21例新型冠状病毒肺炎核酸持续阳性超过30 d患者临床特征分析

Clinical characteristics of 21 patients with COVID-19 SARS-CoV-2 nucleic acid continues to be positive for more than 30 days

目的探讨新型冠状病毒肺炎(COVID-19)核酸检查转为阴性超过30 d患者的临床特征。方法分析2020年2月10日至2020年4月4日火神山医院感染四科二病区收治的由外院确诊转入的170例患者中21例核酸检查反复阳性、持续阳性超过30 d患者的临床资料。结果(1)21例中有17例为中老年患者(45~84岁),15例有慢性基础性疾病,21例发病早期均有不同程度的发热、咳嗽症状,部分轻度活动后气促,均诊断为普通型;(2)2例血白细胞计数减少,3例淋巴细胞降低,4例C-反应蛋白高,21例肺CT示肺浸润范围1.50%~20.00%,平均范围为3.92%;(3)予氧疗,根据病情予控制血压、调整血糖等基础治疗,给予足疗程阿比多尔、胸腺肽、中药等治疗,抗病毒7 d不转阴者再调整抗病毒药物,予口服磷酸氯喹、法维拉韦、输恢复期血浆治疗;(4)从第一次核酸检测阳性到核酸转阴30~40 d的4例,41~60 d的13例,>60 d 4例。结论COVID-19核酸检测反复阳性、持续阳性时间超过30 d患者多见于中老年,多合并慢性基础病,一般抗病毒治疗及免疫治疗核酸转阴效果不理想,需多种抗病毒手段干预。此类患者核酸持续阳性时间长,给防控带来巨大的困难。

Objective To investigate the clinical features of Covid-19 patients whose nucleic acid changed from positive to negative after 30 days.Methods The clinical data about 21 cases admitted to our ward section between February 2020 and April 2020 whose nucleic acid persistently tested positive for over 30 days was analyzed retrospectively.Results Among the 21 cases,17 cases were middle-aged and elderly patients(ranging 45 to 84 years old),and 15 cases had chronic preexisting diseases.All the 21 cases had different degrees of fever and cough and were diagnosed as of the common type.Some of these cases had shortness of breath after mild activity in the early stage of onset.Two cases had decreased white blood cell count,3 cases had decreased lymphocyte count,and 4 cases had high levels of C-reactive protein.The lung CT showed that lung infiltration of these cases ranged from 1.50%to 20.00%,with an average range of3.92%.They were given oxygen therapy,basic treatment such as control of blood pressure and adjustment of blood glucose according to their conditions,adequate treatment with abidol,thymosin,traditional Chinese medicine.Such antiviral drugs as chloroquine phosphate and favipiravir were adjusted for those whose nucleic acid did not turn negative within 7 days.Some patients received plasma transfusion in the convalescent period.There were 3 cases whose nucleic acid took 30 to 40 days to change from positive to negative,compared with 41 to 60 days in 13 cases,and more than 60 days in 4 cases.Conclusion The commonly-used antiviral therapies and immune therapy are not effective enough,so a variety of antiviral interventions are needed.The fact that some Covid-19 patients have persistent positive nucleic acid is likely to add difficulty to prevention and control of related infections.