新型冠状病毒Omicron变异株与Delta变异株感染患者的临床特征分析

doi:10.3969/j.issn.1004-583X.2023.07.003

摘要/Abstract

摘要：

目的探讨新型冠状病毒Omicron变异株与Delta变异株感染患者临床及实验室特征。方法采用回顾性研究方法,收集2021年12月至2022年3月我院收治的Omicron 变异株组(51例)与Delta变异株组(45例)感染者的临床资料,比较两组临床基线资料、胸部 CT 影像学的特征差异。结果两组各个年龄段均有发病,Omicron变异株组儿童及女性患者多于Delta变异株组(P<0.01)。Omicron变异株组以轻型为主和Delta变异株组以普通型为主,两组差异有统计学意义(P<0.01),但两组在接种疫苗情况差异无统计学意义。两组均以发热、咽痛症状为主,Omicron变异株组发热比率较Delta变异株组高(86.3% vs 51.5%, P<0.01)。Omicron变异株组患者的 CRP异常人数少于Delta变异株组(P<0.01),且胸部CT首次影像学特征改变较少(2.0% vs 73.3%,P<0.05)。经治疗后Omicron变异株组鼻咽拭子检测核酸转阴时间比Delta变异株组更短(29.96±8.17 d vs 25.82±10.73 d, P=0.013)。此外,Omicron变异株组中与鼻咽拭子检测相比,肛拭子检测核酸转阴时间更短(P<0.01),入院时血清IgG水平为(6.504±1.33) S/CO,在1周后明显升高为(218.6±14.51) S/CO(P<0.01)。入院时血清IgM水平为(0.05±0.01) S/CO,1周后也呈升高趋势,平均为(1.205±0.22) S/CO(P<0.01)。结论与Delta 变异株相比,Omicron变异株组以轻型为主,发热、咽痛为主要表现,肺部CT出现新冠肺炎影像学特征性改变较少且轻微。Omicron变异株组鼻咽拭子检测核酸转阴时间比Delta变异株组长;且Omicron变异株患者入院时血清IgM、IgG抗体阴性或数值较低,发病1周后显著升高。

关键词: 新型冠状病毒感染, Omicron变异株, Delta 变异株, 临床特征

Abstract:

Objective To explore the clinical and laboratory characteristics of patients infected with Omicron and Delta variants in novel coronavirus. Methods A retrospective study was conducted, and the clinical data were collected from patients infected with Omicron variant (51 cases) and Delta variant (45 cases) admitted in our hospital from December 2021 to March 2022. The clinical baseline data and chest CT imaging characteristics were compared between the two groups. Results Both groups had the onset of the disease in all age groups, with more children and women in the Omicron variant group than in the Delta variant group (P<0.01). The Omicron variant group was mainly light and the Delta variant group was mainly ordinary, with significant differences between the two groups (P<0.01). However, there was no significant difference in vaccination status between the two groups. Fever and sore throat were the main symptoms in both groups, with the rate of fever significantly higher in the Omicron variant group than the Delta variant group (86.3% vs 51.5%, P<0.01). The number of patients with C-reactive protein (CRP) abnormalities in the Omicron variant group was less than that in the Delta variant group (P<0.01), and there were fewer changes in the first imaging feature of chest CT (2.0% vs 73.3%, P<0.05). After treatment, the nasopharyngeal swab test in the Omicron variant group showed a significantly shorter nucleic acid conversion time compared to the Delta variant group (29.96±8.17 days vs 25.82±10.73 days, P=0.013). In addition, compared with nasopharyngeal swab test, the anal swab test had a significantly shorter nucleic acid conversion time in the Omicron variant group (P<0.01). The serum IgG level was (6.504±1.33) S/CO at admission, which increased to (218.6±14.51) S/CO after one week (P<0.01). Meanwhile, the serum IgM level was (0.05±0.01) S/CO at admission, and it showed an increasing trend after one week, with an average of (1.205±0.22) S/CO (P<0.01). Conclusion Compared with Delta variant, the Omicron variant group was mainly mild, with fever and sore throat as the main manifestations. The pulmonary CT showed less and slight changes in the imaging characteristics of COVID-19. The nasopharyngeal swab test of the Omicron variant group showed a longer nucleic acid conversion time compared to the Delta variant group. In addition, serum levels of IgM and IgG antibodies in patients with Omicron variant were negative or low at admission, which increased significantly 1 week after onset.

Key words: COVID-19, Omicron variant, Delta variant, clinical features

中图分类号:

R563.12

黄华艳, 林春光, 吴昌儒, 陈永东, 黄焕谋. 新型冠状病毒Omicron变异株与Delta变异株感染患者的临床特征分析[J]. 临床荟萃, 2023, 38(7): 600-605.

Huang Huayan, Lin Chunguang, Wu Changru, Chen Yongdong, Huang Huanmou. Clinical characteristics of patients infected with Omicron and Delta variants in novel coronavirus[J]. Clinical Focus, 2023, 38(7): 600-605.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.07.003

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I7/600

图/表 7

参考文献 24

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特征	Omicron变异株感染组(n=51)	Delta变异株感染组(n=45)	χ²/Z值	P值
年龄
0~14岁	19(37.30)	1(2.20)	15.729	<0.01
15~59岁	28(54.90)	43(95.60)	18.458	<0.01
≥60岁	4(7.84)	1(2.20)	0.603	0.437^*
性别
男女	22(43.10) 29(56.90)	36(80.0) 9(20.0)	13.584	<0.01
吸烟史
有无	0 51(100.00)	5(11.10) 40(88.90)		0.020^*
合并基础疾病
高血压	0	4(8.90)		0.045^*
糖尿病	0	1(2.20)		0.469^*
脑梗死	1(2.00)	0(0.00)		1.000^*
呼吸疾病	0	2(4.40)		0.217^*
消化疾病	1(2.00)	2(4.40)	0.012	0.912
慢性肝炎	0	2(4.40)		0.217^*
临床分型
轻型	50(98.00)	17(37.80)	38.369	<0.01
普通型	1(2.00)	25(55.55)	32.111	<0.01
重型	0	2(4.44)		0.217^*
危重型	0	1(2.22)		0.469^*
接种疫苗史
是否	43(84.30) 8(15.70)	41(91.10) 4(8.90)	0.484	0.487

特征	Omicron变异株感染组(n=51)	Delta变异株感染组(n=45)	χ²/Z值	P值
年龄
0~14岁	19(37.30)	1(2.20)	15.729	<0.01
15~59岁	28(54.90)	43(95.60)	18.458	<0.01
≥60岁	4(7.84)	1(2.20)	0.603	0.437^*
性别
男女	22(43.10) 29(56.90)	36(80.0) 9(20.0)	13.584	<0.01
吸烟史
有无	0 51(100.00)	5(11.10) 40(88.90)		0.020^*
合并基础疾病
高血压	0	4(8.90)		0.045^*
糖尿病	0	1(2.20)		0.469^*
脑梗死	1(2.00)	0(0.00)		1.000^*
呼吸疾病	0	2(4.40)		0.217^*
消化疾病	1(2.00)	2(4.40)	0.012	0.912
慢性肝炎	0	2(4.40)		0.217^*
临床分型
轻型	50(98.00)	17(37.80)	38.369	<0.01
普通型	1(2.00)	25(55.55)	32.111	<0.01
重型	0	2(4.44)		0.217^*
危重型	0	1(2.22)		0.469^*
接种疫苗史
是否	43(84.30) 8(15.70)	41(91.10) 4(8.90)	0.484	0.487

症状	Omicron变异株感染组(n=51)	Delta变异株感染组(n=45)	χ²/Z值	P值
发热	44(86.30)	23(51.50)	14.020	<0.01
咳嗽	35(68.60)	27(60.00)	0.778	0.378
咽痛	15(29.40)	4(8.90)	5.116	0.024
鼻塞	2(3.90)	0(0.00)		0.497^*
腹泻	3(5.90)	0(0.00)		0.245^*
乏力	11(21.60)	7(15.60)	0.567	0.451
肌肉酸痛	2(3.90)	0(0.00)		0.497^*

症状	Omicron变异株感染组(n=51)	Delta变异株感染组(n=45)	χ²/Z值	P值
发热	44(86.30)	23(51.50)	14.020	<0.01
咳嗽	35(68.60)	27(60.00)	0.778	0.378
咽痛	15(29.40)	4(8.90)	5.116	0.024
鼻塞	2(3.90)	0(0.00)		0.497^*
腹泻	3(5.90)	0(0.00)		0.245^*
乏力	11(21.60)	7(15.60)	0.567	0.451
肌肉酸痛	2(3.90)	0(0.00)		0.497^*

项目	正常范围	Omicron变异株感染组(n=51)	Delta变异株感染组(n=45)	χ²/Z值	P值
WBC计数	4~10
<4×10⁹/L		3(5.90)	0		0.245^*
4~10×10⁹/L		48(94.10)	44(97.8)	0.147	0.701
>10×10⁹/L		0(0.00)	1(2.20)		0.469^*
LYM计数	0.8~4
<0.8×10⁹/L		10(19.60)	4(8.90)	2.205	0.138
0.8~4×10⁹/L		37(72.50)	39(86.70)	2.889	0.089
>4×10⁹/L		4(7.80)	2(4.40)	0.070	0.792
ALT	0~40
≤40 U/L >40 U/L		46(90.20) 5(9.80)	32(71.10) 13(28.90)	5.716	0.017
AST	0~37
≤37 U/L >37 U/L		43(84.30) 8(15.70)	40(88.90) 5(11.10)	0.427	0.513
LDH	80~285
≤285 U/L >285 U/L		50(98.00) 1(2.00)	44(97.80) 1(2.20)	0.000	1.000
CK	20~250
≤250 U/L >250 U/L		48(94.10) 3(5.90)	44(97.80) 1(2.20)	0.147	0.701
D-二聚体	0~500
≤500 μg/L >500 μg/L		42(82.40) 9(17.60)	32(71.10) 13(28.90)	1.710	0.191
CRP	0~5
≤5 mg/L >5 mg/L		26(51.00) 25(49.00)	42(93.30) 3(6.70)	18.757	<0.01
CT阳性表现
毛玻璃影		1(2.00)	26(57.80)	34.135	<0.01
实变影		0(0.00)	6(13.30)		0.009^*
弥漫病灶影		0(0.00)	1(2.20)		0.469^*