新型冠状病毒感染患者核酸长期阳性的相关因素与核酸转阴的特点分析

Analysis of the correlative factors of long-term positive nucleic acid and the characteristics of nucleic acid conversion in novel coronavirus infected patients

分析新型冠状病毒感染患者核酸长期阳性的相关因素与核酸转阴特点。回顾性纳入2022年12月至2023年6月北京清华长庚医院住院的新型冠状病毒感染患者,选取新型冠状病毒核酸阳性时间≥30 d的患者为长阳组;以年龄、性别匹配的核酸阳性时间<30 d患者为对照组。收集所有纳入患者的临床资料,采用二分类logistic回归分析核酸阳性时间≥30 d的影响因素;采用Cox风险比例模型分析重症患者住院期间死亡的危险因素,比较组间上、下呼吸道核酸转阴时间的差别。长阳组共纳入30例,男24例,女6例,年龄[M(Q_(1),Q_(3))]为77(64,86)岁;对照组患者58例,男46例,女12例,年龄78(66,86)岁。移植状态(OR=50.32,95%CI:1.98~1278.63,P=0.018)、恶性肿瘤(OR=12.85,95%CI:1.65~99.88,P=0.015)、CD4^(+)T细胞计数(OR=0.99,95%CI:0.99~1.00,P=0.005)为核酸阳性时间≥30 d的相关因素。急性生理与慢性健康评分(APACHE)Ⅱ评分(HR=1.12,95%CI:1.03~1.22,P=0.012)、核酸阳性时间(HR=1.16,95%CI:1.01~1.33,P=0.031)为重症患者死亡的相关因素。两组下呼吸道标本核酸转阴时间均晚于上呼吸道标本(均P<0.001)。基础免疫低下是新型冠状病毒核酸长期阳性的相关因素,重症患者核酸长期阳性提示高死亡风险。下呼吸道标本核酸晚于上呼吸道标本核酸转阴。

To analyze the correlative factors of long-term positive nucleic acid and the characteristics of negative nucleic acid conversion in novel coronavirus infected patients.Novel coronavirus infected patients who were hospitalized in Beijing Tsinghua Changgung Hospital from December 2022 to June 2023 were retrospectively included.Patients who were positive for novel coronavirus nucleic acid for≥30 days were selected as the long-positive group,and age-and sex-matched patients with novel coronavirus nucleic acid for<30 days were selected as the control group.The clinical data of all enrolled patients were collected.Binary logistic regression was used to analyze the influencing factors of the positive duration of nucleic acid≥30 days.The Cox risk ratio model was used to analyze the risk factors for the prognosis of severe patients during hospitalization,and the difference in the time of nucleic acid conversion between the upper and lower respiratory tract was compared between the groups.A total of 30 patients were included in the long-positive group,including 24 males and 6 females,aged[M(Q_(1),Q_(3))]77(64,86)years.Fifty-eight patients were included in the control group,including 46 males and 12 females,aged 78(66,86)years.Transplantation status(OR=50.32,95%CI:1.98-1278.63,P=0.018),malignant tumor(OR=12.85,95%CI:1.65-99.88,P=0.015),CD4^(+)T cell count(OR=0.99,95%CI:0.99-1.00,P=0.005)were correlative factors for positive nucleic acid≥30 days.Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore(HR=1.12,95%CI:1.03-1.22,P=0.012)and nucleic acid positive time(HR=1.16,95%CI:1.01-1.33,P=0.031)were correlative factors for death in severe patients.The nucleic acid conversion time of the lower respiratory tract specimens in both groups was later than that of the upper respiratory tract specimens(all P<0.001).Weakened underlying immunity is a correlative factor for long-term novel coronavirus nucleic acid positivity,and long-term positive novel coronavirus nucleic acid in severe patients indicates high risk of death.The nucleic acid of the lower respiratory tract specimen turned negative later than the upper respiratory tract specimen.