.0~55.0
  <356(4.4)
  35.0~55.0129(95.6)
 球蛋白(g/L, n=135) 30.2±4.720.0~35.0
  <201(0.7)
  20.0~35.0117(86.7)
  >3517(12.6)
 尿素(mmol/L, n=138) 4.8±1.33.1~8.8
  3.1~8.8137(99.3)
  >8.81(0.7)
 肌酐(μmol/L, n=138) 66±2141~81
  41~81111(80.4)
  >8127(19.6)
 高密度脂蛋白胆固醇(mmol/L, n=135) 1.14±0.30>1.04
  <1.0454(40.0)
  >1.0481(60.0)
 肌酸激酶(U/L, n=138) 110±11024~170
  24~170121(87.7)
  >17017(12.3)
 乳酸脱氢酶(U/L, n=138) 225±73109~245
  135~24595(68.8)
  >24543(31.2)
炎症指标
 CRP(mg/L, n=138) 9.57±22.350.00~5.00
  0.00~5.0076(55.1)
  >5.0062(44.9)
 PCT(ng/ml, n=138) 0.05±0.060.00~0.35
  0.00~0.35138(100.0)
  >0.350
 血清淀粉样蛋白A(mg/L, n=132) 43.18±69.550.00~10.00
  0.00~10.0060(45.5)
  >10.0072(54.5)
 IL-6(pg/ml, n=138) 6.96±13.810.00~10.00
  0.00~10.00114(82.6)
  >10.0024(17.4)
鼻咽拭子SARS-CoV-2核酸检测(n=138)
 ORF1ab基因 26.31±7.63>40
  <40122(88.4)
  >4016(11.6)
 N基因 26.35±7.17>40
  <40123(89.1)
  >4015(10.9)  
), ArticleFig(id=1208435599606923812, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106713664823781, language=EN, label=Tab.4, caption=

The abnormal chest CT findings in local confirmed cases in Gansu Province caused by SARS-CoV-2 Delta variant(n=101)

, figureFileSmall=null, figureFileBig=null, tableContent=
胸部CT异常表现构成[例(%)]
肺部异常病灶位置
 左肺11(10.9)
 右肺18(17.8)
 双肺72(71.3)
肺部异常病灶性质
 片状、斑片状磨玻璃影75(74.3)
 混合磨玻璃影12(11.9)
 结节状磨玻璃影7(6.9)
 实变影4(4.0)
 纤维灶(网格影、索条影)3(3.0)
), ArticleFig(id=1208435599682421286, tenantId=1146029695717560320, journalId=1189873630562394117, articleId=1208106713664823781, language=CN, label=表4, caption=

SARS-CoV-2 Delta变异株引起的甘肃省本土确诊病例胸部CT异常表现分布(n=101)

, figureFileSmall=null, figureFileBig=null, tableContent=
胸部CT异常表现构成[例(%)]
肺部异常病灶位置
 左肺11(10.9)
 右肺18(17.8)
 双肺72(71.3)
肺部异常病灶性质
 片状、斑片状磨玻璃影75(74.3)
 混合磨玻璃影12(11.9)
 结节状磨玻璃影7(6.9)
 实变影4(4.0)
 纤维灶(网格影、索条影)3(3.0)
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甘肃省SARS-CoV-2 Delta变异株感染的COVID-19流行病学和临床特征分析
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周心怡 , 王虹 , 黄晖蓉 , 张天明 , 万毅新 *
解放军医学杂志 | 临床研究 2022,47(4): 359-366
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解放军医学杂志 | 临床研究 2022, 47(4): 359-366
甘肃省SARS-CoV-2 Delta变异株感染的COVID-19流行病学和临床特征分析
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周心怡, 王虹, 黄晖蓉, 张天明, 万毅新*
作者信息
  • 兰州大学第二医院呼吸内科，兰州 730030

    • 周心怡，硕士研究生，主治医师，主要从事肺癌、呼吸系统感染性疾病的诊断与治疗研究

通讯作者:

万毅新，E-mail：
Epidemiological and clinical features of COVID-19 infected with SARS-CoV-2 Delta variant in Gansu Province
Xin-Yi Zhou, Hong Wang, Hui-Rong Huang, Tian-Ming Zhang, Yi-Xin Wan*
Affiliations
  • Department of Respiratory, Second Hospital of Lanzhou University, Lanzhou 730030, China
出版时间: 2022-04-28 doi: 10.11855/j.issn.0577-7402.2022.04.0359
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摘要
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目的 分析新型冠状病毒(SARS-CoV-2) Delta变异株感染的新型冠状病毒肺炎(COVID-19)的流行病学及临床特征。方法 回顾性分析2021年10月25日－11月19日兰州市第二人民医院雁滩分院收治的SARS-CoV-2 Delta变异株感染的本土138例COVID-19确诊患者的流行病学和临床特征，采集流行病学及人口学信息、临床症状、实验室检查、胸部CT、治疗和预后数据，最终随访日期为2021年11月27日。结果 截至2021年11月19日，甘肃省此次疫情累计报告COVID-19确诊病例144例，其中兰州市第二人民医院雁滩分院集中收治138例，男65例(47.1%)，女73例(52.9%)，男女比例为1:1.12，年龄2~87(42.7±21.0)岁，临床分型以普通型(48.6%，67/138)为主。SARS-CoV-2 Delta变异株的传播方式以密闭空间为主，具有明显的旅行团聚集性和家庭聚集性；密切接触者筛查和社区排查是发现感染者的主要途径；86.2%(119/138)的确诊患者已接种国产COVID-19灭活疫苗；临床症状最常见的为咳嗽(57.2%，79/138)，其次为咽痛(28.3%，39/138)、咽干(24.6%，34/138)、咳痰(21.0%，29/138)等，有发热症状的患者仅占20.3%(28/138)，4例(2.9%)出现嗅觉、味觉减退或丧失。实验室检查血清淀粉样蛋白A和高密度脂蛋白胆固醇升高明显，SARS-CoV-2核酸检测ORF1ab基因Ct值为26.31±7.63，N基因为26.35±7.17；71.3%(72/101)的确诊患者胸部CT显示双侧肺叶受累，病灶位置以双肺下叶多见，病灶形态主要为片状、斑片状磨玻璃影。所有确诊患者均采用中西医结合治疗，以俯卧位通气和中医治疗为主，重症患者中医治疗率达100%，在呼吸支持、营养支持、抗凝的基础上配合中和抗体等免疫治疗。结论 甘肃省SARS-CoV-2 Delta变异株感染的COVID-19确诊患者主要临床特征为发热比例低、病毒核酸转阴时间长、疫苗接种后重症风险低、治疗效果好，无插管，无体外膜肺氧合(ECMO)，无死亡病例。“一人一方案”的中西医结合个性化治疗可有效控制病情进展，治愈疾病。

新型冠状病毒肺炎  /  新型冠状病毒Delta变异株  /  甘肃  /  临床特征

Objective To analyze the epidemiological and clinical features of coronavirus disease 2019 (COVID-19) infected with the Delta variant of SARS-CoV-2. Methods Retrospectively analyze the epidemiological and clinical features of 138 confirmed cases of COVID-19 infected with the Delta variant of SARS-CoV-2 from October 25, 2021 to November 19, 2021 in Yantan Branch of the Second People's Hospital of Lanzhou City. The epidemiological and demographic information, clinical symptoms, laboratory tests, chest CT, treatment and prognosis data were collected, with a final follow-up date of November 27,2021. Results As of November 19, 2021, a total of 144 confirmed cases of COVID-19 were reported in Gansu Province, of which 138 cases [65 males (47.1%) and 73 females (52.9%), aged 2-87 (42.7±21.0) years old, with the clinical classification of mainly common type (48.6%, 67/138)] were concentrically treated in the Yantan Branch of the Second People's Hospital of Lanzhou City. The transmission mode of the Delta variant of SARS-CoV-2 is mainly in confined spaces, with obvious tour group and family aggregation; screening the close contacts and community investigation are the main approaches of finding the infected persons; 86.2% (119/138) of confirmed patients have been vaccinated with the domestic inactivated COVID-19 vaccine. The most common clinical symptoms are cough (57.2%, 79/138), followed by sore throat (28.3%, 39/138), dry throat (24.6%, 34/138), and expectoration (21.0%, 29/138). Only 20.3% (28/138) of patients have fever, and 4 patients (2.9%) have decreased or lost sense of smell and taste. Laboratory tests showed that serum amyloid A and high-density lipoprotein cholesterol increased significantly.The Ct value of SARS-CoV-2 ORF1ab gene is 26.31±7.63, and N gene is 26.35±7.17. Chest CT fined that 71.3% (72/101) of confirmed patients showed bilateral lung lobes involvement, and the lesions are mostly located in the lower lobes of both lungs;the lesions are mainly flaky and patchy ground-glass opacities. All confirmed cases are treated with integrated traditional Chinese and Western medicine, mainly prone position ventilation and traditional Chinese medicine (TCM) treatment. The TCM treatment rate is 100% for severe cases. On the basis of respiratory support, nutritional support and anticoagulation, immunotherapy such as neutralizing antibodies are combined. Conclusions The main clinical features of COVID-19 infected by the Delta variant of SARS-CoV-2 in Gansu Province are low rate of fever, long time for viral nucleic acid turned to negative, low risk of severe illness after vaccination, the good therapeutic effect, no intubation, no extracorporeal membrane oxygenation (ECMO), and no deaths. "One person, one plan" personalized treatment with integrated Chinese and Western medicine can effectively control the progression of the disease and cure the disease.

coronavirus disease 2019  /  Delta variant of SARS-CoV-2  /  Gansu  /  clinical features
周心怡, 王虹, 黄晖蓉, 张天明, 万毅新. 甘肃省SARS-CoV-2 Delta变异株感染的COVID-19流行病学和临床特征分析. 解放军医学杂志, 2022 , 47 (4) : 359 -366 . DOI: 10.11855/j.issn.0577-7402.2022.04.0359
Xin-Yi Zhou, Hong Wang, Hui-Rong Huang, Tian-Ming Zhang, Yi-Xin Wan. Epidemiological and clinical features of COVID-19 infected with SARS-CoV-2 Delta variant in Gansu Province[J]. Medical Journal of Chinese People’s Liberation Army, 2022 , 47 (4) : 359 -366 . DOI: 10.11855/j.issn.0577-7402.2022.04.0359
正文
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自2019年12月新型冠状病毒肺炎(coronavirus disease 2019，COVID-19)疫情蔓延并席卷全球，截至2021年12月8日，全球累计确诊病例已达266 504 411例，累计死亡病例达5 268 849例[1]。COVID-19是自1918年流感大流行以来最严重的全球健康危机。2020年9月，新型冠状病毒(severe acute respiratory syndrome coronavirus-2，SARS-CoV-2) Delta变异株在印度首次报道后，迅速在全球多个国家流行，严重威胁全球公共卫生安全。Delta变异株具有病毒载量高、传染力强、潜伏期短、抗原逃逸等致病特点，对COVID-19的防治提出了新的挑战。甘肃省位于中国西北，地处内陆，在2020年疫情初始阶段，累计确诊本土病例92例。2021年10月18日，在连续561d无本土病例后，甘肃省兰州市发现本轮第1例核酸检测阳性人员，19日凌晨报告本轮首例确诊病例，随后，突如其来的新一轮疫情波及甘肃省兰州市、天水市、张掖市、嘉峪关市及陇南市等，流行病学调查和病毒基因测序显示，本轮疫情由SARS-CoV-2 Delta变异株引起。截至2021年11月27日，甘肃省本轮确诊病例全部治愈出院。本研究分析了甘肃省此次省级定点救治医院收治的138例COVID-19确诊病例的流行病学和临床特征，以期为SARS-CoV-2 Delta变异株引起的COVID-19疫情防控和病例救治提供参考。
1 资料与方法
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1.1 资料来源
通过甘肃省卫生健康委员会官网(http://wsjk.gansu.gov.cn/)，收集2021年10月19日－11月19日甘肃省SARS-CoV-2感染确诊病例的性别、年龄、发病日期、报告日期、传播途径、发现方式等相关资料。通过兰州市第二人民医院雁滩分院电子病历管理系统回顾性收集2021年10月25日－11月19日收治的138例COVID-19确诊病例的病史、实验室检查、胸部CT检查、治疗用药及转归情况等。
COVID-19确诊病例诊断标准参照2021年国家卫生健康委员会《新型冠状病毒感染的肺炎诊疗方案(试行第八版修订版)》[2]。所有确诊病例呼吸道标本均经实验室检测及疾控部门复核实时荧光RT-PCR确诊SARS-CoV-2核酸阳性。
临床分型标准参照2021年国家卫生健康委员会《新型冠状病毒感染的肺炎诊疗方案(试行第八版修订版)》[2]。轻型：临床症状轻微，影像学未见肺炎表现。普通型：具有发热、呼吸道症状等，影像学可见肺炎表现。重型：成人符合以下任何一条：(1)出现气促，呼吸频率(respiratory rate，RR)≥30次/min；(2)静息状态下，吸气时指氧饱和度≤93%；(3)动脉血氧分压(partial pressure of arterial oxygen，PaO2)/吸氧浓度(fraction of inspiration oxygen，FiO2)≤300 mmHg；(4)临床症状进行性加重，肺部影像学显示24~48 h病灶明显进展>50%。危重型：符合以下任何一条：(1)出现呼吸衰竭，且需要机械通气；(2)出现休克；(3)合并其他器官衰竭需重症监护病房(intensive care unit，ICU)监护治疗。
1.2 方法
回顾性分析138例确诊患者的临床特征、实验室检查结果[(1)血常规，包括白细胞计数、中性粒细胞计数、淋巴细胞计数、血红蛋白、血小板计数等；(2)血生化，包括谷丙转氨酶、谷草转氨酶、直接胆红素、总蛋白、白蛋白、球蛋白、尿素、血肌酐、肌酸激酶、乳酸脱氢酶、高密度脂蛋白胆固醇等；(3)炎症指标，包括C反应蛋白(C-reactive protein，CRP)、降钙素原(procalcitonin，PCT)、血清淀粉样蛋白A、白细胞介素-6(IL-6)等；(4)凝血指标，包括血浆D-二聚体等；(5)胸部影像学资料，主要包括电子病历HIS系统中胸部CT表现的病灶形态、部位等]。收集性别、年龄、流行病学、分型、临床症状、新冠疫苗接种情况、基础疾病、确诊日期、出院日期等一般资料。
1.3 统计学处理
采用Excel电子表格(WPS Office 11.1.0.11194)建立数据库，使用SPSS 25.0软件进行处理和分析，描述性分析研究对象的临床表现、实验室检查结果、胸部影像学表现等特征，计量资料以$\bar{x}±s$表示，计数资料以率(%)表示。每日新增确诊病例数以条形图表示。
2 结果
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2.1 发病日期
2021年10月19日－11月19日，甘肃省本轮疫情累计报告COVID-19确诊病例144例，无症状感染者2例。每日新增确诊病例数如图1所示。全部感染者呼吸道标本(鼻咽拭子)经甘肃省疾病预防控制中心SARS-CoV-2全基因组二代测序，确定为Delta变异株。
2.2 人群分布
甘肃省本轮疫情确诊的144例患者中，共138例收治或由当地集中转运至省级定点医疗救治机构——兰州市第二人民医院雁滩分院。所有患者的入院日期从收治当地定点医疗救治机构之日开始计算。138例确诊患者中，男65例(47.1%)，女73例(52.9%)，男女比例为1:1.12；年龄2~87(42.7±21.0)岁。<18岁、18~60岁和60岁以上年龄段分别占15.9%(22/138)、60.1%(83/138)和23.9%(33/138)。
2.3 传染途径
根据流行病学调查和病毒二代基因测序结果，本轮病例感染的病毒均为Delta变异株。Delta变异株的传播方式以密闭空间为主，本次疫情具有明显的旅行团成员和家庭成员聚集性，主要传播场所为旅行团大巴、就餐餐馆、家庭及学校等；密切接触者筛查和社区排查是发现感染者的主要途径。
2.4 分型及疫苗接种史
138例确诊患者中，轻型43例(31.2%)，普通型67例(48.6%)，重型26例(18.8%)，危重型2例(1.4%)，临床分型以普通型为主。
119例(86.2%)接种国产COVID-19灭活疫苗，其中接种1剂次6例(5.0%)，接种2剂次110例(92.4%)，接种3剂次3例(2.5%)，疫苗生产厂家有北京科兴中维生物技术有限公司、国药集团中国生物北京生物制品研究所有限责任公司及国药集团中国生物兰州生物制品研究所。15例(10.9%)未接种COVID-19疫苗，其中11例年龄在2~11岁，在此次疫情暴发时甘肃省尚未启动3~11岁人群COVID-19疫苗接种工作。4例(2.9%)COVID-19疫苗接种情况不详。
2.5 临床表现
138例确诊患者首发症状以呼吸系统症状为主，最常见的为咳嗽(57.2%，79/138)，其次是咽痛(28.3%，39/138)、咽干(24.6%，34/138)、咳痰(21.0%，29/138)；28例(20.3%)出现发热，体温波动于37.5~39.5 ℃；4例(2.9%)出现嗅觉、味觉减退或丧失(表1)。
2.6 基础病史
138例确诊患者中，43例(31.2%)合并基础疾病，其中1例重型患者合并高血压病、2型糖尿病、脑梗死、心力衰竭、癫癎5种基础疾病，13例合并2种基础疾病。138例患者中共有28例(20.3%)合并高血压病，7例(5.1%)合并2型糖尿病，4例(2.9%)合并冠状动脉粥样硬化性心脏病(表2)。
2.7 实验室检查
138例确诊患者中，血常规可见白细胞计数、淋巴细胞计数减少；凝血指标可见活化部分凝血活酶时间缩短，纤维蛋白原升高或降低，血浆D-二聚体升高；血生化提示谷丙转氨酶、谷草转氨酶、结合胆红素、血肌酐、肌酸激酶、乳酸脱氢酶不同程度升高，高密度脂蛋白胆固醇明显升高；炎症指标以血清淀粉样蛋白A升高为主，CRP和IL-6不同程度升高，PCT在正常范围内。部分患者住院期间反复核酸检测N基因、ORFlab基因显示Ct值较低，提示Delta病毒载量较高，患者经治疗后核酸转阴时间较长。实验室检查结果如表3所示。
2.8 影像学检查
138例确诊患者中，2例(1.4%)幼儿因不能配合未行胸部CT检查，1例(0.7%)因妊娠早期未行胸部CT检查，34例(24.6%)入院首次胸部CT检查正常，101例(73.2%)胸部CT有异常表现，病灶主要分布、范围及数量如表4所示。72例(71.3%)双侧肺叶受累，29例(28.7%)单侧肺叶受累，其中左侧肺叶受累11例，右侧肺叶受累18例。病灶位置以右肺下叶受累最多见，其次为左肺下叶。双肺病灶累及3个肺段以上者40例(39.6%)。
病灶形态主要表现为片状、斑片状磨玻璃影，占74.3%(75/101)，混合磨玻璃影占11.9%(12/101)，结节状磨玻璃影占6.9%(7/101)，实变影占4.0%(4/101)。仅1例重型患者出现双侧少量胸腔积液。部分患者胸部CT表现如图2所示。
2.9 治疗及转归
所有确诊患者均集中隔离救治，采用“一患一方案”的中西医结合治疗方法。普通型、重型及危重型患者以俯卧位通气并依据患者个人体质辨证施治的中草药汤剂治疗为主，辅以心理疏导，严密监测血氧饱和度变化，测定并记录患者静息状态、运动后、吸氧后及俯卧位、俯卧位吸氧等5种状态下的血氧饱和度。重症病例中医治疗率达100%，在氧疗、营养支持、低分子肝素抗凝的基础上，配合胸腺肽、康复者恢复期血浆、中和抗体等免疫治疗。最终，所有确诊患者无气管插管、无体外膜肺氧合(extracorporeal membrane oxygenation，ECMO)、无死亡。2021年11月27日，138例确诊患者全部治愈出院，住院时间7~35(18.7±4.9) d。
3 讨论
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COVID-19是由SARS-CoV-2感染引起的一种具有高度传染性的急性呼吸道传染病[2]。SARS-CoV-2为β属单链RNA病毒，在不断适应环境和人类宿主的过程中容易发生基因突变，选择性进化成致病性更强的优势毒株[3]，且在进化过程中获得更多编码蛋白质的能力，逃避宿主的免疫清除[4]。
本研究针对甘肃省此次SARS-CoV-2 Delta变异株感染的COVID-19确诊病例进行流行病学和临床特征分析，旨在揭示此轮疫情发生、发展的规律，为今后更有效地应对COVID-19疫情提供参考。甘肃省本次疫情是由前往西北地区旅游的旅行团成员感染引起的暴发流行。甘肃省地形东西跨度大，涉疫旅行团途径的嘉峪关、陇南等地相距1200多千米，旅游景点分散、相互间隔距离远，造成了此次疫情点多、面广、分散、传播快速的特点。此次旅行团成员以老年人为主，高龄且合并多种基础疾病，长途旅行身体劳累，抵抗力下降，因此重型病例比例高。
SARS-CoV-2二代基因测序结果显示，此次疫情由新的境外输入相关的SARS-CoV-2 Delta变异株感染引起。此前，Delta变异株被证实具有传播力强和免疫逃逸的特点，病毒通过不断的基因突变，增强了自身与人体的结合能力[5]，以及对中和抗体的抵抗性[6]，具有更高的细胞融合水平和更强的传染性[4]。部分患者住院期间反复核酸检测N基因、ORFlab基因显示Ct值较低，提示Delta变异株病毒载量较高，因此患者经治疗后核酸转阴时间较长，平均住院时间延长。
此次疫情大部分患者具有明确的流行病学史，已接种过2剂次国产COVID-19灭活疫苗，提示接种新冠疫苗仍可能感染COVID-19，但接种疫苗对降低重型COVID-19的发生率仍有益处，确诊病例预后较好，病死率低，因此，接种疫苗仍是预防病毒传播、终结疫情的有效手段，需继续加强未成年人和老年人COVID-19疫苗的接种以及第3针疫苗的补种工作。
本研究结果显示，确诊患者临床表现以咳嗽、咽痛、咽干等呼吸道症状为主，发热比例较低，不同于既往国内报道的广州[7]和张家界[8]Delta变异株感染发热发生率高、热峰高和持续时间长的特点，也有别于既往报道的甘肃省[9]或兰州[10]地区SARS-CoV-2野生株感染的临床特征。最常见的临床症状为咳嗽，以干咳为主，这与SARS-CoV-2主要侵犯肺泡上皮细胞有关[11]。
本研究实验室检查结果显示，部分患者早期白细胞计数正常或减低、淋巴细胞计数减少，转氨酶、肌酐、肌酸激酶、乳酸脱氢酶、CRP升高，降钙素原正常，血浆D-二聚体升高等，这些特点与《新型冠状病毒感染的肺炎诊疗方案(试行第八版修订版)》[2]中的描述一致。这是由于病毒主要作用于淋巴细胞，尤其是T淋巴细胞[12]，淋巴细胞计数减少表明SARS-CoV-2可消耗免疫细胞，抑制人体的细胞免疫功能[13]，因此影响血常规指标。同时，炎症指标以血清淀粉样蛋白A升高为主。SARS-CoV-2病毒颗粒可通过呼吸道黏膜扩散，诱发肺部免疫细胞过度活化，产生大量炎性因子，引发体内细胞因子风暴，产生一系列免疫反应，导致炎性因子如CRP、血清淀粉样蛋白A、血浆D-二聚体升高[14]；同时引发心、肝、肾脏等多器官功能受损，出现肝酶、肌酐、肌酶等的异常升高。既往研究发现，高密度脂蛋白胆固醇可逆转运胆固醇，且具有多效保护作用，包括抗感染、抗炎症、抗氧化和抗血栓形成等[15]。在重症感染或急性疾病发作期间，高密度脂蛋白胆固醇水平降低非常快。有研究发现，高密度脂蛋白胆固醇水平降低可作为SARS-CoV-2感染预后不良的独立危险因素[16]。本研究中，此次COVID-19确诊患者高密度脂蛋白胆固醇水平升高，一定程度上证实了高密度脂蛋白胆固醇具有抗感染、抗炎症等保护作用。
胸部影像学检查仍以磨玻璃样病变为主要特征，病灶主要累及两下肺，沿胸膜分布。对比SARS-CoV-2野生株感染的患者，Delta变异株感染导致近2/5的患者出现双侧3个以上肺叶受累，少数患者合并胸腔积液和实变。因此，动态复查胸部CT观察病灶形态及范围变化仍是评估病情的重要方法。
在治疗方案的制定方面，所有患者均采用中西医结合治疗方案，以清醒俯卧位通气、中药抗病毒药物为基础，配合抗凝、中和抗体及其他对症支持治疗。清醒俯卧位通气[17]可改善氧合，尽早干预可降低发生急性呼吸窘迫综合征(acute respiratory distress syndrome，ARDS)及插管的概率。患者每日俯卧位通气时间不少于16 h，动态监测血氧饱和度变化和胸部CT是COVID-19患者最重要的治疗措施之一。最终，所有患者均治愈出院，实现了零插管、零ECMO、零死亡的目标。
综上所述，甘肃省此次SARS-CoV-2 Delta变异株感染引起的疫情中老年患者多，合并多种基础疾病，且多为普通型，经过积极诊断和中西医结合治疗后病情均趋于稳定，并最终全部治愈出院。当前，在疫情防控常态化的形势下，接种COVID-19疫苗、佩戴口罩、勤洗手、保持1 m文明距离等仍是最有效的防控措施。低风险区医护人员仍需警惕散发病例的出现，了解Delta变异株感染的流行病学特点和临床特征，早期识别、早期确诊、早期隔离治疗，将COVID-19传播的风险降至最低。本研究的不足之处在于样本量较小，为回顾性研究，存在回忆偏倚，随访时间有限。后续力争在条件允许的情况下开展前瞻性研究，关注COVID-19治愈患者的呼吸康复及对日常生活的影响。
基金
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  • 甘肃省科技计划项目(20YF2FA025)
文献
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参考文献 引证文献
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2022年第47卷第4期
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doi: 10.11855/j.issn.0577-7402.2022.04.0359
  • 接收时间：2021-12-28
  • 首发时间：2025-12-17
  • 出版时间：2022-04-28
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  • 收稿日期：2021-12-28
  • 录用日期：2022-01-09
基金
Science and Technology Planning Project of Gansu Province(20YF2FA025)
甘肃省科技计划项目(20YF2FA025)
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    兰州大学第二医院呼吸内科，兰州 730030

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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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