新型冠状病毒肺炎抗体及核酸检测和影像学诊断价值

Diagnostic value of COVID-19 IgM/IgG antibody detection,nucleic acid detection,and CT imaging detection

目的探究免疫球蛋白M/免疫球蛋白G(IgM/IgG)抗体检测、咽拭子和痰液核酸检测以及CT影像学在2019新型冠状病毒(2019-nCoV)诊断中的价值。方法选取2020年2月8日-2020年3月5日56例确诊2019-nCoV感染的住院患者和同期留观患者61例作为研究对象。对所有纳入研究患者行IgM/IgG总抗体和IgM抗体检测,记录患者CT影像学资料、实验室数据和临床一般资料;选取19例确诊患者同时采集痰液和咽拭子标本,行核酸检测。统计学分析各检测方法的诊断性能。结果两组患者一般资料和实验室数据间差异无统计学意义,确诊组CT异常率高于留观组(P<0.05)。确诊患者IgM/IgG总抗体检出率为98.21%,IgM为83.93%,初次咽拭子核酸检出率为55.36%。2例患者经>3次咽拭子核酸确诊。复核抗体检测诊断敏感性、特异度、阳性预测值和阴性预测值均处于较高水平,优于IgM、CT和咽拭子初次核酸检测,且有助于无症状感染者的发现。结论2019-nCoV IgM/IgG总抗体检测具有较高的诊断性能,可作为核酸检测阴性疑似病例的补充检测、在疑似病例确诊时与核酸检测协同应用或用于快速鉴别CT异常患者,此外由于其检测简便易行且快速,或可适用于基层医院对密接人群核酸检测筛查的协同检测手段。

OBJECTIVE To investigate the value of IgM/IgG antibody and nucleic acid detection in throat swabs and sputum,and CT scan in the diagnosis of 2019-nCOV.METHODS Fifty-six inpatients who were diagnosed with COVID-2019 and 61 observation patients were recruited as the research objects during Feb.8,2020 to Mar.5,2020.IgM/IgG antibody and IgM antibody tests were performed on all patients included in the study.CT imaging data,laboratory data,and general clinical data were collected.RNAs of SARS-Cov-2 in sputum and throat swab samples among 19 confirmed patients were detected.Diagnostic efficiency was statistical analyzed.RESULTS There was no significant difference of general data and laboratory data between the two groups of patients;the abnormal rate of CT imaging in the confirmed group was significantly higher than that in the observation group(P<0.05).The detectable rate of IgM/IgG antibody and IgM antibody in the confirmed patients were 98.21%and 83.93%respectively,and the initial detectable rate of nucleic acid in throat swab was only 55.36%.Two patients were confirmed with more than 3 times of throat swab nucleic acid detection.The sensitivity,specificity,positive predictive value,and negative predictive value of the IgM/IgG antibody detection were at high levels,which were better than those of the initial nucleic acid detection in throat swabs,IgM antibody detection and CT.It may help to find out subjects who were asymptomatic infection.CONCLUSION The diagnostic efficiency of SARS-Cov-2 IgM/IgG antibody test was high,and can be used as a supplementary assay for the suspected cases negative nucleic acid detection results.It can be used in combination of nucleic acid detection to distinguish patients with abnormal CT imaging.The assay can be used for the screening of close contacts by its relative simplicity,convenience,cost-effectiveness and quickness.