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Objective:To evaluate the imaging features of CT scan in patients with COVID-19.Methods:Clinical data of 56 patients with COVID-19 from January 17 to 19, 2020 admitted to Wenzhou Central Hospital and the Second Affiliated Hospital of Wenzhou Medical University were retrospectively reviewed. The clinical manifestations, lung imaging characteristics and treatment outcomes of patients with different severity were analyzed with SAS software.Results:Fever (92.8%, 52/56), dry cough (75.0%, 42/56) and asthenia (58.9%, 33/56) were the first symptoms in most of the patients; some patients also had shortness of breath (25.0%, 14/56) and pharyngeal pain (10.7%, 6/56). Chest high-resolution CT scan showed that in 42 moderate patients, ground glass-like high-density shadows in the lung were observed in 30 cases (71.4%) ; localized plaque consolidation shadows and bronchial inflation signs were observed in 10 cases (23.8%). In 12 severe patients, 11 had high-density patches involving multiple lung lobes (≥3). In 2 critically ill patients the patches and stripes involving the entire lung were observed; and cord-like high-density shadow, local consolidation and fibrosis were also shown.Conclusion:The multiple ground-glass changes outside the lungs are early imaging manifestations of COVID-19 patients. The increase in pulmonary lobe consolidation and fibrosis may indicate the disease progression, and the degree of lung consolidation and fibrosis is closely related to the disease severity.
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Objective:To compare the efficacy of the combination of abidol, lopinavir/ritonavir plus recombinant interferon α-2b (rIFNα-2b) and the combination of lopinavir/ritonavir plus rIFNα-2b for patients with COVID-19 in Zhejiang province.Methods:A multicenter prospective study was carried out to compare the efficacy of triple combination antiviral therapy and dual combination antiviral therapy in 15 medical institutions of Zhejiang province during January 22 to February 16, 2020. All patients were treated with rIFNα-2b (5 million U, 2 times/d) aerosol inhalation, in addition 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir/ritonavir (2 tablets, 1 time/12 h) (triple combination group) and 41 patients were treated with lopinavir/ritonavir (2 tablets, 1 time/12 h) (dual combination group). The patients who received triple combination antiviral therapy were further divided into three subgroups: <48 h, 3-5 d and >5 d according the time from the symptom onset to medication starting. The therapeutic efficacy was compared between triple combination group and dual combination group, and compared among 3 subgroups of patients receiving triple combination antiviral therapy. SPSS 17.0 software was used to analyze the data.Results:The virus nucleic acid-negative conversion time in respiratory tract specimens was (12.2±4.7) d in the triple combination group, which was shorter than that in the dual combination group [(15.0±5.0) d] ( t=6.159, P<0.01). The length of hospital stay in the triple combination group [12.0 (9.0, 17.0) d] was also shorter than that in the dual combination group [15.0 (10.0, 18.0) d] ( H=2.073, P<0.05). Compared with the antiviral treatment which was started within after the symptom onset of in the triple combination group, the time from the symptom onset to the viral negative conversion was 13.0 (10.0, 17.0), 17.0 (13.0, 22.0) and 21.0 (18.0, 24.0) d in subgroups of 48 h, 3-5 d and >5 d, respectively ( Z=32.983, P<0.01), while the time from antiviral therapy to viral negative conversion was (11.8±3.9), (13.5±5.1) and (11.2±4.3) d, respectively( Z=6.722, P<0.05). Conclusions:The triple combination antiviral therapy of abidol, lopinavir/litonavir and rIFNα-2b shows shorter viral shedding time and shorter hospitalization time, compared with the dual combination antiviral therapy; and the earlier starting triple combination antiviral therapy will result in better antiviral efficacy.
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Objective@#Comparing the benefit of Abidor, lopinavir/ritonavir and recombinant interferon α-2b triple combination antiviral therapy and lopinavir/ritonavir and interferon dual combination antiviral therapy to hospitalized novel coronavirus pneumonia 2019 in Zhejiang province.@*Methods@#A multi-center prospective study was carried out to compare the effect of triple combination antiviral therapy with dual combination antiviral therapy in 15 medical institutions of Zhejiang Province. All patients were treated with recombinant interferon α-2b (5 million U, 2 times/d) aerosol inhalation. 196 patients were treated with abidol (200 mg, 3 times/d) + lopinavir / ritonavir (2 tablets, 1 time/12 h) as the triple combination antiviral treatment group. 41 patients were treated with lopinavir / ritonavir (2 tablets, 1 time/12 h) as the dual combination antiviral treatment group. The patients who received triple combination antiviral therapy were divided into three groups: within 48 hours, 3-5 days and > 5 days after the symptom onset. To explore the therapeutic effects of triple combination antiviral drugs and dual combination antiviral drugs, as well as triple combination antiviral drugs with different antiviral initiate time. SPSS17.0 software was used to analyze the data.@*Results@#The time of virus nucleic acid turning negative was (12.2 ± 4.7) days in the triple combination antiviral drug group, which was shorter than that in the dual combination antiviral drug group [(15.0 ± 5.0) days] (t = 6.159, P < 0.01 ). The length of hospital stay [12 (9, 17) d] in the triple combination antiviral drug group was also shorter than that in the dual combination antiviral drug group [15 (10, 18) d] (H = 2.073, P < 0.05). Comparing the antiviral treatment which was started within 48 hours, 3-5 days and > 5 days after the symptom onset of triple combination antiviral drug group, the time from the symptom onset to the negative of viral shedding was 13 (10,16.8), 17 (13,22) and 21 (18-24) days respectively (Z = 32.983, P < 0.01), and the time from antiviral therapy to the negative of viral shedding was (11.8±3.9) , (13.5±5.1) and (11.2±4.3) d. The differences among the three groups were statistically significant (Z=32.983 and 6.722, P<0.01 or<0.05).@*Conclusions@#The triple combination antiviral therapy of Abidor, Lopinavir/Litonavir and recombinant interferon α-2b showed shorter viral shedding time and hospitalization time compared with the dual combination antiviral therapy. The earlier the time to initiate triple antiviral treatment, the shorter the time of virus shedding.
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Objective To elaborate the changes of the soluble B cell-activating factor of the tumor necrosis factor family (BAFF) in the peripheral blood of chronic human immunodeficiency virus (HIV)-infected patients ,and to study the correlation between the soluble BAFF in HIV-infected patients and the progressions of acquired immune deficiency syndrome (AIDS).Methods Fifty untreated HIV outpatients and 30 healthy controls were recruited .According to the counts of CD4+T lymphocytes ,HIV-infected patients were divided into three groups ,＜ 200 cells／μL group , (200 － 350 ) cells／μL group and ＞350 cells／μL group .B cell counts and the BAFF levels were compared among the three groups and the healthy controls .The correlation analysis was conducted for the levels of BAFF ,the counts of CD4+T lymphocytes and B cells ,and viral load in HIV-infected patients .The value of BAFF in staging of HIV disease was identified by receiver operating characteristic (ROC) curve.Results The B cell counts were (90.3 ± 43.1)cells／μL in ＜200 cells／μL group ,(114 .4 ± 28 .8) cells／μL in (200 －350) cells／μL group ,and (162 .1 ± 29 .5) cells／μL in ＞350 cells／μL group and (307.1 ± 97 .0) cells／μL in healthy controls ,which was significantly different among the four groups (F＝47.92 ,P＜0.05).The concentrations of BAFF in the four groups were (1 737.5 ± 719.7) ,(962.8 ± 341.1) ,(859.8 ± 270.4) ,and (456.9 ± 163.7) ng／L ,with significant difference among the groups (F＝36.72 ,P＜0.05).The level of BAFF was negatively correlated with both B cell counts and CD4+T lymphocyte counts (r＝ －0.722 and －0.568 ,respectively ;both P＜0.05) ,and positively correlated with viral load (r＝0.607 ,P＜0 .05).The area under the ROC curve was 0 .881.If the level of BAFF was 1 281.5 ng／L ,the sensitivity and specificity to predict the period of AIDS were 74 .1% and 87.0%,respectively .Conclusion The levels of soluble BAFF in HIV-infected patients are significantly increased and related with the reduction of B cell counts and disease progression.
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Objective@#To determine the clinical significance of nontuberculous mycobacteria (NTM) isolated from respiratory specimens. @*Methods@#Clinical data of patients with NTM strains isolated from the respiratory tract between January 2014 and February 2017 were retrospectively analyzed. Clinical significance of NTM isolated strains was evaluated based on diagnostic criteria of NTM pulmonary diseases from American Thoracic Society (ATS). Quantitative data of two groups were analyzed by independent t test. Categorical data were analyzed by Pearson χ2 test or Fisher exact test. @*Results@#Totally 352 NTM strains from 257 patients had been isolated between January 2014 and February 2017. Among 15 identified NTM species, M. intracellular (51.7%, 182/352), M. abscessus (25.6%, 90/352), and M. avium (10.8%, 38/352) were predominant. Of the 157 patients with full clinical data involved in the analysis, 58 (36.9%) patients were determined to have definite disease, and 34 patients (21.7%) were designated as probable disease candidates, and 16 (10.2%) patients were regarded as uncertain disease, and 49(31.2%) patients were diagnosed as unlikely disease. The age of 58 patients with definite disease was (63.9±12.7) years, and 48.3% (28/58) were female. M. intracellulare (55.2%, 32/58) was the main cause of pulmonary NTM disease, followed by M. abscessus (25.9%, 15/58) and M. avium (12.1%, 7/58), while other NTM species only accounted for 6.8% (4/58). Definite cases with M. intracellulare, M. abscessus, M. avium, M. kansasii, M. marseillense, and M. columbia accounted for 35.2% (32/91), 57.7% (15/26), 7/15, 2/3, 1/3 and 1/2, respectively, among patients with corresponding isolations, while patients with other species of isolation did not meet the diagnostic criteria. Patients with clinical significant isolation of NTM were older than those without clinical significance (χ2=3.603, P=0.000), and proportion of anti-acid staining positivity of patients with clinical significance was higher than that of patients without clinical significance (χ2=18.815, P=0.000). The proportion of M. abscessus in patients with clinical significance was higher than that in patients without clinical significance (χ2=6.313, P=0.012). However, there was no significant difference between the two groups in the isolation of M. Gordon (Fisher exact test, P=0.028). The proportion of M. abscessus lung disease in women was 11/15, which was higher than that of M. intracellulare lung disease (41.5%, 17/41), and the difference between the two groups was statistically significant (χ2=4.462, P=0.035). There was no significant difference of clinical symptoms and underlying diseases in NTM lung disease among different groups (all P>0.05). In these patients with definite disease, 39.7% (23/58) of them manifested the upper lobe cavitary form, 53.4% (31/58) exhibited nodular bronchiectatic form, and only 6.9% (4/58) exhibited unclassified form. The upper lobe cavitary form (43.8%, 14/32) and the nodular bronchiectatic form (53.1%, 17/32) dominated in patients with M. intracellulare lung disease. M. abscessus lung disease was dominated by the nodular bronchiectatic form (11/15) while the upper lobe cavitary form only accounts for 3/15. There was no significant difference of image characteristics between NTM lung disease and other different groups (all P>0.05). @*Conclusions@#36.9% of the patients with NTM isolates met the ATS diagnostic criteria for NTM lung disease. Different species have different clinical significance. M. intracellulare and M. abscessus are the most predominant NTM isolated species that cause NTM lung disease. Majority of patients manifest as the upper lobe cavitary form, followed by the nodular bronchiectatic form.
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Objective To study the correlation between CD169 expression of monocytes and disease progression in human immunodeficiency virus (HIV )-infected patients .Methods Sixty HIV-infected patients and 30 healthy controls were recruited .According to the CD4 + T lymphocyte counts ,HIV-infected patients were divided into three groups including < 200 cells/μL ,200 — 350 cells/μL and > 350 cells/μL groups . The differences in monocytes counts ,the proportions of CD16 + and CD169 + monocytes were analyzed among the three groups and healthy controls .The correlations between proportion of CD169 + monocytes and CD4 + T lymphocyte counts ,viral load ,and proportion of CD16 + monocytes were analyzed .Results The monocyte counts in CD4 + T lymphocytes < 200 cells/μL group , (200 — 350 ) cells/μL group , >350 cells/μL group and healthy control group were (342 ± 99) ,(396 ± 145) ,(365 ± 80) ,and (404 ± 106)/μL ,respectively ,which were not significantly different (F= 2 .55 , P > 0 .05) .The proportions of CD16 + monocytes in the four groups were (19 .8 ± 8 .8)％ ,(14 .3 ± 2 .8)％ ,(9 .7 ± 2 .0)％ and (4 .0 ± 0 .8)％ ,respectively ,which were significantly different ( F = 30 .90 , P < 0 .05 ) . The proportions of CD169 + monocytes in the four groups were (72 .6 ± 11 .4)％ ,(59 .4 ± 14 .7)％ ,(33 .3 ± 14 .5)％ and (2 .6 ± 0 .8)％ ,respectively ,which were significantly different (F = 152 .40 , P< 0 .05) .The proportion of CD169 + monocytes was negatively correlated with CD4 + T lymphocyte counts (r = 0 .792 , P< 0 .05) , while positively correlated with both viral load (r= 0 .485 ,P< 0 .05) and proportion of CD16 + monocytes (r= 0 .395 , P< 0 .05) .Conclusions The CD169 expressions of monocytes in HIV-infected patients are significantly increased and correlated with both monocyte activation and disease progression .
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Objective To investigate the isolation rate, distribution and trend of nontuberculous mycobacteria (NTM) in Wenzhou during 2014 to 2016.Methods Sputum or alveolar lavage specimens of patients with suspected pulmonary tuberculosis were collected for mycobacteria culture from January 2014 to December 2016.Mycobacterium culture positive strains were further identified by gene chip, 16S rRNA and hsp65 gene sequencing.SPSS 19.0 software was used to analyze the data.Results After excluding repetitive strains, 3 295 mycobacteria strains (MTB) were isolated from respiratory specimens, included 3 032 mycobacterium tuberculosis complex strains, 238 NTM strains, 20 Gordon genera strains, 3 Nocardia genera strains and 2 Tsukamurella genera strains.The proportion of NTM among confirmed mycobacteria was 8.5％ (86/1 006), 6.7％ (72/1 079) and 6.8％ (80/1 185) in 2014, 2015 and 2016, respectively (x2 =2.459,P ＞ 0.05).The overall prevalence of NTM was 7.3 ％ (238/3 270).There were 15 species of NTM, and the most common NTM strain was Mycobacterium intracellulare (52.5％,125/238), followed by Mycobacterium abscessus (22.7％, 54/238) and Mycobacterium avium (10.1％, 24/238), other species were only accounted for 14.7％ (35/238).The ranking of Mycobacterium avium went up rapidly from the fifth in 2014 to the second in 2016 (x2 =18.259, P ＜ 0.01), while proportion of Mycobacterium abscess, dropped from 34.9％ (30/86) in 2014 to 17.5％ (14/80) in 2016 (x2 =7.335, P＜0.01).Among patients from whom the NTM strains were isolated, 56.7％ (135/238) were male and most of them were aged 45 years or above (79.8％, 190/238).Conclusions In the past three years, the trend of NTM isolation rate in Wenzhou is steady.The most prevalent NTM species is Mycobacterium intracellulare, followed by Mycobacterium abscessus and Mycobacterium avium.Mycobacterium avium shows a continuously upward trend, while the separation of Mycobacterium abscessus shows a downward trend.
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Objective To investigate the efficacy and safety of levofloxacin and rifapentine for elderly initial treatment pulmonary tuberculosis.Methods 120 cases of elderly initial treatment pulmonary tuberculosis patients January 2015 to January 2016 in our hospital were randomly divided into A,B,C three groups,with 40 cases in each group.Treatment regimen of group A: 2HRZE/4HR; treatment regimen of group B: 2Rft(rifapentine capsules)HZE/4HRft; treatment regimen of group C: 2Rft(rifapentine capsules)HELfx/4HRft.The clinical symptoms,signs and adverse drug reactions were compared between the three groups of patients,observation the changes of blood,urine,liver and kidney function,perform imaging and bacteriological examination to determine the treatment effect.Results Five cases in group A and one case in group B abandoned treatment because of liver damage and severe gastrointestinal reaction,but no one in the 40 cases of group C abandoned treatment.There was no statistically significant difference among three groups in sputum negative conversion rate and focus absorption.The number of cases presenting gastrointestinal reaction and liver damage in group C was significantly smaller than that in group A and group B(P<0.05).Rifampicin was replaced by levofloxacin in two cases of group A as a result of allergy,and no allergy occurred in the other two groups.Conclusion Levofloxacin and rifapentine have good efficacy and few side effects for elderly initial treatment pulmonary tuberculosis,initial treatment regimen for elderly pulmonary tuberculosis patients should be individualized,drugs with few side effects can be used to guarantee smooth proceeding of treatment.
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Objective To elucidate the changes of the peripheral blood B cells in acquired immunodeficiency syndrome (AIDS) patients after the initiation of the highly active antiretroviral therapy (HAART ) ,and to investigate the effect of B cell count on the curative effect of HARRT .Methods Fifty‐three cases of AIDS outpatients and 26 healthy controls were collected between April 2011 and December 2014 . CD4+ T and B lymphocytes counts were compared between the two groups before HAART treatment ,3 ,6 and 12 months after the treatment .The correlation between ΔCD4+ T cells andΔB cells (i .e .the difference value of CD4+ T cells and B cells before HAART treatment and after 12‐month treatment , respectively ) were analyzed . According to whether the CD4+ T lymphocyte count increased by 100/μL after 1 year of the first HAART ,patients were divided into treatment response and nonresponse groups .B cell counts were compared between the two groups ,and the most suitable B cell count to initiate HAART was identified by mean of receiver operating characteristic (ROC) curve .Pre‐and post‐treatment results were compared by paired samples t test .Comparison of measurement data between multiple groups were analyzed by one‐way ANOVA analysis .Correlation between the two groups were analyzed by Pearson correlation analysis .Results B cell counts of AIDS patients before treatment ,3 ,6 and 12 months after treatment were (115 .0 ± 41 .0)/μL ,(130 .3 ± 54 .1)/μL ,(154 .2 ± 68 .1)/μL and (193 .9 ± 84 .0)/μL ,respectively ,while the B cell count of healthy controls was (299 .4 ± 125 .1)/μL . Significant differences among the five groups were observed (F= 24 .8 ,P< 0 .01) .Increases of the B lymphocyte counts with varying degrees were observed after treatments ,which were slow in the initial 3 months and faster afterwards .ΔCD4+ T cell was positively correlated with ΔB cell (r= 0 .493 , P<0 .05) .The B cell counts before treatment in the treatment response and nonresponse groups were (130 .6 ± 40 .4)/μL and (87 .2 ± 24 .5)/μL ,respectively ,which was significantly different (t=4 .77 ,P<0 .05) .The area under the ROC curve was 0 .848 .If the B cell count before treatment was 99 .5/μL ,the sensitivity and specificity to predict effective treatment were 82 .4% and 84 .2% , respectively . Conclusions B cell counts increase with varying degrees during HAART .B cell count before treatment can predict the therapeutic effect of HAART .
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Objective To investigate the clinical features and effective treatment of patients with severe type A H1N1 flu in Wenzhou. Methods The clinical data of 42 hospitalized patients with severe type A H1N1 flu were analyzed and the clinical features were summarized. Results A total of 42 patients with severe type A H1N1 flu all began with fever and cough. The symptoms of expectoration, pharyngalgia, chilly accounted for 92. 9%, 90. 5% and 42. 9%, respectively. The peripheral leucocyte counts were normal or reduced. C-reactive protein and erythrocyte sedimentation rate levels both increased in 30 patients (71.4%). About 95.2% (40/42) patients had changes of pulmonary imaging. All of the patients were treated with oseltamivir and effective antibiotic drugs as well as symptomatic management. No patients was treated with glucocorticoid. The patients with underlying diseases were given proper treatment. Three cases were treated with antifungal therapy and 3 pregnant patients were timely terminated of pregnancy. Conclusions Severe type A H1N1 flu progresses rapidly and the lower respiratory tract is involved soon after onset. Therefore, the patient should be diagnosed early and treated promptly after presenting fever, which will lead to good prognosis.