COVID-19患者病毒核酸阳性持续时间与临床转归的相关研究

A study on the relationship between the duration of viral RNA detection and clinical outcome in COVID-19 patients

目的探讨新型冠状病毒肺炎(COVID-19)患者不同部位的新型冠状病毒核酸阳性持续时间与临床转归的关系及可能的致病机理。方法选取2020年1-2月汕头大学医学院第一附属医院COVID-19确诊病例13例为研究对象。全病程中连续采集患者的口咽拭子和痰液、肛拭子和粪便、眼结膜拭子、尿液和血清样本,采用实时荧光PCR方法检测严重急性呼吸综合征冠状病毒2(SARS-CoV-2)核酸,收集并分析临床资料。结果所有患者痰液和口咽拭子的SARS-CoV-2核酸检测阳性,11例患者粪便伴8例肛拭子病毒核酸阳性,2例危重患者的血液、眼结膜和尿液中检出了病毒核酸。呼吸道病毒核酸检出阳性持续时间在轻型、普通型和重型之间差异无统计学意义(P>0.05),与呼吸道症状及胸部CT炎症持续时间差异无统计学意义(P>0.05)。粪便病毒核酸阳性的患者中有7例出现腹泻,持续1~6 d。1例危重型患者病程第6~17天血液中连续检出病毒核酸,第7天出现了重度的急性呼吸窘迫综合征(ARDS)。结论 COVID-19患者呼吸道病毒核酸阳性持续时间可能与病情的转归和严重程度无明显的关联性。消化道病毒核酸阳性的患者,可无或表现轻微消化道症状。病毒血症可能是激发炎症风暴导致ARDS的重要因素。

Objective To investigate the relationship between the detection of severe acute respiratory syndrome coronavirus2(SARS-CoV-2) RNA and the clinical outcomes in corona virus disease 2019(COVID-19) patients and the potential pathogenicity.Methods COVID-19 confirmed cases were studied.Samples of sputum,stool,urine,oropharyngeal and rectal swabs,tear and conjunctival secretion and serum were collected during the hospitalization.SARS-CoV-2 RNA was extracted and detected with real-time fluorescence PC.R.The clinical data was collected and analyzed.Results Viral RNA was detected from the oropharyngeal swabs and sputum samples from all patients.11 stool samples and 8 anal swabs were positive.Virus nucleic acid was detected in blood,conjunctiva and urine of 2 severe cases.There was no correlation between the duration of the detection of viral RNA in the respiratory tract and the symptoms,chest C.T inflammation,and clinical type(P>0.05).7 patients with positive virus detection in stool samples had diarrhea for 1 to 6 days.The patient who developed severe acute respiratory distress syndrome(ARDS) on day 7 of his disease course,viral nucleic acid was detected from his serum at day 6 to 17.Conclusions The length of period that viral RNA detected in respiratory tract might not be associated with the duration and severity of the disease.Most patients with viral RNA detected in the digestive tract showed no or mild digestive tract symptoms.Viral RNA could be detected from most of COVID-19 patients,who showed no or mild digestive tract symptoms;Viremia was an important factor that might stimulate inflammatory storms,which could finally cause ARDS.