重型新型冠状病毒肺炎患者病毒核酸阳性持续时间的影响因素分析

Influencing factors for positive duration of viral nucleic acid in patients with severe coronavirus disease 2019

目的分析重型新型冠状病毒肺炎(COVID-19)患者病毒核酸阳性持续时间及其影响因素,为了解重型COVID-19患者的病毒清除状态及临床治疗和管理提供依据。方法回顾性收集2020年2月10日至3月28日在湖北武汉同济医院中法院区住院治疗的41例重型COVID-19患者的临床资料,采集患者口咽部分泌物的病毒核酸检测结果及其临床信息和实验室检查结果。患者从发病到病毒核酸转阴时间定义为病毒核酸阳性持续时间。使用多因素Cox回归分析探讨影响重型COVID-19患者病毒核酸阳性持续时间的因素。结果41例重型COVID-19患者中男20例(48.8%)、女21例(51.2%),中位年龄为68.0(58.5,74.0)岁,平均病毒核酸阳性持续时间为(28.98±11.71)d。多因素Cox回归分析提示糖尿病、淋巴细胞绝对值及较大剂量糖皮质激素(激素总量≥300 mg)的使用与病毒核酸阳性持续时间有关(P均<0.05),而较小剂量糖皮质激素(激素总量<300 mg)的使用与病毒核酸阳性持续时间无关(P>0.05)。结论重型COVID-19患者病毒核酸持续时间较长;糖尿病、淋巴细胞绝对值降低及较大剂量糖皮质激素(激素总量≥300 mg)的使用是病毒核酸阳性持续时间的独立危险因素。

Objective To analyze the positive duration of viral nucleic acid in severe coronavirus disease 2019(COVID-19)patients and to explore its influencing factors,so as to understand the virus clearance state and provide evidence for treatment and management.Methods The clinical data of 41 patients with severe COVID-19 were retrospectively collected;the patients were hospitalized in Sino-French New City Branch of Tongji Hospital in Wuhan,Hubei Province from Feb.10 to Mar.28,2020.The detection results of viral nucleic acid,clinical information and laboratory findings in oropharyngeal secretion were collected.The time from onset to negative of viral nucleic acid was defined as the positive duration of viral nucleic acid.Multivariate Cox regression analysis was used to explore the influencing factors affecting the positive duration of viral nucleic acid in severe COVID-19 patients.Results Among 41 patients with severe COVID-19,20(48.8%)were males and 21(51.2%)were females,with a median age of 68.0(58.5,74.0)years.The average positive duration of viral nucleic acid was(28.98±11.71)d in the patients.Multivariate Cox regression analysis indicated that diabetes mellitus,lymphocyte count and use of high dose of glucocorticoid(total hormone≥300 mg)were associated with the positive duration of viral nucleic acid(all P<0.05),while use of low dose of glucocorticoid(total hormone<300 mg)was not related to the positive duration of viral nucleic acid(P>0.05).Conclusion Positive duration of viral nucleic acid is longer in severe COVID-19 patients.Comorbidity of diabetes mellitus,decreased lymphocyte count and use of high dose of glucocorticoid(total hormone≥300 mg)are independent risk factors for positive duration of viral nucleic acid.