河北医科大学病理生理学教研室
标题:
(转载)钟南山院士领衔发表中国新冠病例特征论文
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作者:
胡晓
时间:
2020-3-1 10:05
标题:
(转载)钟南山院士领衔发表中国新冠病例特征论文
<p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"> 当地时间 2 月 28 日,由国家卫健委高级别专家组组长、中国工程院院士钟南山领衔的「中国 2019 新型冠状病毒疾病的临床特征」研究论文在顶级医学期刊《新英格兰医学杂志》(NEJM)上在线公开发表。论文中涉及了公众关注的「潜伏期」、「超级传播者」等重要内容。</p><h1 class="m-article-header__title f-h18" style="box-sizing: inherit; touch-action: inherit; margin: 16px auto -2px; padding-top: 2px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-weight: 400; font-stretch: inherit; line-height: 36px; font-family: ff-quadraat-web-pro, "Times New Roman", serif; font-size: 32px; vertical-align: baseline; outline: 0px; letter-spacing: -0.005em; color: rgb(26, 26, 26); max-width: calc((((100vw - 520px) / 12) * 10) + 360px); text-align: center;"><span class="title_default" style="box-sizing: inherit; touch-action: inherit; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px;">Clinical Characteristics of Coronavirus Disease 2019 in China</span></h1><span class="sr-only" style="box-sizing: inherit; touch-action: inherit; margin: -1px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: inherit; font-family: ff-quadraat-web-pro, "Times New Roman", serif; font-size: 10px; vertical-align: baseline; outline: 0px; position: absolute; width: 1px; height: 1px; overflow: hidden; clip: rect(0px, 0px, 0px, 0px); white-space: nowrap; color: rgb(77, 77, 77); text-align: center;">List of authors.</span><ul class="m-article-header__authors f-ui" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-right: auto; margin-left: auto; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 24px; font-family: ff-scala-sans-pro, ff-scala-sans-web-pro, Helvetica, Arial, sans-serif; font-size: 16px; vertical-align: baseline; outline: 0px; list-style: none; color: rgb(102, 102, 102); max-width: calc((((100vw - 520px) / 12) * 10) + 360px); text-align: center;"><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Wei-jie Guan, Ph.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Zheng-yi Ni, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Yu Hu, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Wen-hua Liang, Ph.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Chun-quan Ou, Ph.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Jian-xing He, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Lei Liu, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Hong Shan, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Chun-liang Lei, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">David S.C. Hui, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Bin Du, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;">Lan-juan Li, M.D., </li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline-block; width: 0px; height: 0px; opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline-block; width: 0px; height: 0px; opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline-block; width: 0px; height: 0px; opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li style="box-sizing: inherit; 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opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline-block; width: 0px; height: 0px; opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline-block; width: 0px; height: 0px; opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline-block; width: 0px; height: 0px; opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline-block; width: 0px; height: 0px; opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline-block; width: 0px; height: 0px; opacity: 0; overflow: hidden; transition: opacity 0.2s ease 0s;"></li><li class="m-article-header__authors__show-all" style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;"><button data-behavior="ShowAllAuthors" style="box-sizing: inherit; touch-action: inherit; -webkit-appearance: none; font-family: ff-scala-sans-pro, ff-scala-sans-web-pro, Helvetica, Arial, sans-serif; font-size: 16px; line-height: 24px; display: inline; border-width: 0px; border-style: none; border-color: initial; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; color: rgb(102, 102, 102); text-decoration-line: underline; cursor: pointer;">et al.,</button></li><li class="m-article-header__authors__group" style="box-sizing: inherit; touch-action: inherit; margin-left: 0px; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; vertical-align: baseline; outline: 0px; list-style-type: none; display: inline;"> for the China Medical Treatment Expert Group for Covid-19<span style="box-sizing: inherit; touch-action: inherit; border: 0px; background: transparent; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; font-size: 12.24px; vertical-align: baseline; outline: 0px; position: relative; top: -0.4em;"><a href="https://www.nejm.org/doi/pdf/10.1056/NEJMoa2002032?articleTools=true#header_fn1" data-behavior="ShowPopupTip" data-popup-content-ids="fn1" style="box-sizing: inherit; touch-action: inherit; text-decoration-line: none; color: rgb(11, 79, 130);">*</a></span></li></ul><br><br><br><h2 class="a-article-h1 f-h3" style="box-sizing: inherit; touch-action: inherit; margin-top: 28px; margin-bottom: -1px; padding-top: 1px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 32px; font-family: ff-quadraat-web-pro, "Times New Roman", serif; font-size: 1.75rem; vertical-align: baseline; outline: 0px; letter-spacing: -0.005em; position: relative; color: rgb(26, 26, 26);">Abstract</h2><h3 class="a-article-h2 a-article-h2--inline f-h12" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-right: 1em; margin-bottom: -3px; padding-top: 3px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 28px; font-family: ff-scala-sans-pro, ff-scala-sans-web-pro, Helvetica, Arial, sans-serif; font-size: 0.8125rem; vertical-align: baseline; outline: 0px; text-transform: uppercase; letter-spacing: 0.12em; color: rgb(26, 26, 26); float: left;">BACKGROUND</h3><p class="f-body" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-bottom: -2px; padding-top: 2px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 28px; font-family: ff-quadraat-web-pro, "Times New Roman", serif; font-size: 1.1875rem; vertical-align: baseline; outline: 0px; color: rgb(77, 77, 77);">Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients.</p><h3 class="a-article-h2 a-article-h2--inline f-h12" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-right: 1em; margin-bottom: -3px; padding-top: 3px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 28px; font-family: ff-scala-sans-pro, ff-scala-sans-web-pro, Helvetica, Arial, sans-serif; font-size: 0.8125rem; vertical-align: baseline; outline: 0px; text-transform: uppercase; letter-spacing: 0.12em; color: rgb(26, 26, 26); float: left;">METHODS</h3><p class="f-body" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-bottom: -2px; padding-top: 2px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 28px; font-family: ff-quadraat-web-pro, "Times New Roman", serif; font-size: 1.1875rem; vertical-align: baseline; outline: 0px; color: rgb(77, 77, 77);">We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death.</p><h3 class="a-article-h2 a-article-h2--inline f-h12" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-right: 1em; margin-bottom: -3px; padding-top: 3px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 28px; font-family: ff-scala-sans-pro, ff-scala-sans-web-pro, Helvetica, Arial, sans-serif; font-size: 0.8125rem; vertical-align: baseline; outline: 0px; text-transform: uppercase; letter-spacing: 0.12em; color: rgb(26, 26, 26); float: left;">RESULTS</h3><p class="f-body" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-bottom: -2px; padding-top: 2px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 28px; font-family: ff-quadraat-web-pro, "Times New Roman", serif; font-size: 1.1875rem; vertical-align: baseline; outline: 0px; color: rgb(77, 77, 77);">The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission.</p><h3 class="a-article-h2 a-article-h2--inline f-h12" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-right: 1em; margin-bottom: -3px; padding-top: 3px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 28px; font-family: ff-scala-sans-pro, ff-scala-sans-web-pro, Helvetica, Arial, sans-serif; font-size: 0.8125rem; vertical-align: baseline; outline: 0px; text-transform: uppercase; letter-spacing: 0.12em; color: rgb(26, 26, 26); float: left;">CONCLUSIONS</h3><p class="f-body" style="box-sizing: inherit; touch-action: inherit; margin-top: 20px; margin-bottom: -2px; padding-top: 2px; border: 0px; background-image: initial; background-position: initial; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial; font-variant-ligatures: common-ligatures; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; line-height: 28px; font-family: ff-quadraat-web-pro, "Times New Roman", serif; font-size: 1.1875rem; vertical-align: baseline; outline: 0px; color: rgb(77, 77, 77);">During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)</p><br><i>(评论文转载自“丁香园”)</i><br><b>重点解读:</b><br><br><p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"><font face="微软雅黑">1. 数据来自于 552 家医院收治的 1099 例 Covid-19 患者,全部是 2020 年 1 月 29 日之前经核酸检测确诊的患者。其中重症占比 15.7%。</font></p><p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"><font face="微软雅黑">2. 患者中 3.5% 是医务工作者。25.9% 的患者没有任何形式上的武汉接触史(没去过武汉、没接触过武汉来人)。不能排除「超级传播者」的存在。有没有武汉接触史,并没有对重症率产生影响。</font></p><p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"><font face="微软雅黑"><span style="color: rgb(51, 51, 51);">3. 中位潜伏期为 4 天,多数在 2~7 天。虽然有极少数明显延长的潜伏期情况,但不建议作为常规评估依据。</span></font></p><p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"><font face="微软雅黑"><span style="color: rgb(51, 51, 51);">4. 发热是 Covid-19 最常见的症状,但也有 11.3% 的患者自始至终没有出现发热,不发热比例远高于 SARS 和 MERS。发热以外,咳嗽出现的比例为 67.8%,其他症状就很少见了。</span></font></p><p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"><font face="微软雅黑"><span style="color: rgb(51, 51, 51);">5.<b> CT 最常见的肺部表现为磨玻璃样混浊(56.4%)和双肺斑片状阴影(51.8%)</b>。有 2.9% 的重症、17.9% 的非重症并没有异常肺部 CT 改变。另外还有 83.2% 的患者淋巴细胞计数减少。</span><span style="color: rgb(51, 51, 51);">6. 58.6% 的患者接受了抗菌药输液治疗,35.8% 使用了奥司他韦,另有 18.6% 接受了糖皮质激素治疗。</span></font></p><p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"><font face="微软雅黑"><span style="color: rgb(51, 51, 51);">7. 整体病死率 1.4%。所有患者出现转入 ICU 或机械通气或死亡的累积风险是 3.6%,而重症患者是 20.6%。</span></font></p><p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"><font face="微软雅黑"><span style="color: rgb(51, 51, 51);">8. 局限性:部分数据记录不全、有些患者仍在住院、很多未住院的轻症没被纳入统计</span></font></p>大家如何看待钟南山院士团队发表的这篇论文呢?欢迎大家就上述观点进行讨论~<br><br><p style="box-sizing: border-box; margin-bottom: 18px; overflow: hidden; font-size: 16px; line-height: 26px;"><br style="box-sizing: border-box; color: rgb(51, 51, 51); font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", "
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作者:
羡晓辉
时间:
2020-3-1 10:21
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Clinical Characteristics of Coronavirus Disease 2019 in China.pdf
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