上海市方舱医院新型冠状病毒奥密克戎变异株成人感染者临床特征与核酸转阴时间的影响因素分析

Analysis of clinical characteristics and influencing factors of nucleic acid negative conversion time in adult patients infected with severe acute respiratory syndrome coronavirus-2 Omicron variant in Shanghai Shelter Hospital

目的分析上海市方舱医院收治的新型冠状病毒(新冠病毒)奥密克戎变异株感染成人患者的临床特征和核酸转阴时间的影响因素。方法选择2022年4月6日至21日作者作为援沪医疗队队员在上海市临港方舱医院B1-1F舱收治的确诊新冠病毒奥密克戎变异株成人感染者作为研究对象。收集患者临床资料及核酸检测结果,以核酸转阴时间8 d为界,比较核酸转阴时间>8 d和≤8 d两组患者临床资料的差异;采用多因素Logistic回归分析法分析影响核酸转阴时间的因素。结果共收治2705例奥密克戎变异株感染患者,男性和女性比例约为2∶1;年龄18~89岁,中位年龄47(34,54)岁;接种疫苗者2423例(占89.6%),其中接种2剂次及以上者2313例(占85.5%),无症状感染者2084例(占77.0%),轻型感染621例(23.0%),临床症状以咳嗽、咳痰、肌肉酸痛、发热为主;患者平均核酸转阴时间为(7.9±2.9)d。单因素分析显示,与核酸转阴时间≤8 d组比较,核酸转阴时间>8 d组患者的年龄更大〔岁:49(37,55)比46(33,54)〕,有症状者和接种≥2剂次疫苗患者的比例更低〔有症状:20.0%(212/1058)比24.8%(409/1647),接种≥2剂次疫苗:81.7%(864/1058)比88.0%(1449/1647),均P<0.05〕;多因素Logistic回归分析显示,年龄是影响病毒核酸转阴时间的危险因素〔优势比(odds ratio,OR)=1.015,95%可信区间(95%confidence interval,95%CI)为1.009~1.022,P<0.05〕;而接种≥2剂次疫苗和有症状则是保护因素(OR值分别为0.619、0.788,95%CI分别为0.498~0.769、0.651~0.953,均P<0.05)。结论奥密克戎变异株成人感染者以无症状为主,有症状者症状较轻,以咳嗽、咳痰、肌肉酸痛、发热为主,核酸转阴快。年龄是核酸转阴时间延长的独立危险因素,对于老年人临床应重点关注和保护,而接种≥2剂次疫苗则是较好的保护措施。

Objective To analyze the clinical characteristics and influencing factors of nucleic acid negative conversion time in adult patients infected with severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)Omicron variant infection in Shanghai Shelter Hospital.Methods From April 6 to 21,2022 the author as a member of the medical team to assist Shanghai,adults patients infected with SARS-CoV-2 Omicron variant who were admitted to Cabin B1-1F of Shanghai Lingang Shelter Hospital were enrolled as research object.The clinical data and nucleic acid test results were collected,and the difference of the clinical data between patients with nucleic acid conversion time>8 days and those with nucleic acid conversion time≤8 days was compared.Multivariate Logistic regression analyses were performed to analyze the factors affecting negative conversion time of nucleic acid.Results A total of 2705 patients infected with Omicron variant were collected.The male-to-female ratio was 2∶1,the overall median age was 47(34,54)years old,with a range from 18-89 years old.A total of 2423 cases(89.6%)were vaccinated with SARS-CoV-2 vaccine,and 2313 cases(85.5%)were vaccinated with two or more doses of vaccine.Among them,2084 cases(77.0%)were asymptomatic infections,and 621 cases(23.0%)were mild infections,whose major clinical symptoms were cough,sputum production,muscle soreness,and fever.The average nucleic acid negative conversion time in adult patients infected with SARS-CoV-2 Omicron variant were(7.9±2.9)days.Univariate analysis showed that patients in the negative conversion time>8 days group were older[years:49(37,55)vs.46(33,54)],had lower proportions of symptomatic,and two or more doses vaccinated patients compared with the negative conversion time≤8 days group[symptomatic:20.0%(212/1058)vs.24.8%(409/1647),two or more doses vaccine:81.7%(864/1058)vs.88.0%(1449/1647),both P<0.05].Multivariate Logistic regression analysis showed that age was the risk factor for the negative convention time[odds ratio(OR)=1.015,95%confidence interval(95%CI)was 1.009-1.022,P<0.05].However,two or more doses of vaccine and having clinical symptoms were protective factors(OR was 0.619 and 0.788,95%CI was 0.498-0.769,and 0.651-0.953,both P<0.05).Conclusions Most adult patients infected with Omicron variant were asymptomatic,and symptomatic patients had mild symptoms,mainly cough and sputum,muscle aches and fever,with short negative convention time.Age was an independent risk factor for prolonged negative convention time,and the elderly should be paid attention to and protected clinically.However,vaccination of two or more vaccines was a better protective measure.