奥密克戎轻型及无症状感染老年患者核酸阳性持续时间的影响因素分析

Analysis of factors influencing viral shedding time in elderly patients with mild and asymptomatic Omicron infection

目的分析奥密克戎轻型及无症状感染老年患者核酸阳性持续时间的影响因素。方法回顾性收集2022年4月14日-5月1日收治于上海国家会展中心方舱医院第四分院一病区的1441例奥密克戎轻型及无症状感染老年(≥60岁)患者的临床资料,比较不同年龄、性别、疫苗接种针数,以及是否合并高血压病、糖尿病的奥密克戎患者的核酸阳性持续时间。采用Pearson检验分析患者年龄与核酸阳性持续时间的关系,Kaplan-Meier曲线和Log-rank检验评估不同临床特征老年患者核酸阳性持续时间的差异检验,多因素Cox风险回归分析老年奥密克戎患者核酸阳性持续时间的影响因素。结果1441例老年患者中男791例(54.9%),女性650例(45.1%)。未接种疫苗者513例(35.6%),接种1针疫苗者29例(2.0%),接种2针疫苗者405例(28.1%),接种3针疫苗者494例(34.3%)。与60~70岁患者相比,70~80岁患者核酸阳性持续时间更长(P<0.001)。合并高血压、糖尿病患者的核酸阳性持续时间与不合并者比较更长(P<0.05)。疫苗接种方面,接种2针或3针疫苗者的核酸阳性持续时间明显短于接种1针或未接种者(P<0.05)。患者核酸阳性持续时间与年龄呈正相关(R2=0.029,P<0.001)。Kaplan-Meier生存曲线分析显示,不同疫苗接种次数患者的核酸阳性持续时间有明显差异(P<0.001);年龄≥70岁,合并高血压病、糖尿病患者的核酸阳性时间均较长(P<0.05)。多因素Cox风险回归分析结果显示,年龄≥70岁是核酸阳性持续时间较长的危险因素,接种过2针及3针疫苗是核酸阳性持续时间较长的保护因素(P<0.05)。结论在奥密克戎轻型及无症状感染老年患者中,随着年龄增长,核酸阳性持续时间延长,接种过2针及以上疫苗者的核酸阳性持续时间明显缩短。

Objective To analyze the potential factors influencing the viral shedding time(duration of nucleic acid positivity)in elderly patients with mild and asymptomatic infection.Methods The clinical data of 1141 elderly(≥60 years)patients with mild and asymptomatic Omicron infection who were admitted to National Exhibition and Convention Center(Shanghai)Cabin Hospital from April 14,2022 to May 1,2022 were retrospectively collected,viral shedding time of patients were compared between different groups(age,gender,number of vaccination,hypertension,diabetes).Pearson analysis was adopted to analyze the relationship between age and viral shedding time.Kaplan-Meier curve and Log-rank test were used to evaluate the viral shedding time in elderly patients with different clinical characteristics.Multivariate Cox proportional-hazards regression model was adopted to analyze the factors influencing viral shedding time in elderly patients with Omicron.Results Among 1441 patients,791(54.9%)males and 650(45.1%)females.There were 513(35.6%)patients receiving 0 dose of vaccine,29(2.0%)patients received 1 dose of vaccine,405(28.1%)patients received 2 doses of vaccine,494(34.3%)patients received 3 doses of vaccine.Compared with patients aged 60 to 70 years,patients aged 70 to 80 years had longer viral shedding time(P<0.001).The viral shedding time in patients with hypertension and diabetes was longer than that in patients without hypertension and diabetes(P<0.05).In terms of vaccination,the viral shedding time of patients receiving 2 or 3 doses of vaccine was significantly shorter than that of patients receiving 1 dose of vaccine or none(P<0.05).There was a positive correlation between patient age and viral shedding time,with an R2=0.029(P<0.001).Kaplan-Meier curve showed that there existed significant difference in viral shedding time between the patients with different vaccination doses(P<0.001),and patients with age≥70,hypertension and diabetes were all associated with prolonged viral shedding time(P<0.05).Cox regression analysis showed that the age≥70 years was a risk factor for prolonged viral shedding time,and 2 or 3 doses of vaccine was a protective factor for prolonged viral shedding time(P<0.05).Conclusions Among the elderly population,the viral shedding time would gradually increase with age.Patients who received≥2 doses of vaccine would have reduced viral shedding time compared with those who received<2 doses of vaccine.