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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.

武汉市 2019 例新型冠状病毒患者临床特征分析

  • 影响因子:10.28
  • DOI:10.1016/S0140-6736(20)30183-5
  • 作者列表:"Huang C","Wang Y","Li X","Ren L","Zhao J","Hu Y","Zhang L","Fan G","Xu J","Gu X","Cheng Z","Yu T","Xia J","Wei Y","Wu W","Xie X","Yin W","Li H","Liu M","Xiao Y","Gao H","Guo L","Xie J","Wang G","Jiang R","Gao Z","Jin Q","Wang J","Cao B
  • 发表时间:2020-01-24
Abstract

BACKGROUND:A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. METHODS:All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. FINDINGS:By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0-58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0-13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. INTERPRETATION:The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. FUNDING:Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

摘要

背景: 中国武汉最近的肺炎病例集中是由一种新型的 β 冠状病毒引起的,2019新型冠状病毒(2019-nCoV)。我们报告了这些患者的流行病学、临床、实验室和放射学特征以及治疗和临床结局。 方法: 所有疑似 2019-nCoV 患者均入住武汉市定点医院。我们通过实时 RT-PCR 和新一代测序,前瞻性收集并分析了实验室确诊的 2019-nCoV 感染患者的数据。使用国际严重急性呼吸道和新兴感染联盟从电子病历中共享的标准化数据收集表格获得数据。研究人员还直接与患者或其家属沟通,以确定流行病学和症状数据。还比较了入住重症监护病房 (ICU) 和未入住 ICU 的患者的结局。 结果: 到 2020年1月2日,41 例住院患者被确定为实验室确诊的 2019-nCoV 感染。感染患者多为男性 (30 例 [73%],共 41 例); 仅有不到一半的患者有基础疾病 (13 例 [32%]),包括糖尿病 (8 例 [20%]) 、高血压 (6 例 [15%]) 和心血管疾病 (6 例 [15%])。中位年龄 49 · 0 岁 (IQR 41 · 0-58 · 0)。41 例患者中有 27 例 (66%) 曾接触过华南海产品市场。发现一个家庭群集。发病时常见症状为发热 (40 例 [98%]) 、咳嗽 (31 例 [76%]) 、肌肉疼痛或乏力 (18 例 [44%]); 较不常见的症状是咳痰 (39 例中的 11 例 [28%]) 、头痛 (38 例中的 3 例 [8%]) 、咯血 (2 例[39 例中的 5%]) 和腹泻 (38 例中的 1 例 [3%])。40 例患者中有 22 例 (55%) 出现呼吸困难 (从发病到呼吸困难 8 · 0 天的中位时间 [IQR 5 · 0-13 · 0])。41 例患者中 26 例 (63%) 出现淋巴细胞减少。41 例患者均有肺炎,胸部 CT 表现异常。并发症包括急性呼吸窘迫综合征 (12 例 [29%]) 、 rnaomia (6 例 [15%]) 、急性心脏损伤 (5 例 [12%]) 和继发感染 (4 例 [10%])。13 例 (32%) 患者入住 ICU,6 例 (15%) 死亡。与非 ICU 患者相比,ICU 患者血浆 IL2 、 IL7 、 IL10 、 GSCF 、 IP10 、 MCP1 、 MIP1A 和 tnf α 水平较高。 解释: 2019-nCoV 感染引起了类似于严重急性呼吸综合征冠状病毒的严重呼吸系统疾病的聚集,并与入住 ICU 和高死亡率相关。我们对疾病的起源、流行病学学、人类传播的持续时间和临床谱的知识的主要差距需要通过未来的研究来实现。 基金资助: 科技部、中国医学科学院、国家自然科学基金委员会、北京市科学技术委员会。

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影响因子:3.89
发表时间:2020-01-31
DOI:10.1002/jcp.29586
作者列表:["Cong Z","Li D","Tao Y","Lv X","Zhu X"]

METHODS::Acute respiratory distress syndrome (ARDS), characterized by acute hypoxic respiratory dysfunction or failure, is a manifestation of multiple organ failure in the lung, and the most common risk factor is sepsis. We previously showed that blocking α2 -adrenoceptor (α2 -AR) could attenuate lung injury induced by endotoxin in rats. α2A -adrenoceptor (α2A -AR), a subtype of α2 -AR plays a key role in inflammatory diseases, but the mechanism remains unknown. Here, we explored the effect of BRL-44408 maleate (BRL), a specific α2A -AR antagonist, on cecal ligation puncture (CLP)-induced ARDS in rats and the underlying mechanism. Preadministration of BRL-44408 maleate significantly alleviated CLP-induced histological injury, macrophage infiltration, inflammatory response, and wet/dry ratio in lung tissue. However, there was no statistical difference in survival rate between the CLP and CLP+BRL groups. Extracellular regulated protein kinase (ERK1/2), p38MAPK, and p65 were activated in the CLP group, and BRL-44408 maleate inhibited the activation of these signal molecules, c-Jun N-terminal kinase (JNK) and protein kinase A (PKA) showed no changes in activation between these two groups. BRL-44408 maleate decreased lipopolysaccharide (LPS)-induced expression of cytokines in NR8383 rat alveolar macrophages and reduced phosphorylation of ERK1/2, p38MAPK, and p65. JNK and PKA were not influenced by LPS. Together, these findings suggest that antagonism of α2A -AR improves CLP-induced acute lung injury and involves the downregulation of ERK1/2, p38MAPK, and p65 pathway independent of the activation of JNK and PKA.

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