抗体检测阴性新型冠状病毒患者的临床与实验室特征分析

Clinical and laboratory features in COVID-19 patients without anti-SARS-CoV-2 antibody

目的探讨新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)确诊患者抗体检测阴性群体的临床特征与实验室检验特征,有助于增进对确诊患者抗体检测阴性结果的合理判读及对此类患者的有效管理。方法回顾性分析荆门市第一人民医院2020年1月23日至2020年3月27日确诊的116例COVID-19患者的临床资料,并对患者一年内的总抗体检测结果进行跟踪分析。依总抗体检测结果、患者的临床分型分为抗体阳性/阴性组,轻症组(轻型、普通型)、重症组(重型、危重型)。采集上述患者的临床与实验室检测数据并分析比较。结果总抗体阴性患者比例为17.2%(20/116)。慢性肾病者与糖尿病分属抗体阴性组、抗体阳性组的首位并发症。抗体阴性组的平均住院日(17.80±11.70)d少于抗体阳性组(28.88±10.14)d,抗体阴性组的谷丙转氨酶(中位数20.10)低于抗体阳性组(中位数28.00),两组间的平均住院日、谷丙转氨酶差异均有统计学意义;抗体阴性组、阳性组入院时的白细胞计数、淋巴细胞计数基本一致;抗体阴性患者组的谷草转氨酶、乳酸脱氢酶、D-二聚体、C反应蛋白(中位数分别为22.05,186.75,0.77,8.80)均低于抗体阳性患者组(中位数分别为23.15,217.10,0.86,9.45),但组间差异无统计学意义。抗体检出结果与患者症状相关,轻症患者组与重症患者组间抗体检出结果差异有统计学意义。结论抗体阴性组除平均住院日短、谷丙转氨酶低外,其他临床与实验室特征与抗体阳性组接近。抗体检出结果与患者的临床分型有关,轻症患者易出现抗体阴性结果。提示COVID-19患者抗体阴性可能是部分患者的免疫应答表现,且这类患者并不少见,值得关注和开展进一步临床研究。

Objective The aim of this study is to investigate the clinical and laboratory features in confirmed COVID-19 patients without specific anti-SARS-CoV-2 antibody,it is important to interpret SARS-CoV-2 antibody test results correctly and provide effective management for COVID-19 patients without specific anti-SARS-CoV-2 antibody.Methods The clinical and laboratory data of 116 confirmed COVID-19 patients in The First People′s Hospital of Jingmen from January 23,2020 to March 27,2020 were retrospectively analyzed,and total antibody detection data of the patients within one year were followed up.The patients were categorized as antibody negative and positive group based on the results of anti-SARS-CoV-2 antibody detection,or divided into regular group(mild and moderate type)and severe group(severe and critical type)according to clinical classification.Clinical and laboratory data of 116 COVID-19 patients were collected and analyzed.Results The prevalence of total antibody negative COVID-19 patients was 17.2%(20/116).Chronic kidney diseases and diabetes was the most common comorbidities for antibody negative and positive group,respectively.Antibody negative group was found shorter average length of stay(17.80±11.70)compared to antibody positive group(28.88±10.14).Alanine aminotransferase(ALT)in antibody negative group(median 20.10)was lower than that of antibody positive group(median 28.00),average length of stay and ALT in antibody negative group were statistically significant lower compared to antibody positive group(P<0.05).The results of white blood cell count(WBC)and lymphocyte count(LYM)at admission were basically the same between two groups.Asparate aminotransferase(AST),lactate dehydrogenase(LDH),D-dimer(DD),C-reactive protein(CRP)of antibody negative group(median 22.05,186.75,0.77,8.80)was lower than antibody positive group(median 23.15,217.10,0.86,9.45),but the group difference for AST,LDH,DD,CRP had no statistically significant(P>0.05).The results of antibody were associated with the disease severity,there was a significant difference in the results of anti-physical examination between mild and severe patients(P<0.05).Conclusions For antibody negative group,other indicators are basically the same with antibody positive group except shorter length of stay and lower ALT.Mild and moderate patients were more prone to produce negative antibody response.It indicates that seronegative phenomenon may be one kind of immunological response for parts of COVID-19 patients,and the number of this kind of patients are not uncommon.It is worthwhile to pay more attention and explore further for seronegative COVID-19 patients.