肛拭子阳性在COVID-19患者中的临床价值分析

Clinical value of anal swab positive in COVID-19 patients

目的探究肛拭子阳性患者临床特征及其价值。方法选取104例COVID-19确诊患者,在入院时采集咽拭子、痰液、血液和肛拭子检测2019-nCoV核酸;依据不同标本核酸阴阳性分组比较临床特征和血液学指标;选取15例肛拭子核酸阳性患者追踪分析其不同标本核酸转阴时间。结果与肛拭子阴性患者相比,阳性患者具有较低的淋巴细胞(LYM)和较高的乳酸脱氢酶(LDH)及超敏C反应蛋白(HsCRP),且重症比例更高。咽拭子阳性患者HsCRP、IL-6和重症比例亦显著高于阴性患者。痰液阴阳性患者间血液学指标和重症比例差异无统计学意义。血液阳性比例仅为1.92%,但均为重症患者;痰液阳性率最高为46.15%。咽拭子和肛拭子均阳性患者LYM显著下降,而HsCRP、IL-6和危重比例均显著增高。追踪结果显示肛拭子和痰液转阴时间较长,警惕痰液复阳现象。结论肛拭子阳性患者具有更低的LYM和更高的炎症水平及重症比例,提示其可能成为预测重症发生的因素。且转阴时间长于咽拭子,联合咽拭子和肛拭子检测有助于预测重症发生。

Objective To investigate the value of anal swabs positive for 2019-nCoV in patients with COVID-19 and the clinical features of the patients.Methods Throat swabs,sputum and blood samples,and anal swabs were collected from 104 patients with COVID-19 at admission to test for 2019-nCoV nucleic acid.Clinical characteristics and hematological indexes were compared between viral nucleic acid-positive and-negative groups of different sample types.Fifteen patients whose anal swabs were positive for viral nucleic acid were selected to analyze the length of time before the nucleic acid turned negative in different specimens.Results Compared with the patients having negative anal swab test results,those having positive test results showed decreased lymphocytes,increased lactate dehydrogenase(LDH)and high-sensitivity C-reactive protein(HsCRP),and higher incidence of severe COVID-19.The levels of HsCRP and IL-6 and the incidence of severe COVID-19 were significantly higher in patients with positive throat swab test results than in those with negative results.No significant difference in hematological indexes or the proportion of severe cases was detected between the patients with positive and negative sputum test results.Only 1.92%of the patients had positive blood test results,but all of them were severe patients.The positive rate of sputum test was the highest,which was 46.15%.Patients with positive results of both throat and anal swab test had significantly decreased lymphocytes,increased HsCRP and IL-6 levels,and higher incidence of critical COVID-19.It took longer time for patients to have negative anal swab and sputum test results.Moreover,it should be noticed that the viral nucleic acid in sputum might become positive again after it turned negative.Conclusions Patients with positive anal swab test results had reduced lymphocytes,enhanced inflammatory response and higher incidence of severe COVID-19,suggesting that a positive anal swab test might be an indicator of severe COVID-19.Moreover,the time of 2019-nCoV nucleic acid turning negative in anal swabs was longer than that in throat swabs.The combined detection of throat swabs and anal swabs would help to predict the occurrence of severe COVID-19.