Analysis in early clinical characteristics of Coronavirus Disease 2019 patients with Delta strain in Yangzhou City of Jiangsu Province
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摘要:目的 分析确诊感染德尔塔（Delta）毒株新型冠状病毒肺炎（COVID-19）患者的流行病学特点、临床特征和辅助检查结果。方法 纳入2021年7月29日-8月16日在扬州市苏北人民医院发热门诊确诊的75例Delta毒株COVID-19患者，并与2020年2月扬州市37例确诊原始毒株COVID-19患者进行比较，包括流行病学特点、临床特征和辅助检查结果。结果 75例Delta毒株感染患者中，男26例，女49例，中位年龄50.7（35.0，67.0）岁，其中41~64岁者24例（32.0%），≥ 65岁者28例（37.3%）；原始毒株感染患者中位年龄46.2（36.5，55.5）岁，其中41~64岁者20例（54.1%）。47例（62.7%）确诊Delta毒株COVID-19患者曾接种过1~3针疫苗，66例（88.0%）患者行初步流行病学调查后有明确的接触史，而34例（91.9%）原始毒株感染患者有明确接触史。5例Delta毒株感染患者无临床症状，54例（72.0%）有不同程度的发热，39例（52.0%）有咳嗽、咽痛、鼻塞、流涕等呼吸道症状，21例（28.0%）有神经系统症状。就诊时病程>48 h患者年龄大于病程 < 24 h患者，差异有统计学意义（P < 0.05）。病程>48 h患者单核细胞计数低于病程 < 24 h患者，病程>48 h患者血小板计数低于病程 < 24 h及24~48 h患者，差异均有统计学意义（P < 0.05）。就诊时病程24~48 h以及>48 h患者胸部CT特征性炎症检出率高于病程 < 24 h患者，差异有统计学意义（P < 0.05）。不同病程患者咽拭子核酸开放阅读框基因、核壳蛋白基因Ct值无差异。结论 扬州市Delta毒株COVID-19患者以中老年人为主，首发症状多为发热及呼吸道症状。与COVID-19原始毒株相比，Delta毒株感染患者神经系统症状高发，肺部病灶进展迅速，建议早期诊治。Abstract:Objective To analyze the epidemiological features, clinical characteristics and auxiliary examination results of patients diagnosed as Delta strain of Coronavirus Disease 2019 (COVID-19).Methods A total of 75 patients diagnosed as Delta strain of COVID-19 from July 29 to August 16 in 2021 in the fever clinic of Subei People's Hospital of Yangzhou City were included, and they were compared with 37 patients diagnosed as original strain of COVID-19 in February 2020 in Yangzhou City in aspects of epidemiological features, clinical characteristics and auxiliary examination results.Results Among 75 patients infected with Delta strain of COVID-19, there were 26 males and 49 females, with a median age of 50.7(35.0, 67.0) years, including 24 cases (32.0%) aged 41 to 64 years old and 28 cases (37.3%) aged ≥ 65 years old. The median age of patients with the original strain was 46.2(36.5, 55.5) years, among whom 20 cases (54.1%) were 41 to 64 years old. Totally 47 patients (62.7%) diagnosed as Delta strain of COVID-19 had received 1 to 3 doses of vaccine, and 66 patients (88.0%) had a clear contact history after preliminary epidemiological investigation. Totally 34 patients (91.9%) with original strain had a clear contact history. Five patients infected with Delta strain had no clinical symptoms, 54 cases (72.0%) had fever in varying degrees, 39 cases (52.0%) had respiratory symptoms such as cough, sore throat, nasal congestion and runny nose, and 21 cases (28.0%) had neurological symptoms. The age of patients with course of disease at visit >48 h was significantly higher than that of patients with course of disease < 24 h (P < 0.05). The monocyte count of patients with course of disease >48 h was significantly lower than that of patients with course of disease < 24 h, and the platelet count of patients with course of disease >48 h was significantly lower than that of patients with course of disease < 24 h and from 24 to 48 h (P < 0.05). The detection rate of chest CT characteristic inflammation in patients with course of disease from 24 to 48 h and >48 h was significantly higher than that in patients with course of disease < 24 h (P < 0.05). There was no difference in the CT values of open reading frame gene and nucleocapsid protein gene in nucleic acid detection of pharyngeal swab in patients with different course of disease.Conclusion The patients infected with Delta strain of COVID-19 in Yangzhou City are mainly middle-aged and elderly people, and the primary symptoms are mostly fever and respiratory symptoms. Compared with the original strain of COVID-19, patients infected with Delta strain have high incidence of neurological symptoms and rapid progress of pulmonary lesions, and early diagnosis and treatment are recommended.
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表 1 扬州市Delta毒株与原始毒株确诊COVID-19患者的流行病学特征[n(%)][M(P25, P75)]
特征 Delta毒株(n=75) 原始毒株(n=37) 性别 男 26(34.7) 17(45.9) 女 49(65.3) 20(54.1) 年龄/岁 50.7(35.0, 67.0) 46.2(36.5, 55.5) 年龄分布 ≤18岁 8(10.7) 3(8.1) 19~40岁 15(20.0) 8(21.6) 41~64岁 24(32.0) 20(54.1)* ≥65岁 28(37.3) 6(16.2)* 明确接触史 有 66(88.0) 34(91.9) 无 9(12.0) 3(8.1) 与Delta毒株比较, *P < 0.05。 
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表 2 扬州市Delta毒株与原始毒株确诊COVID-19患者的首发临床表现[n(%)]
首发临床表现 Delta毒株(n=75) 原始毒株(n=37) 病例分类 确诊 70(93.3) 23(62.2)* 阳性核酸 5(6.7) 14(37.8)* 临床分型 普通型 30(40.0) 22(59.5) 轻型 40(53.3) 1(2.7)* 无症状感染者 5(6.7) 14(37.8)* 临床特征 发热 54(72.0) 18(48.6)* 咳嗽等呼吸道症状 39(52.0) 18(48.6) 腹泻等消化道症状 8(10.7) 2(5.4) 肌肉酸痛 7(9.3) 3(8.1) 乏力 15(20.0) 5(13.5) 神经系统症状 21(28.0) 2(5.4)* 与Delta毒株比较, *P < 0.05。
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表 3 Delta毒株COVID-19患者实验室检查及CT结果
起病时间 n 年龄/岁 血常规 胸部CT阳性率/% 咽拭子核酸Ct值 Hb/(g/L) WBC/(×109/L) NE/(×109/L) LY/(×109/L) MO/(×109/L) PLT/(×109/L) ORF基因 N基因 < 24 h 37 43.5±4.0 135.6±2.1 5.7±0.3 4.0±0.2 0.9±0.1 0.7±0.0 191.8±7.9 24.3 30.8±0.4 29.6±0.6 24~48 h 15 54.2±3.6 141.4±3.5 5.3±0.6 3.7±0.5 0.9±0.1 0.5±0.1 181.8±18.4 53.3* 33.8±0.8 31.6±0.8 >48 h 18 61.6±3.9* 134.5±3.6 4.7±0.3 3.2±0.3 1.0±0.1 0.5±0.0* 145.9±11.4*# 72.2* 32.2±0.9 30.1±1.0 Hb: 血红蛋白; WBC: 白细胞; NE: 中性粒细胞; LY: 淋巴细胞; MO: 单核细胞; PLT: 血小板; Ct: 循环阈值; ORF: 开放阅读框; N: 核壳蛋白。与起病时间 < 24 h比较, *P < 0.05; 与起病时间24~48 h比较, #P < 0.05。
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