核酸阴性COVID-19病例临床特征分析

Clinical Characteristics of Patients with Multiple Negative RNA Tests but Diagnosed with COVID-19

目的分析新型冠状病毒鼻咽拭子核酸检测多次阴性后被临床确诊为新型冠状病毒肺炎(COVID-19)患者的临床特征。方法分析2020年1月29日至3月17日在湖北省武汉市新洲区中医院住院治疗的新冠肺炎患者病例资料。选取58例新型冠状病毒鼻咽拭子核酸检测阴性、临床诊断为COVID-19的患者作为研究对象,与73例核酸阳性新冠肺炎患者作比较。结果与核酸阳性COVID-19组比较,核酸阴性组发病到入院时间较长,重型及危重型患者较多(P<0.05),更容易出现咳痰和胸痛、头痛、头晕现象(P<0.05)。与核酸阳性组比较,核酸阴性组淋巴细胞与中性粒细胞比值明显低于阳性组,乳酸脱氢酶水平、D二聚体和碱性磷酸酶水平明显高于阳性组(P<0.05)。58例核酸阴性患者影像学均呈典型COVID-19影像学改变,并以进展期为主,其中25例患者为重症期改变(P<0.05)。核酸阴性组患者使用抗生素、激素及丙种球蛋白的病例数明显多于核酸阳性者、住院天数明显多于核酸阳性组(P<0.05)。结论核酸阴性COVID-19患者与阳性患者临床特征存在差异。

Objective To investigate the clinical characteristics of the patients who tested negative RNA for many times of SARS-CoV-2 in nasopharyngeal swabs but were diagnosed with Corona Virus Disease 2019(COVID-19).Methods We analyzed the case data of COVID-19 patients who were hospitalized in the isolation wards of Wuhan XinZhou District Hospital of Traditional Chinese Medicine from January 29,2020 to March 17,2020 by retrospective analysis.The subjects were 58 patients who tested negative multiple times for SARS-CoV-2 but were clinically diagnosed with COVID-19,and comparison with 73 patients who tested positive for SARS-CoV-2 of COVID-19.Results The time from onset to hospitalization was longer,and the number of the severe and critically ill patients was larger in the RNA negative group than RNA positive group.There were more likely to have cough sputum,chest pain,headache and dizziness clinical manifestations in the RNA negative group than those of RNA positive group(P<0.05).The ratio of Lymphocyte/Neutrophil counts was lower,lactate dehydrogenase,D dimer and alkaline phosphatase were higher in the RNA negative group than RNA those of positive group(P<0.05).All of the patients who were presented typical COVID-19 imaging changes in the RNA negative group,and the progression stage was dominant,there were 25 cases of severe stage change(P<0.05).The number of patients who were the RNA negative group received antibiotics,hormones and gamma globulin significantly more than RNA positive group.And the length of hospital stay was significantly higher than RNA positive group(P<0.05).Conclusion There were differences in clinical characteristics between patients with nucleic acid negative and positive COVID-19.