新型冠状病毒肺炎核酸复阳者与未复阳者的临床特征比较

A comparison of clinical characteristics between COVID-19 patients with and without re-positive nucleic acid test

目的比较新型冠状病毒肺炎(COVID-19)患者出院后核酸复阳者与未复阳者的临床特征,探讨新型冠状病毒(SARS-CoV-2)核酸复阳的影响因素,并分析康复期COVID-19患者淋巴细胞亚群的动态变化。方法纳入成都市公共卫生临床医疗中心出院后半月、1月、2月(各时间点前后±5 d)复诊期间核酸复阳的31例COVID-19患者(复阳组),同时纳入同期未复阳的治愈患者53例(未复阳组),比较两组的一般临床资料及实验室检查结果,进行单因素和多因素Logistic回归分析,探讨康复期患者核酸复阳的影响因素,并分析淋巴细胞亚群的动态变化。结果复阳组中,81%(25/31)的患者在出院后15 d内复阳,且有3人在出院后2月再次复阳。复阳组患者年龄大于未复阳组,男性占比低于未复阳组,差异有统计学意义(P<0.05);复阳组入院及出院时的丙氨酸氨基转移酶(ALT)低于未复阳组,差异有统计学意义(P<0.05)。多因素Logistic分析显示所筛选的指标均未与核酸复阳独立相关(P>0.05)。两组CD4^(+)T/CD8^(+)T比值及B细胞计数在不同时间点的差异无统计学意义(P>0.05),且同一时间点两组CD4^(+)T/CD8^(+)T比值及B细胞计数的差异均无统计学意义(P>0.05)。复阳组入院时的CD4^(+)T计数最低,从出院时至出院后2个月CD4^(+)T计数无明显变化,差异无统计学意义(P>0.05);未复阳组从入院时至出院1个月CD4^(+)T计数的变化差异无统计学意义(P>0.05),出院2个月时CD4^(+)T计数较前明显升高(P<0.05)。结论核酸“复阳”主要发生在出院后1个月内,未发现与住院时间、基础疾病发生率、COVID-19分型等临床特征及实验室检查指标有关。但在出院早期CD4^(+)T细胞计数仍明显偏低,T细胞功能被抑制可能与病毒未被彻底清除致核酸复阳有关。

Objective To compare the clinical characteristics of COVID-19 patients with or without re-positive nucleic acid after discharge in order to explore the influencing factors of SARS-CoV-2 nucleic acid turning re-positive and analyze the dynamic changes of lymphocytes subsets of patients with COVID-19 during the rehabilitation period.Methods COVID-19 patients who were discharged from the Public and Health Clinical Center of Chengdu and referral in the hospital after half a month,1 month,and 2 months(5 days before or after each time point)were followed up.General clinical data and laboratory test results were collected.Influencing factors of nucleic acid turning re-positive in rehabilitation patients with COVID-19 were analyzed by Logistic regression analysis.The dynamic changes of lymphocyte subsets were alos analyzed.Results 81%(25/31)cases in the re-positive group had re-positive RT-PCR results of virus nucleic acid within 15 days after discharge.There were 3 cases with re-positive RT-PCR again at the time of 2 months after discharge.Patients in the repositive group were older than those in the non re-positive group,and the proportion of males was lower than that in the non re-positive group(P<0.05).The alanine aminotransferase(ALT)levels of patients in the re-positive group at admission and discharge were both lower than those in the non re-positive group(P<0.05).Multivariate Logistic analysis showed that the selected indicators were not independently related to nucleic acid turning re-positive(P>0.05).There was no significant difference in CD4^(+)T/CD8^(+)T and B cell counts between patients at different time points(P>0.05);the difference in CD4^(+)T/CD8^(+)T and B cell counts between two groups at the same time point had no statistical significance(P>0.05).The CD4^(+)T counts at admission of the patients was lower than other time point in the re-positive group,and there was no significant change in the CD4^(+)T counts from the time of discharge to 2 months after discharge(P>0.05).There was no statistically significant change in the CD4^(+)T counts from the time of admission to 1 month after discharge in the non re-positive group(P>0.05),and the CD4^(+)T counts were significantly higher at the time of 2 months after discharge than before(P<0.05).Conclusions Re-positive RT-PCR of virus nucleic acid mainly occurred within 1 month after discharge in patient with COVID-19.There were no exact evidences showed that re-positive RT-PCR were related with any clinical characteristics such as hospital stay,the incidence of underlying diseases,COVID-19 classification and any laboratory indicators.CD4^(+)T count was still significantly lower than normal in the early stage of discharge.Inhibition of T cell function might be related to the incomplete elimination of virus and re-positive RT-PCR of virus nucleic acid.