新型冠状病毒肺炎患者出院隔离观察期核酸复阳情况分析

Analysis of Positive Recurrence of Nucleic Acid in COVID-19 Patients during Isolation Observation Period after Discharge

背景近期部分地方报告了新型冠状病毒肺炎(COVID-19)出院后核酸复阳病例,但核酸复阳的具体原因尚不清楚,这可能为COVID-19的防控带来新的挑战,需引起高度重视。目的分析COVID-19患者出院隔离观察期核酸复阳情况。方法选取2020-01-21至2020-04-15首都医科大学附属北京地坛医院收治的出院隔离观察期核酸复阳的26例COVID-19患者作为复阳组,另选取同期出院隔离观察期核酸未复阳的118例COVID-19患者作为未复阳组。比较两组患者一般资料(包括性别、年龄、临床分型及合并症)、流行病学史、住院时间、临床表现、实验室检查指标〔包括白细胞计数、中性粒细胞分数、淋巴细胞计数、血小板计数、K^+、Na^+、Cl^-、尿素氮(BUN)、肌酐(Cr)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(HBDH)、肌酸激酶同工酶(CK-MB)、CD4^+T淋巴细胞计数〕、胸部CT检查结果及超声心动图检查结果。结果复阳组患者CD4^+T淋巴细胞计数高于未复阳组(P<0.05);复阳组患者主肺动脉内径大于未复阳组(P<0.05)。两组患者一般资料、流行病学史、住院时间、临床表现、其他实验室检查指标、胸部CT检查结果及其他超声心动图检查结果比较,差异均无统计学意义(P>0.05)。结论与出院隔离观察期核酸未复阳的COVID-19患者相比,核酸复阳的COVID-19患者除CD4^+T淋巴细胞计数升高及主动脉内径增大外,其他指标均无明显改变;建议临床规范COVID-19样本检测操作流程,并对治愈出院的COVID-19患者定期进行核酸检测,以降低复发率。

Background Recently,positive recurrence of nucleic acid after discharge in coronavirus disease 2019(COVID-19)patients has been reported in some areas,but the specific cause of positive recurrence of nucleic acid is not clear.This may bring new challenges to the prevention and control of COVID-19,and which calls for great attention.Objective To analyse the positive recurrence of nucleic acid in COVID-19 patients during isolation observation period after discharge.Methods From 2020-01-21 to 2020-04-15,26 COVID-19 patients with positive recurrence of nucleic acid during isolation observation period after discharge who were admitted to Beijing Ditan Hospital,Capital Medical University were selected as the recovery positive group,and 118 COVID-19 patients with non-positive recurrence of nucleic acid during isolation observation period after discharge were selected as the non-recovery positive group.General information(including gender,age,clinical classification and complications),epidemiological history,length of stay,clinical manifestations,laboratory test indicators〔including white blood cell count,neutrophil percentage,lymphocyte count,platelet count,K^+,Na^+,Cl^-,urea nitrogen(BUN),creatinine(Cr),lactate dehydrogenase(LDH),α-hydroxybutyrate dehydrogenase(HBDH),creatine kinase isoenzyme(CK-MB),CD4^+T lymphocyte count〕,chest CT examination results and echocardiographic examination results were compared between the two groups.Results The number of CD4^+T lymphocyte count in the recovery positive group was higher than that in the non-recovery positive group(P<0.05);the diameter of main pulmonary artery in the recovery positive group was larger than that in the non-recovery positive group(P<0.05).There was nosignificant difference in general information,epidemiological history,length of stay,clinical manifestations,other laboratory test indicators,chest CT examination results and other echocardiographic examination results between the two groups(P>0.05).Conclusion Compared with COVID-19 patients with non-positive recurrence of nucleic acid during isolation observation period after discharge,COVID-19 patients with positive recurrence of nucleic acid have no significant changes except for the increased CD4^+T lymphocyte count and the increase of diameter of main pulmonary artery.It is suggested that we should standardize the operation procedure of COVID-19 sample detection,and regularly conduct nucleic acid detection for the cured and discharged patients with COVID-19,so as to reduce the recurrence rate.