感染奥密克戎变异株的2019冠状病毒病轻型和普通型患者核酸检测转阴时间影响因素分析

Influencing factors of nucleic acid negative conversion in patients with mild and common COVID-19 induced by the Omicron variant of SARS-COV-2

目的:观察感染奥密克戎变异株的2019冠状病毒病(COVID-19)轻型和普通型患者临床特征,分析影响患者病毒核酸检测转阴时间的相关因素。方法:回顾性分析2022年4月12日至5月26日上海某方舱医院收治的1781例COVID-19患者的临床资料,包括患者年龄、性别、身高、体重、临床症状、基础疾病史、COVID-19疫苗接种情况、治疗用药情况及核酸检测转阴时间等。采用单因素分析和多因素logistic回归分析患者核酸检测转阴时间的影响因素。结果:1781例患者中,男性995例,女性786例,年龄中位数为39(30,52)岁,超重偏肥胖[体质指数(BMI)为24kg/cm^(2)以上]727例(40.8%),存在基础疾病413例(23.2%);未接种COVID-19疫苗205例(11.5%),接种疫苗1576例(88.5%);有1种及以上症状1233例(69.2%),以咳嗽(60.3%)、咳痰(50.4%)、发热(36.9%)多见;接受中药治疗1444例(81.0%),西药治疗78例(4.4%),中西医结合治疗14例(0.8%),未接受药物治疗245例(13.8%),所有患者经过对症处理后均改善,全部痊愈出院,核酸检测转阴中位时间为10.3(7.4,12.4)d。单因素和多因素分析结果显示,年龄为60岁及以上(OR=1.537,95%CI:1.116~2.115,P<0.01)、BMI为24kg/cm^(2)以上(OR=1.344,95%CI:1.106~1.634,P<0.01)、合并高血压(OR=1.518,95%CI:1.094~2.106,P<0.05)是患者核酸检测转阴时间延长的独立危险因素;接种COVID-19疫苗(OR=0.548,95%CI:0.398~0.755,P<0.01)是保护因素,即接种COVID-19疫苗核酸检测转阴时间缩短。结论:奥密克戎变异株感染的COVID-19患者临床症状相对较轻,病情隐匿,患者年龄为60岁及以上、未接种COVID-19疫苗、BMI为24kg/cm^(2)以上、合并高血压是核酸检测转阴时间延长的独立影响因素。

Objective:To observe the clinical characteristics of mild and common COVID-19 patients infected with the Omicron variant,and to analyze related factors affecting the time to negative conversion of viral nucleic acid detection.Methods:Clinical data of 1781 patients with coronavirus disease 2019(COVID-19)admitted to a cabin hospital in Shanghai from April 12 to May 26,2022,were retrospectively analyzed,including age,gender,height,weight,clinical symptoms,comorbid diseases,COVID-19 vaccination,treatment,and nucleic acid negative conversion time.Univariate and multivariate logistic regression analyses were used to analyze the influencing factors of nucleic acid negative conversion time.Results:Among the 1781 patients,995 were male and 786 were female,with a median age of 39(30,52)years.There were 727 patients(40.8%)with overweight and obesity[body mass index(BMI)>24 kg/cm^(2))and 413 patients(23.2%)had comorbid diseases.205 cases(11.5%)were not vaccinated while 1576 cases were vaccinated.There were 1233 cases(69.2%)with one or more symptoms.The main clinical symptoms were cough(60.3%),expectoration(50.4%)and fever(36.9%).1444 cases(81.0%)were treated with Chinese medicine,78 cases(4.4%)were treated with western medicine,14 cases(0.8%)were treated with integrated Chinese and western medicine,and 245 cases(13.8%)did not receive any medical treatment.All patients improved and were discharged.The median nucleic acid negative conversion time was 10.3(7.4,12.4)d.Univariate and multivariate analysis showed that,age≥60 years(OR=1.537,95%CI:1.116-2.115,P<0.01),BMI>24 kg/cm^(2)(OR=1.344,95%CI:1.106-1.634,P<0.01)and hypertension(OR=1.518,95%CI:1.094-2.106,P<0.05)were independent risk factors for prolonged nucleic acid negative conversion.COVID-19 vaccination(OR=0.548,95%CI:0.398-0.755,P<0.01)was a protective factor,that is,vaccination shortened the time for the nucleic acid test to become negative.Conclusions:The symptoms of the Omicron variant infection were relatively mild and occult.Age≥60 years old,comorbid hypertension,no vaccination and BMI>24 kg/cm^(2)are independent influencing factors for prolonged nucleic acid negative conversion.