新型冠状病毒肺炎患者康复期血清特异性IgM、IgG抗体监测及其影响因素分析

Monitoring of serum specific IgM and IgG antibodies in patients with COVID-19 during convalescence and analysis of the influencing factors

目的动态监测新型冠状病毒肺炎(COVID-19)患者康复期血清特异性IgM、IgG抗体水平变化,并探讨其影响因素。方法选取COVID-19康复患者60例,其中轻型+普通型32例、重型+危重型28例。采用化学发光法检测患者出院即刻及出院第4、8、12、16、20、24周的血清IgM、IgG抗体水平,并判断抗体阳性情况、记录抗体阳性持续时间。采用COX模型分析血清IgM、IgG抗体阳性持续时间的危险因素,线性回归法分析血清IgG抗体峰值的影响因素。结果60例患者出院即刻及出院第4、8、12、16、20、24周血清IgM抗体中位水平分别为3.62、1.27、0、0、0、0、0 s/co,血清IgG抗体分别为42.68、62.00、51.43、48.16、30.65、19.14、12.99 s/co。60例患者出院即刻及出院第4、8、12、16、20、24周血清IgM抗体阳性率分别为98.3%、50.0%、0、0、0、0、0,血清IgG抗体阳性率分别为100%、100%、100%、91.6%、71.2%、54.1%、20.3%;血清IgM、IgG抗体中位阳性持续时间分别为4周(95%CI:3.10~4.91周)及20周(95%CI:19.02~20.98周)。轻型+普通型、重型+危重型患者IgM抗体中位阳性持续时间比较差异无统计学意义(P>0.05),前者IgG抗体中位阳性持续时间短于后者(P<0.05)。COX单因素及多因素分析结果显示,患者血清IgM抗体阳性持续时间与性别、年龄、基础疾病及临床分型均无关(P均>0.05),临床分型是患者血清IgG抗体阳性持续时间的独立影响因素(P<0.05)。≥60岁、合并基础疾病、临床分型为重型+危重型的患者血清IgG抗体峰值较高(P均<0.05),临床分型是患者血清IgG抗体峰值的独立影响因素(P<0.05)。结论COVID-19患者康复期内特异性IgM、IgG抗体水平及阳性率均逐渐降低,重型及危重型患者较轻型及普通型患者IgG抗体阳性持续时间更长且峰值更高。

Objective To dynamically detect the changes of serum specific IgM and IgG antibodies in patients with corona virus disease 2019(COVID-19)during convalescence and to explore their influencing factors.Methods Sixty COVID-19 recovered patients were selected,including 32 cases of mild-moderate type and 28 cases of severe-critical type.The serum IgM and IgG antibody levels of the patients at discharge and at week 4,8,12,16,20,and 24 after discharge were detected by chemiluminescence method,and the positive rate was calculated and the positive time was recorded.The risk factors for the antibody positive duration of serum IgM and IgG were analyzed by COX model,and the risk factors for the peak of serum IgG antibody were analyzed by linear regression method.Results The median levels of serum IgM an⁃tibody in 60 patients were 3.62,1.27,0,0,0,0,and 0 s/co at discharge and at week 4,8,12,16,20,and 24 after discharge,respectively.The median levels of serum IgG antibody were 42.68,62.00,51.43,48.16,30.65,19.14,and 12.99 s/co,respectively.The positive rates of serum IgG antibody at discharge and at week 4,8,12,16,20,and 24 after discharge were 100%,100%,100%,91.6%,71.2%,54.1%and 20.3%,respectively.The median duration of positive IgM and IgG antibodies were 4 weeks(95%CI 3.10-4.91)and 20 weeks(95%CI 19.02-20.98),respectively,after discharge.During the rehabilitation period,there was no statistically significant difference in the median duration of positive IgM antibody between the mild-moderate group and the severe-critical group(P>0.05),the median duration of positive IgG antibody in the former was shorter than that in the latter(P<0.05).COX univariate and multivariate analysis showed that the duration of positive serum IgM antibody was not related to gender,age,underlying diseases or clinical clas⁃sification(all P>0.05),and clinical classification was an independent risk factor for the duration of positive serum IgG antibody(P<0.05).The peak of serum IgG antibody was higher in patients older than 60 years old,with underlying dis⁃eases and in the severe-critical group(all P<0.05).The peak of serum IgG antibody was higher in the severe-critical group,and the clinical classification was an independent risk factor affecting the peak of serum IgG antibody(P<0.05).Conclusions The levels and positive rates of specific IgM and IgG antibody antibodies in COVID-19 patients gradually decrease during the rehabilitation period.The severe-critical COVID-19 cases have longer duration of positive IgG anti⁃body and higher peak during the rehabilitation period than the mild-moderate cases.