如何解读钟南山院士的新型冠状病毒论文

2月10日,一篇来自中国工程院院士钟南山团队,在Medrxiv发表了一篇关于冠状病毒的论文《Clinical characteristics of 2019 novel coronavirus infection in China》。

原文链接:https://www.medrxiv.org/content/10.1101/2020.02.06.20020974v1。梅博士在这里对这篇论文进行下解读。

先来看下论文的摘要原文(如果想直接看解读的话,就跳过这段英文)。

Abstract

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.

钟南山院士对于全国31个省和直辖市的552所医院的1099名确诊患者进行了流行病学分析,重点数据解读如下:

年龄中位数是47岁,男性多于女性。

从发病之初的观察就符合这一规律,患者主要以中老年为主。因此,家里如果有老年人更需要加强防护。中老年人也要更加注意提高自己的防护意识。

1.18%患者有直接野生动物接触史,71.8%患者接触过来自武汉的人员。

只有1%的患者是真正接触了野生动物的,因此绝大多数的患者都是通过人员之间的传播而患病。71%的患者接触过武汉人员,因此截止到29号的时候已经有很多人是非直接接触“武汉人”而患病。

发烧和咳嗽是主要症状,腹泻并不常见。

虽然最近的研究是疾病可以通过粪口传播,但是上呼吸道症状依然是主要的发病症状。因此佩戴口罩和勤洗手,仍是大众群众的主要防御手段。

潜伏期中位数是3天,潜伏期范围是0到24天。

这一条在最近的新闻报导中存在着大量的曲解和误读,虽然论文中有患者的潜伏期达到了24天,但是绝大多数患者的潜伏期都在1周以内。24天潜伏期的患者根据钟南山院士团队澄清,在1099患者中仅出现1例。潜伏期中位数的含义就是50%的患者潜伏期是小于3天的。因此大家也不用过度恐慌和害怕周围的人员,几乎全部患者的潜伏期仍是2周以内。也希望众多媒体不要过分解读这一数据,给大家带来不必要的恐慌。

入院CT检查,典型症状为肺部毛玻璃样占50%

最近媒体也经常报道病毒试剂盒假阴性病例,目前也有医生呼吁将CT检查列入诊断标准,相信通过CT和试剂盒的双重筛选,能对患者的诊断进一步加强。这个数据的另一层含义就是一半患者在诊断的时候,就出现了肺部改变,可以看出新型冠状病毒引起肺部病变的速度是很快速的。

55名患者进入重症监护室,15名患者死亡

55名患者进入ICU进行治疗,病情属于危重,但仅有15名患者死亡,从这一数据来看,这次的疫情致死率并不高,对比SARS,MERS这种著名病毒要低的多。

写在文章最后,

西医在对抗病毒过程中,由于受到药物的限制(没有针对病毒的药物),略显束手无策。目前已经有关于中医中药在对抗病毒的过程中发挥重要作用的报道,试点省份有效率非常高,希望在接下来的战斗中,中医中药再接再厉,发挥当年对抗非典时的决定性作用,将病毒彻底征服。

另外在撰写此文的过程中,在网络上也发现了很多故意抹黑或夸大病情的文章,上一篇文章我也说过,流言比病毒更可怕,面对疫情,身体需要健康,心理更需要健康。有空的时候还是在家多多摆弄扫把脱离地球引力吧。