手足口病患儿的肠道病毒核酸转阴时间探讨

目的探讨手足口病患儿的肠道病毒核酸转阴时间,寻找手足口病的传播规律。方法收集临床确诊手足口病患儿,采集患儿的咽拭子、唾液及粪便样本,采用荧光定量PCR技术筛选出肠道病毒71(EV71)、柯萨奇病毒A组16型(Cox A16)核酸阳性的58例患儿,随后根据病毒类型及疾病严重程度,将研究对象分为EV71轻症组、EV71重症组、Cox A16轻症组、Cox A16重症组,分析4组患儿3种样本的肠道病毒核酸转阴情况。结果 58例手足患儿中,EV71阳性38例(66%),Cox A16阳性20例(34%)。EV71阳性者中,轻症20例、重症18例;Cox A16阳性者中,轻症11例、重症9例。EV71患儿的粪便样本最长排毒时间为63 d,Cox A16患儿的粪便样本最长排毒时间为42 d。EV71及Cox A16重症组患儿的粪便样本在起病后的肠道病毒核酸转阴时间均长于同组的咽拭子和唾液样本(P均<0.05)。EV71及Cox A16轻症组的粪便、咽拭子、唾液样本肠道病毒核酸转阴时间均短于重症组对应的样本(P均<0.05)。结论手足口病患儿排毒时间与疾病严重程度相关,病情越严重其排毒时间越长。疾病早期应采集3类样本同时进行检测,疾病后期应重点对粪便样本进行检测。

Early therapeutic interventions of traditional Chinese medicine in COVID-19 patients:A retrospective cohort study

Objective:To observe the early interventions of traditional Chinese Medicine(TCM)on the conversion time of nucleic acid in patients with coronavirus disease 2019(COVID-19),and find possible underlying mechanisms of action.Methods:A retrospective cohort study was conducted on 300 confirmed COVID-19 patients who were treated with TCM,at a designated hospital in China.The patients were categorized into three groups:TCM1,TCM2 and TCM3,who respectively received TCM interventions within 7,8–14,and greater than15 days of hospitalization.Different indicators such as the conversion time of pharyngeal swab nucleic acid,the conversion time of fecal nucleic acid,length of hospital stay,and inflammatory markers(leukocyte count,and lymphocyte count and percentage)were analyzed to observe the impact of early TCM interventions on these groups.Results:The median conversion times of pharyngeal swab nucleic acid in the three groups were 5.5,7 and16 d(P<0.001),with TCM1 and TCM2 being statistically different from TCM3(P<0.01).TCM1(P<0.05)and TCM3(P<0.01)were statistically different from TCM2.The median conversion times of fecal nucleic acid in the three groups were 7,9 and 17 d(P<0.001).Conversion times of fecal nucleic acid in TCM1 were statistically different from TCM3 and TCM2(P<0.01).The median lengths of hospital stay in the three groups were 13,16 and 21 d(P<0.001).TCM1 and TCM2 were statistically different from TCM3(P<0.01);TCM1 and TCM3 were statistically different from TCM2(P<0.01).Both leucocyte and lymphocyte counts increased gradually with an increase in the length of hospital stay in TCM1 group patients,with a statistically significant difference observed at each time point in the group(P<0.001).Statistically significant differences in lymphocyte count and percentage in TCM2(P<0.001),and in leucocyte count(P=0.043)and lymphocyte count(P=0.038)in TCM3 were observed.The comparison among the three groups showed a statistically significant difference in lymphocyte percentage on the third day of admission(P=0.044).Conclusion:In this study,it was observed that in COVID-19 patients treated with a combination of Chinese and Western medicines,TCM intervention earlier in the hospital stay correlated with faster conversion time of pharyngeal swab and fecal nucleic acid,as well as shorter length of hospital stay,thus helping promote faster recovery of the patient.The underlying mechanism of action may be related to improving inflammation in patients with COVID-19.

儿童新型冠状病毒Omicron变异株感染病毒核酸转阴特点及其影响因素

目的了解上海新型冠状病毒Omicron变异株感染患儿鼻咽拭子新型冠状病毒核酸转阴特点及其影响因素。方法回顾性分析收集2022年4月25日至6月8日于上海交通大学医学院附属儿童医院(上海市新型冠状病毒感染患儿定点救治医院)因确诊新型冠状病毒感染住院的177例患儿的临床症状、实验室检查等资料。根据患儿胸部影像学表现分为轻型、普通型组;按感染年龄将未接种疫苗患儿分为<3岁、3~<18岁组;根据疫苗接种情况将3~<18岁患儿分为未接种、接种1剂次、接种2剂次组。组间比较采用独立样本t检验、方差分析,多因素分析采用多元线性回归分析。结果177例新型冠状病毒Omicron变异株感染患儿中男96例、女81例,发病年龄3(1,6)岁,病毒核酸转阴时间为(10.3±3.1)d。轻型138例、普通型39例。3~<18岁新型冠状病毒疫苗接种适龄儿童中未接种疫苗55例、接种1剂次5例、接种2剂次36例。接种2剂次疫苗患儿末次疫苗接种时间≤6个月比>6个月病毒核酸转阴时间更短[(7.1±1.9)比(10.8±3.0)d,t=-3.23,P=0.004]。单因素分析显示新型冠状病毒核酸转阴时间受未接种疫苗患儿年龄、基础疾病、消化道症状、白细胞计数、中性粒细胞比例、淋巴细胞比例、新型冠状病毒疫苗接种情况的影响(t=3.87、2.55、2.04、4.24、3.51、2.92,F=16.27,均P<0.05);多元线性回归分析显示年龄增长(β=-0.33,95%CI-0.485~-0.182,P<0.001)、接种新型冠状病毒灭活疫苗剂次增多(β=-0.79,95%CI-1.463~-0.120,P=0.021)是患儿病毒核酸转阴时间缩短的保护因素,淋巴细胞比例减少(β=-0.02,95%CI-0.044~-0.002,P=0.031)、有基础疾病(β=1.52,95%CI 0.363~2.672,P=0.010)则是患儿病毒核酸转阴时间延长的危险因素。结论淋巴细胞比例减少、有基础疾病的新型冠状病毒Omicron变异株感染患儿病毒核酸转阴时间长,年龄增长、接种新型冠状病毒灭活疫苗剂次增多患儿病毒核酸转阴时间短。

影响Omicron变异株感染轻型和普通型COVID-19患儿核酸转阴时间缩短因素分析

目的探讨Omicron变异株感染轻型与普通型新型冠状病毒疾病(COVID-19)患儿的临床特征及影响其核酸检测结果转为阴性(以下简称为"核酸转阴")时间缩短因素。方法选取2022年4月7日至5月20日上海交通大学医学院附属仁济医院南院区"亲子病房"集中收治的150例Omicron变异株感染轻型和普通型COVID-19患儿为研究对象。采用回顾性分析方法,根据这150例患儿的核酸转阴中位时间为13 d,将其分别纳入快转阴组(n=84,核酸转阴时间<13 d)和慢转阴组(n=66,核酸转阴时间≥13 d)。对2组患儿年龄、性别、轻型与普通型COVID-19患儿构成比、疫苗接种率、COVID-19相关临床表现及COVID-19发病48 h内系统炎症指数(SII)、中性粒细胞与淋巴细胞比值(NLR)、淋巴细胞与单核细胞比值(LMR)、血小板与淋巴细胞比值(PLR)等,进行成组t检验、Mann-Whitney U检验或χ2检验。采用多因素非条件logistic回归分析方法,分析影响Omicron变异株感染轻型与普通型COVID-19患儿核酸转阴时间缩短的因素。2组患儿合并基础疾病占比、采取对症治疗率等一般临床资料分别比较,差异均无统计学意义(P>0.05)。本研究遵循的程序符合2013修订的《世界医学协会赫尔辛基宣言》要求。结果①快转阴组患儿年龄、女性患儿比例、普通型COVID-19患儿比例、疫苗接种率,发热、咽痛、胃肠道症状发生率,均显著高于慢转阴组,而热峰、肌肉酸痛发生率,则均显著低于慢转阴组,2组比较,差异均有统计学意义(P<0.05)。②多因素非条件logistic回归分析结果显示,伴有咽痛、接种疫苗是轻型与普通型COVID-19患儿核酸转阴时间缩短的独立保护因素(OR=14.609、7.866,95%CI:1.108~192.697、1.313~47.121,P=0.042、0.024),而伴有肌肉酸痛、男性患儿则是其独立危险因素(OR=0.275、0.206,95%CI:0.087~0.874、0.083~0.511,P=0.029、0.001)。③快转阴组患儿SII为250.9×109/L(111.1×109/L,466.9×109/L),NLR为1.0(0.6,2.2),均分别显著高于慢转阴组的109.8×109/L(47.2×109/L,266.7×109/L)与0.5(0.2,1.2),并且差异均有统计学意义(Z=6.48、5.34,P=0.011、0.021)。快转阴组患儿LMR为4.1(2.5,9.4),显著低于慢转阴组的8.2(3.4,11.1),并且差异有统计学意义(Z=4.50,P=0.034)。结论轻型与普通型COVID-19患儿临床表现不典型,以发热、咳嗽为主,高SII、NLR及低LMR患儿核酸转阴时间较短,接种疫苗、伴有咽痛是促进核酸转阴时间缩短的保护性因素,伴有肌肉酸痛及男性是影响核酸转阴时间缩短的危险因素。