循环阈值、铁蛋白、CRP及SAA与COVID-19患者疾病严重程度的相关性研究

The Relationship Between Cycle Threshold,Serum Ferritin,CRP,SAA andDisease Severity in Patients Diagnosed with COVID-19

目的分析不同临床分型新型冠状病毒肺炎(corona virus disease 2019,COVID-19)患者新冠病毒核酸循环阈值(cycle threshold,Ct值)、血清铁蛋白(serum ferritin,SF)、C-反应蛋白(C-reactive protein,CRP)及全血血清淀粉样蛋白A(serum amyloid A,SAA)检测结果,探讨其与COVID-19疾病严重程度之间的关系。方法选取2021年1月至2月石家庄市人民医院收治的COVID-19确诊患者81例,根据新型冠状病毒诊疗方案(试行第八版)分型标准分为重症组(24例)和轻症组(57例),分别统计其入院后新型冠状病毒核酸循环阈值、血清铁蛋白、CRP及全血SAA的检测结果,分析以上指标与疾病严重程度的关系。结果重症组患者病毒核酸循环阈值在入院后多个时间点均显著低于轻症组(P<0.05);同时,与轻症组相比,重症组患者核酸阳性率更高,阳性持续时间更长,两者差异具有统计学意义(P<0.05);重症组患者血清铁蛋白、CRP和SAA均显著高于轻症组(P<0.05);ROC分析结果表明血清铁蛋白、CRP及全血SAA可用于COVID-19患者疾病严重程度分级(AUC分别为0.961、0.967、0.952),同时,确定了3指标用于COVID-19疾病严重程度分级的临界值分别为:204.95ng/mL、26.70mg/L、144.28mg/L;另外,相关性分析发现CRP和SAA均与新冠病毒核酸循环阈值呈负相关(P<0.05),未发现铁蛋白与循环阈值之间的相关性(P>0.05)。结论新型冠状病毒核酸循环阈值、阳性持续时间、血清铁蛋白、CRP及全血SAA的结果均与COVID-19疾病严重程度相关,监测这些指标对病情判断、疾病分级及预后评估均有重大意义。

Objective By analyzing the detection results of the Ct value of the viral nucleic acid(RNA),serum ferritin,CRP and whole blood SAA in patients diagnosed with different clinical types of COVID-19,to explore the relationship between these indexes and the severity of COVID-19.Methods Eighty-one COVID-19 diagnosed patients in Shijiazhuang People’s Hospital from January,2021 to February,2021 were selected and divided into two groups:the severe group(24 cases)and mild group(57 cases),according to the New Coronavirus diagnosis and treatment plan(Trial Eighth Edition).Test results of ferritin,CRP,SAA and the Ct value of the RNA of SARS-CoV-2 were recorded,then the relationship between these indexes and the severity of disease was analyzed.Results Ct value of the severe group was significantly lower than that of the mild group at multiple time points after admission(P<0.05).Compared with the mild group,the positive rate of RNA in the severe group was higher and the duration of RNA positive time was longer(P<0.05).The test results of serum ferritin,CRP and SAA of the severe group were significantly higher than those of the mild group(P<0.05).ROC analysis showed that serum ferritin,CRP and whole blood SAA could be used to grade the severity of the disease in patients with COVID-19(AUC:0.961,0.967 and 0.952,respectively).The cut-off for grading the severity of the disease were 204.95ng/mL,26.70mg/L and 144.28mg/L,respectively.In addition,correlation analysis showed that CRP and SAA were negatively correlated with Ct value of the RNA of SARS-CoV-2(P<0.05),but no correlation was found between ferritin and Ct value(P>0.05).Conclusion The test results of serum ferritin,CRP,whole blood SAA,Ct value and the duration of RNA positive time are both related to the severity of COVID-19.Monitoring these indicators is of great significance in judging the disease condition,grading disease and evaluating prognosis.