症状好转后影像加重复检阳性新型冠状病毒肺炎1例思考

Imaging plus repeated positive test of COVID-19 of one patient after improvement of symptoms

目的 探究新型冠状病毒肺炎(Corona Virus Disease 2019,COVID-19)的临床症状、影像学特征及相关感染指标变化规律,并揭示与病毒核酸载量变化之间的联系.方法 对1例有明确疫区旅居史,以“发热、咳嗽、咽痛3d”起病的31岁男性病例的临床症状、肺CT影像学特征、实验室指标等进行回顾性分析.结果 该患者起病时两次核酸检测均为阴性,经治疗后症状迅速消失.起病14 d后复查肺CT较前加重,复检病毒核酸为阳性,确诊为新型冠状病毒肺炎,后痊愈.病程中临床症状、实验室指标与影像学表现并不平行.结论 结合该患者症状、检验指标、影像学表现互不平行的特点,参照已有研究,不排除新型冠状病毒在体内复制过程中存在消长过程,病程中不同阶段核酸载量的差异决定了核酸检测的结果.提示在诊治过程中,务必重视核酸重复检测的必要性,当症状好转而病毒核酸复检阳性时应高度警惕症状、影像再次加重的可能.

OBJECTIVE To explore the changes of clinical symptoms,imaging features and related infection indexes of the Corona Virus Disease 2019(COVID-19)and reveal its relationship with the change of viral nucleic acid load.METHODS A 31-year-old male patient who had a history of staying in the epidemic-affected area and a history of fever,cough,and sore throat was enrolled in the study,and the clinical symptoms,CT imaging features and laboratory test indexes of the patient were retrospectively analyzed.RESULTS The patient was tested twice for the nucleic acid at the onset,the symptoms disappeared quickly after treatment.The lung CT was re-checked 14 days after the onset,the viral nucleic acid test showed positive after the re-test,and the patient was conformed as COVID-19 and was cured successfully.During the course of the disease,the clinical symptoms and laboratory indicators were not parallel with the imaging findings.CONCLUSION Combined with the characteristics of the case whose symptoms and test indicators are not parallel with the imaging findings and the existing studies,it does not rule out that the COVID-19 has a growth and decline process during the in vivo replication process,and the difference in nucleic acid load at different stages in the course of the disease determines the result of nucleic acid test.It is suggested that in the process of diagnosis and treatment,attention should be paid to the need for repeated test of nucleic acid,and when the symptoms improve and the virus nucleic acid re-test is positive,you should be highly vigilant of the possibility of aggravation of the symptom and the image.