新型冠状病毒性肺炎核酸“复阳”再入院患者临床特征分析

Clinical characteristics of re-hospitalized COVID-19 patients with re-positive results in nucleic acid detection

目的通过比较新型冠状病毒性肺炎(COVID-19)核酸复验阳性(复阳)再入院患者和非复验阳性入院患者的临床特征,为管理“复阳”COVID-19患者提供参考。方法采用回顾性病例,纳入武汉市中心医院后湖院区的3个COVID-19救治病区(发热6、10、11病区)2020年2月25日—3月20日之间的COVID-19患者。收集患者入院时的临床参数和结局参数,根据是否为“复阳”入院将患者分为“复阳组”与“非复阳组”,比较两组患者的临床参数。结果83例患者中有10例“复阳”患者,平均年龄(53.00±9.94)岁。平均初始症状发生至本次入院时间(36.10±11.55)d,中位时间为41d,平均住院(16.10±4.80)d。“复阳”患者再入院时的症状普遍较轻,均无发热,最常见的症状为咳嗽。平均MuLBSTA评分3.10±3.14,炎症指标(CRP、IL-6)均显著低于“非复阳”患者。“复阳”患者大部分仍存在肺部影像改变,但程度较“非复阳”患者轻,表现为病灶局限,范围较小。83例患者共执行核酸检验499例次,阳性标本95例次,其中“复阳”患者74例次,阳性标本14例次,与“非复阳”患者无显著差异。8例“复阳”患者在住院期间仍可检测到核酸阳性,其中有3例在入院后仍表现为持续或反复核酸检测阳性,较“非复阳”患者显著。无一例“复阳”患者院内发生病情进展和不良结局。结论本组“复阳”患者病程均处于恢复期,症状轻微,虽然仍存在肺部异常影像和核酸间歇阳性现象,但预后良好,未发现病毒传播依据。

Objective By comparing the clinical characteristics of re-hospitalized COVID-19patients being re-positive in nucleic acid test and those of non-repositive patients,this study provides reference for the management of re-positive COVID-19patients.Methods This retrospective study included the COVID-19patients treated in 3COVID-19wards(Fever wards 6,10and 11)of Houhu Division of Wuhan Central Hospital from February 25to March 20,2020.The clinical parameters and outcome parameters of patients at admission were collected,and these patients were divided into“re-positive group”and“non-repositive group”according to whether they were re-positive at admission.The clinical parameters of two groups were compared.Results Ten of the 83patients were re-positive with an average age of(53.00±9.94)years.The mean interval time from the onset of initial symptoms to this admission was(36.10±11.55)days,and the median time was 41days.The mean hospital stay was(16.10±4.80)days.The symptoms of re-positive patients were generally mild at readmission without fever,and the most common symptom was cough.The mean MuLBSTA score(3.10±3.14),and the inflammatory indexes(CRP and IL-6)were significantly lower than those of the non-repositive patients.Most of the re-positive patients still had pulmonary imaging changes,but the degree was less than that of the non-repositive patients,showing limited lesions with small range.83patients ran a total of 499nucleic acid tests,with 95positive samples.Among them,there were 74re-positive cases and 14positive cases,without significant difference from non-repositive patients.8re-positive patients were still positive in nucleic acid test during hospitalization.Among them,3patients still showed continuous or repeated positive in nucleic acid tests after admission,with significant difference from non-repositive patients.None of the re-positive patients had disease progression or adverse outcomes in hospital.Conclusion The disease course of this group of re-positive patients is in the convalescence stage,with mild symptoms.Although there are still abnormal lung imaging and intermittent positive results in nucleic acid tests,the prognosis is good and there is no evidence of virus transmission.