新型冠状病毒肺炎患者病毒清除时间延迟的相关因素分析

Factors associated with prolonged viral clearance in COVID-19 patients

目的探究已治愈新型冠状病毒肺炎(COVID-19)患者的病毒清除时间延迟相关因素。方法以武汉协和医院2020年1—3月228例经核酸确诊的COVID-19病例为研究对象,根据病毒清除时间21 d为界,分为延迟清除组(136例)和对照组(92例),对比分析两组患者临床特征、发病至入院时间、实验室检查指标等。应用Logistic分析与COVID-19患者病毒清除时间延长风险相关的因素。采用Kaplan-Meier曲线描述不同IL-6水平、不同入院时间的病毒核酸阳性比例,使用log-rank检验比较延迟清除组和对照组病毒清除速度的差异。结果所有病例总体病毒清除时间为23.00(18.00,30.25)d,两组常见临床症状为发热和咳嗽。病毒清除时间延迟的危险因素有发病至入院时间>10 d(aOR=6.581,95%CI:3.505~12.354)和IL-6浓度>17.49 pg/mL(aOR=2.766,95%CI:1.282~5.964)。Kaplan-Meier曲线显示,发病至入院时间>10 d以及病程中IL-6浓度>17.49 pg/mL的患者病毒清除速度更慢(log-rank P<0.05或0.01)。结论IL-6浓度和发病至入院时间长短与COVID-19患者的病毒清除时间是否延长相关,因此在症状出现后尽早入院治疗有利于患者病毒清除。

Objective To understand the factors associated with prolonged viral clearance in cured patients with COVID-19.Methods A total of 228 confirmed cases with COVID-19 in Union Hospital of Wuhan from January to March 2020 were enrolled.Based on the duration of viral clearance with 21 d as the cut-off point,patients were divided into prolonged viral clearance group(136 cases)and control group(92 cases).The clinical features,onset to door times,laboratory results between the two groups were compared.Multivariate Logistic regression analysis was used to explore factors associated with viral clearance.Kaplan-Meier curve was used to analyze the positive rates of viral RNA in different IL-6 levels and hospital admission times,and log-rank test was to compare the viral clearance between the two groups.Results The duration of viral clearance in 228 cases was 23.00(18.00-30.25)days,and fever and cough were the common clinical manifestations in both groups.The risk factors of prolonged viral clearance were hospital admission time>10 days(aOR=6.581,95%CI:3.505-12.354)and IL-6>17.49 pg/mL(aOR=2.766,95%CI:1.282-5.964).Kaplan-Meier curves showed that the hospital admission time>10 days and IL-6>17.49 pg/mL had a slower viral clearance(log-rank P<0.05 or 0.01).Conclusions IL-6 and the time from onset to admission are associated with the duration of viral clearance in COVID-19 patients.It is necessary for the patients to be admitted to the hospital as soon as possible after symptoms appear,in order to eliminate the virus quickly.