16例粪便严重急性呼吸综合征冠状病毒2核酸阳性患者的临床特征

Clinical characteristics of 16 patients with fecal severe acute respiratory syndrome coronavirus 2 nucleic acid-positive

目的:分析粪便严重急性呼吸综合征冠状病毒2(severe acute respiratory syndrome coronavirus 2,SARSCoV-2)核酸阳性2019新型冠状病毒病(coronavirus disease 2019,COVID-19)患者的临床特征,为COVID-19的防控提供科学依据。方法:回顾性分析2020年1月至2月在长沙市第一医院北院(长沙市公共卫生救治中心)住院的16例粪便SARS-CoV-2核酸阳性COVID-19患者的临床资料,总结其临床表现、实验室数据、影像学资料。结果:16例COVID-19患者中,男9例(56.25%),女7例(43.75%),男女比例1∶1.29,年龄(43.3±14.6)岁,武汉相关接触史15例,本地确诊患者接触史1例,普通型12例(75%),重型4例(25%)。临床症状包括发热14例(87.5%)、咳嗽12例(75%)、气促5例(31.25%)、咽痛10例(62.5%)、乏力7例(43.75%)、腹泻4例(25%)。外周血中白细胞计数正常或降低14例(87.5%)、淋巴细胞计数减少11例(68.75%)、红细胞沉降率升高15例(93.75%)、超敏C反应蛋白增高13例(81.25%)、降钙素原升高5例(31.25%)、血清铁蛋白增高8例(50%),大便常规基本未见异常;与普通型患者相比较,重型患者的白细胞和淋巴细胞计数差异均有统计学意义(均P<0.01),超敏C反应蛋白、血清铁蛋白等感染指标显著升高,差异均有统计学意义(均P<0.01),降钙素原、红细胞沉降率差异无统计学意义(均P>0.05)。胸部CT主要表现为多发小斑片影及间质改变,累及单肺者4例(25%),累及双肺者12例(75%)。结论:本组患者具有一般COVID-19的临床症状,但腹泻等消化道症状更常见,重型患者的白细胞计数、淋巴细胞计数、超敏C反应蛋白、血清铁蛋白等指标改变更明显;粪便核酸阳性提示SARS-CoV-2存在消化道传播的可能性,故粪便核酸检测可以作为一种常规检测方法在临床上推广。

Objective:To analyze the clinical characteristics of fecal severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)nucleic acid-positive in patients with coronavirus dasease 2019(COVID-19)and to provide a scientific basis for the prevention and control of this disease.Methods:The clinical data of 16 patients with fecal SARS-CoV-2 nucleic acid positive,who hospitalized in the North Branch of the First Hospital of Changsha(Changsha Public Health Rescue Center)from January to February 2020,were retrospectively analyzed.Their clinical manifestations,laboratory data and imaging data were summarized.Results:Among the 16 patients,there were 9 males(56.25%)and 7 females(43.75%),the ratio of males to females was 1∶1.29.The age of onset was(43.3±14.6)years.There were 15 patients with contact history of Wuhan,1 patient with contact history of local patient.Twelve patients were common type(75%),and 4 patients were severe type(25%).Clinical symptoms included fever in 14 patients(87.5%),cough in 12 patients(75%),shortness of breath in 5 patients(31.25%),pharyngalgia in 10 patients(62.5%),fatigue in 7 patients(43.75%),and diarrhea in 4 patients(25%).There were 14 patients(87.5%)with normal or decreased white blood cell count,11 patients(68.75%)with decreased lymphocyte count,15 patients(93.75%)with increased erythrocyte sedimentation rate,13 patients(81.25%)with increased hypersensitivity C-reactive protein,5 patients(31.25%)with increased procalcitonin,and 8 patients(50%)with increased serum ferritin in peripheral blood,and stool routine was basically normal.Compared with the common type,there was significant difference in the white blood cell and lymphocyte counts in the severe type(P<0.01);the infection indicators,such as hypersensitivity C-reactive protein and serum ferritin,were significantly increased,with significant difference(all P<0.01);but the procalcitonin and erythrocyte sedimentation rate was not significantly different(both P>0.05).Chest CT mainly showed patchy shadows and interstitial changes.According to imaging examination,4 patients(25%)showed unilateral pneumonia and 12 patients(75%)showed bilateral pneumonia.Conclusion:The patients have the clinical symptoms of COVID-19,but gastrointestinal symptoms(such as diarrhea)are more common,and the changes of white blood cell count,lymphocyte count,hypersensitivity C-reactive protein,ferritin are more obvious in severe patients.The positivity of fecal nucleic acid suggests the possibility of digestive tract transmission of SARS-CoV-2,and fecal nucleic acid testing can be used as a routine testing method in clinical practice.