最近审阅: 2 二月 2021
最近更新: 18 二月 2021
18 Feb 2021

COVID-19 大流行信息更新

根据约翰·霍普金斯大学系统科学与工程中心收集的数据,迄今为止,全球报道了超过 1.098 亿例病例,超过 6180 万例康复,约 240 万例死亡。美国报道的感染和死亡数量为全世界最高。印度报道的病例数量位居第二,此后为巴西、英国、俄罗斯、法国、西班牙、意大利和土耳其。

Johns Hopkins University: coronavirus COVID-19 global cases external link opens in a new window

按 WHO 分区报道的 COVID-19 病例以及全球死亡数(截至 2021 年 2 月 14 日)[Figure caption and citation for the preceding image starts]: 按 WHO 分区报道的 COVID-19 病例以及全球死亡数(截至 2021 年 2 月 14 日)世界卫生组织 [Citation ends].

该更新中有何新内容?

  • 流行病学:危险因素更新(存在合并症;HIV 感染;血脂异常)。

  • 病因学:担忧型变体(variant of concern)和续发率数据更新。

  • 检查:CDC 警告称,脉搏血氧测定准确性可能会受患者皮肤色素沉着影响。

  • 治疗流程:CDC 建议严重免疫功能低下患者中止隔离之前进行额外检测和会诊;预防性抗凝降低住院患者死亡率的新证据。

  • 新兴治疗:英国 RECOVERY 试验表明,托珠单抗降低了给氧住院患者死亡率;MHRA 不建议使用秋水仙碱,除非在临床试验中,或有获批使用指征时;NIH 不建议使用羟氯喹进行暴露后预防。

  • 预防:CDC 建议,只要符合特定标准,接种疫苗者在病例暴露后无需进行检疫;新增阿斯利康疫苗 WHO 指南;疫苗接种后全身过敏反应发生率最新数据;疫苗对 SARS-CoV-2 变体效力的最新数据。

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该专题基于当前可获得的最佳证据,但是由于形势正在迅速发生变化,因此证据有限,部分建议可能基于病例报道、观察性研究和回顾性分析以及随机对照试验和指南。

查看流行病学

原始更新来源external link opens in a new window

小结

定义

病史和体格检查

关键诊断因素

  • 发热
  • 咳嗽
  • 呼吸困难
  • 嗅觉/味觉改变

其他诊断因素

  • 乏力
  • 肌痛或关节痛
  • 痰液产生/排出
  • 胸闷
  • 胃肠道症状
  • 咽痛
  • 头痛
  • 头晕
  • 神经系统症状
  • 眼部症状
  • 流涕/鼻塞
  • 胸痛
  • 皮肤症状
  • 咯血
  • 支气管呼吸音
  • 呼吸急促
  • 心动过速
  • 紫绀
  • 听诊发现湿啰音/啰音

危险因素

  • 与可能或确诊病例产生接触
  • 居住/工作/旅行于传播高风险地区
  • 老年
  • 男性
  • 种族
  • 居住于长期照护机构
  • 合并症的发生
  • 心血管疾病
  • 糖尿病
  • 肥胖
  • 慢性呼吸系统疾病
  • 慢性肾病
  • 妊娠
  • 吸烟
  • 恶性肿瘤
  • 实质脏器移植
  • 唐氏综合征
  • 血红蛋白疾患
  • 高血压
  • 脑血管病
  • 痴呆
  • 慢性肝病
  • 免疫抑制
  • 伴有某些基础疾病的儿童
  • 维生素 D 缺乏
  • 质子泵抑制剂的使用
  • 自身免疫性疾病
  • HIV 感染
  • 血脂异常
  • 手术
  • A 型血和 B 型血
  • 消化道菌群失调
  • 环境因素

诊断性检查

首要检查

  • 实时逆转录聚合酶链反应 (RT-PCR)
  • 脉搏血氧测定
  • 动脉血气分析(ABG)
  • 全血细胞计数(FBC)
  • 生化全项
  • 血糖水平
  • 凝血筛查
  • 心脏生物标志物
  • 血清 C 反应蛋白
  • 血清红细胞沉降率
  • 血清乳酸脱氢酶
  • 血清白细胞介素-6 水平
  • 血清降钙素原
  • 血清铁蛋白水平
  • 血清淀粉样蛋白 A 水平
  • 血清肌酸激酶和肌红蛋白
  • 血液和痰液培养
  • 胸部 X 线检查

需考虑的检查

  • 胸部计算机体层成像(Computed Tomography, CT)
  • 血清学
  • 抗原检测

新兴检查

  • 逆转录环介导等温扩增(RT-LAMP)
  • 肺部超声

治疗流程

撰稿人

Consultant and Honorary Senior Lecturer in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

利益声明

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

利益声明

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

利益声明

RF declares that he has no competing interests.

同行评议者展开全部内容

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

利益声明

WAP declares that he has no competing interests.

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China 

利益声明

XZ declares that he has no competing interests.

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

利益声明

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

Lead Section Editor, BMJ Best Practice

利益声明

IC declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

专家顾问:合并症展开全部内容

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018). MP has accepted sponsorship for travel expenses and accommodation costs from Astellas Pharma Ltd to attend the European Geriatric Society Meeting (Lisbon 2016).

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

利益声明

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

利益声明

MC is a Non-Executive Director of NICE and Chair the Digital Health Committee of the European Society of Cardiology. MC’s university receives support for his research from Abbott, ResMed, Boston Scientific, and Medtronic. MC speaks at educational events and provides consultancy advice to a number of device, diagnostic, and pharmaceutical companies including Novartis, Servier, Bayer, Pfizer, AstraZeneca, Boehringer Ingelheim, Roche Diagnostics, Medtronic, Abbott, ResMed, and Boston Scientific. MC declares that none of these interests is directly related to topics advised on for this project.

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

利益声明

RAE has been reimbursed for a GSK Advisory Board meeting on Physical Activity and Asthma in November 2016, and three Chiesi Education meetings for GPs on COPD care in 2019. RAE received a travel award for ERS 2017 from Chiesi and participated in the GSK clinical experience programme - respiratory in August 2018. RAE participated in the BTS/SIGN guidelines for asthma update 2016 (no fee).

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

利益声明

GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

利益声明

SP declares that he has no competing interests.

BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester

Manchester

UK

利益声明

AA and MJ declare that they have no competing interests.

同行评议:合并症展开全部内容

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018). MP has accepted sponsorship for travel expenses and accommodation costs from Astellas Pharma Ltd to attend the European Geriatric Society Meeting (Lisbon 2016).

Consultant Geriatrician

Liverpool University Hospitals NHS Foundation Trust

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

利益声明

AA declares that he has no competing interests.

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