新型冠状病毒肺炎患者鼻咽拭子核酸阴转时间的影响因素

Influencing factors for negative conversion time of viral RNA from nasopharyngeal swabs of patients with coronavirus disease 2019

目的:分析新型冠状病毒肺炎(COVID-19)患者鼻咽拭子新型冠状病毒(SARS-CoV-2)核酸阴转时间的影响因素。方法:本项单中心回顾性病例对照研究共收集2020年6月11日至2020年7月1日首都医科大学附属北京地坛医院收治的121例确诊为COVID-19患者的临床资料,采用Cox比例风险回归模型分析COVID-19患者鼻咽拭子SARS-CoV-2核酸阴转时间的独立影响因素。结果:121例COVID-19患者发病至鼻咽拭子核酸检测阴转时间为[27(23,34)]d。多因素Cox回归分析提示年龄>45岁(HR=0.583、95%CI:0.388~0.877、P=0.010)和体温>39℃(HR=0.482、95%CI:0.254~0.914、P=0.025)均为影响SARS-CoV-2核酸阴转时间的独立危险因素;CD8^(+)T细胞>300个/μl(HR=1.708、95%CI:1.102~2.647、P=0.017)均为SARS-CoV-2核酸阴转时间的独立保护因素。结论:年龄>45岁、高热及CD8^(+)T细胞≤300个/μl等预测因子有助于临床医生早期识别可能出现SARS-CoV-2核酸阳性持续时间较长的COVID-19住院患者,促进改善治疗策略及调整隔离方案。

Objective To investigate the clinical and laboratory characteristics which influence the negative conversion time of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)ribonucleic acid(RNA)of nasopharyngeal swab in patients with coronavirus disease 2019(COVID-19).Methods Total of 121 patients diagnosed as COVID-19 were admitted to Beijing Ditan Hospital,Capital Medical University,from June 11st 2020 to July 1st 2020.Clinical data of these patients were collected in this single-center retrospective case-control study.Cox proportional hazard regression model analysis was used to investigate the independent factors influencing negative conversion time of virus RNA in nasopharyngeal swabs of patients with COVID-19.Results The period from illness onset to the first day of the two consecutive negative results of nucleic acid of 121 patients with COVID-19 were[27(23,34)]days.Multivariate Cox regression analysis indicated that older than 45 years old(HR=0.583,95%CI:0.388-0.877,P=0.010)and body temperature>39℃(HR=0.482,95%CI:0.254-0.914,P=0.025)were all independent risk factors for negative conversion time of SARS-CoV-2 RNA,while CD8^(+)T cells>300 cells/μl(HR=1.708,95%CI:1.102-2.647,P=0.017)was an independent protective factor affecting negative conversion time of SARS-CoV-2 RNA.Conclusions Predictors such as age>45 years old,hyperthermia and CD8^(+)T lymphocyte count≤300 cells/μl might help clinicians early identify the patients who may present with a longer positive duration of SARS-CoV-2 RNA,and adjust treatment strategies and isolation protocols.