肺部超声检查在血液透析合并新型冠状病毒感染中的临床研究

目的 探讨肺部超声检查在血液透析合并新型冠状病毒感染中的诊断及治疗策略,以期为临床同行提供参考依据。方法 分析1例成功治愈的维持性血液透析合并重型新型冠状病毒感染患者的诊断、治疗等基本临床资料,采用“新型冠状病毒感染”“血液透析”“肺部超声检查”作为关键词对中国知网、PubMed数据库2020-2023年发表的文献进行检索。结果 维持性血液透析合并新型冠状病毒感染患者经氧气治疗、抗病毒、抗炎、血液净化(利用肺部超声评估肺部B线变化)、抗感染、抗凝等治疗后痊愈出院,白细胞介素-6、淋巴细胞计数、C反应蛋白、降钙素原、红细胞沉降率、D-二聚体水平均正常,咽拭子新型冠状病毒核酸抗原检测阴性,床旁肺部超声检查提示双肺未见明显B线,肺部CT检查提示肺部渗出明显吸收。文献检索结果：共检索到文献35篇,排除16篇,最终保留可用文献19篇。结合病例分析及文献复习,对肺部超声检查在维持性血液透析合并新型冠状病毒感染中的临床诊断及治疗方法进行分析总结。结论 床旁肺部超声检查在识别和分层维持性血液透析合并重型新型冠状病毒感染患者方面非常有效,可即时、准确评估患者的容量状态,保证患者透析的充分性。     

新型冠状病毒肺炎:高凝、血栓形成及抗凝

新型冠状病毒肺炎(COVID?19)是由新型冠状病毒(SARS?CoV?2)引起的,其特征是炎症反应过度表达.SARS?CoV?2可触发COVID?19患者产生高凝和血栓形成,50％重症患者合并有高凝状态.高达40％的COVID?19患者合并有深静脉血栓形成(deep veinthrombosis,DVT)和肺栓塞(p...     

新型冠状病毒肺炎合并妊娠病例的临床与实验室指标分析

继2002年暴发的严重急性呼吸综合征冠状病毒(SARS-CoV)和2012年暴发的中东呼吸综合征冠状病毒(MERS-CoV)之后,新型冠状病毒(SARS-CoV-2)是引发人类重症肺炎的第3种跨物种屏障的致病冠状病毒[1]。2020年3月11日,世界卫生组织宣布新型冠状病毒肺炎(COVID-19)是全球性流行病事件。根据国家卫生健康委员会办公厅国家中医药管理局办公室发布的《新型冠状病毒肺炎诊疗方案(试行第七版)》,COVID-19患者的临床表现以发热、咳嗽、乏力为主,疾病早期白细胞计数及淋巴细胞计数正常或减少,肺部呈特征性影像学改变。危重型COVID-19患者可出现休克、呼吸衰竭、多器官功能衰竭。本文通过对3例妊娠合并COVID-19病例的临床特征、实验室检查结果、干预策略及妊娠结局进行分析,以期为临床医生诊断和治疗妊娠合并COVID-19患者提供参考。     

北京某综合三甲医院对COVID-19疑似和非疑似患者进行SARS-CoV-2核酸筛查结果分析

目的 以北京综合三甲医院为例,对新型冠状病毒肺炎(COVID-19)疑似患者和非疑似患者的新型冠状病毒(SARS-CoV-2)核酸筛查结果进行分析,为COVID-19的实验室诊断提供实验依据.方法 SARS-CoV-2核酸检测的咽拭子标本来自2595例患者,COVID-19疑似患者81例,非疑似患者2514例.咽拭子标...     

SARS-CoV-2抗体检测在新型冠状病毒肺炎诊断中的应用价值

目的探讨血清严重急性呼吸综合征冠状病毒(SARS-CoV-2)IgM和IgG抗体检测在新型冠状病毒肺炎(COVID-19)诊断中的价值。方法选取COVID-19患者173例(COVID-19组),其中140例SARSCoV-2首次核酸检测阳性,33例多次检测后呈阳性。以101例排除COVID-19的患者作为对照组。采用胶体金免疫层析法(CGIA)检测SARS-CoV-2 IgM和IgG抗体,采用荧光定量聚合酶链反应(PCR)检测SARS-CoV-2核酸。以临床诊断为金标准,分析SARS-CoV-2 IgM和IgG抗体诊断COVID-19的效能。结果 SARS-CoV-2 IgM和IgG抗体的敏感性分别为76.9%、74.6%,特异性分别为94.0%、95.1%,临床总符合率分别为83.2%、82.1%,与临床诊断的一致性均较好(kappa值分别为0.663、0.644)。受试者工作特征(ROC)曲线分析结果显示,SARS-CoV-2 IgM和IgG抗体诊断COVID-19的曲线下面积(AUC)均为0.85。结论 SARS-CoV-2抗体检测具有较高的敏感性、特异性和临床总符合率,可用于COVID-19的辅助诊断。     

COVID-19患者5种标本的SARS-CoV-2核酸与血浆IgM抗体检测结果分析

目的 分析不同标本类型与检测次数对新型冠状病毒(SARS-CoV-2)核酸检测结果的影响,评价SARS-CoV-2核酸与IgM抗体检测技术在新型冠状病毒肺炎(COVID-19)患者诊断中的应用.方法 连续3次(每天1次)采集患者的痰、咽拭子、血液、唾液和晨尿标本,实时荧光定量逆转录聚合酶链反应(qRT-PCR)检测SA...     

2例新型冠状病毒肺炎粪便SARS-CoV-2核酸阳性临床启示

目前中国新型冠状病毒肺炎(COVID-19)疫情仍十分严峻,及时、早期地识别COVID-19患者是控制疫情的关键步骤。而新型冠状病毒(SARS-CoV-2)核酸检测作为诊断COVID-19的金标准,不但对检测技术提出更高的要求,同时对不同病程患者如何选择标本类型也是一个挑战。本文报道2例COVID-19确诊病例的诊疗经过,并分析采用不同类型标本检测SARS-CoV-2核酸的检出情况,为临床诊断COVID-19时如何选择标本类型和如何提高核酸检出率提供参考。     

新型冠状病毒肺炎的中西医研究进展

自新型冠状病毒(SARS-CoV-2)感染的肺炎疫情发生以来,确诊人数不断增加,及时有效的预防、治疗成为目前对于该病的关键。通过文献阅读及临床数据综合来看,采用中西医结合治疗作用突出,效果显著,中医药已成为不可或缺的一部分。笔者就目前对于该病认识、病因病机、诊断治疗、临床疗效、预后康复做一综述。     

1例COVID-19患者的实验室指标变化及意义

新型冠状病毒(SARS-CoV-2)是单链正义 RNA病毒 ,属于 β 类冠状病毒 ,与严重急性呼吸综合征冠状病毒 (SARS-CoV )和中东呼吸综合症冠状病毒(MERS-CoV)同种属[1-2 ] . 现有的研究结果显示 ,新型冠状病毒肺炎(COVID-19)的传染性和病死率都非常高 ,围绕该病毒的诊断和治疗亟待突...     

抗原交叉反应对新型冠状病毒血清特异性抗体检测的影响

新型冠状病毒肺炎(coronavirus disease 19,COVID-19)疫情发展迅速,早期诊断成为疫情防控的关键。2020年3月3日国家卫生健康委员会发布了最新版本的《新型冠状病毒肺炎诊疗方案(试行第七版)》,新版诊疗方案在原有的核酸检测确诊标准上新增了血清新型冠状病毒(SARS-CoV-2)特异性IgM和IgG抗体作为病原学诊断标准之一。然而,SARS-CoV-2血清抗体检测可受其他亚型的冠状病毒影响,从而造成检测结果的假阳性。该文针对新型冠状病毒的生物学特性、抗体的产生及检测方法等方面进行讨论,为COVID-19的辅助诊断提供参考。     

新型冠状病毒IgM/IgG抗体在病程监测中的临床意义

目的评价新型冠状病毒(SARS-CoV-2)IgM/IgG抗体检测(化学发光法)在新型冠状病毒肺炎(COVID-19)病程监测和转归方面的临床意义。方法回顾性研究。收集2020年1月20日至2020年3月1日在天津市疾病预防控制中心核酸检测阳性的COVID-19确诊患者88例(115例血清样本)作为疾病组,排除COVID-19(核酸检测阴性)的其他疾病患者245例(245例血清样本)作为对照组。用化学发光法检测SARS-CoV-2 IgM和IgG抗体。结果 SARS-CoV-2 IgM抗体检测的敏感性、特异性分别为90.91%、100%;SARS-CoV-2 IgG抗体检测的敏感性、特异性分别为88.64%、100%;IgM和IgG抗体联合检测敏感性显著提高至96.59%,特异性为100%,与核酸检测的总符合率高达99.10%。SARS-CoV-2 IgM抗体水平在COVID-19病程中呈现先升高后降低的趋势,IgG抗体水平随着病程的进展逐渐升高。结论 SARS-CoV-2 IgM和IgG抗体化学发光法联合检测敏感性高,可作为COVID-19一种有效的辅助诊断,在病程监测和转归方面有一定的意义。     

新型冠状病毒特异性IgM/IgG抗体检测的临床应用价值

目的评价新型冠状病毒(SARS-CoV-2)特异性IgM和IgG抗体在新型冠状病毒肺炎(COVID-19)患者中的临床价值。方法收集2020年1月1日至3月13日在长江大学附属第一医院住院的COVID-19患者108例、疑似患者23例以及其他病例90例,采用化学发光法检测所有研究对象的SARS-CoV-2特异性IgM和IgG抗体,以SARS-CoV-2核酸RT-PCR检测结果作为比对标准,对其进行评价,并分析抗体与疾病病程之间的关系。结果确诊患者的首发症状以发热、咳嗽、乏力为主。重型/危重型患者的年龄明显高于普通型患者。IgM/IgG联合检测比IgM和IgG单独检测的敏感性高。IgM/IgG诊断的敏感性、特异性、准确性、阳性似然比、阴性似然比分别为98.1%、89.4%、93.7%、9.24、0.02。普通型和重型/危重型IgM或IgG抗体阳性率差异无统计学意义。不同时间段IgM/IgG抗体下降的程度不一样。结论 SARS-CoV-2特异性IgM和IgG抗体检测对COVID-19的诊断很重要,联合RT-PCR可以更好地排除或确诊,避免疾病漏诊。     

胶体金法与ELISA检测新型冠状病毒IgM和IgG抗体的临床诊断价值比较

目的 通过胶体金法与酶联免疫吸附测定(ELISA)检测新型冠状病毒(SARS-CoV-2)特异性抗体免疫球蛋白(Ig)M和IgG,评价2种方法在检测SARS-CoV-2特异性抗体中的诊断价值.方法 收集2020年1-2月在该院住院的患者81例,根据相关标准分为新型冠状病毒肺炎(COVID-19)确诊患者组38例,疑似患...     

新型冠状病毒IgM和IgG抗体不同检测方法在新型冠状病毒感染中的临床应用评价

目的探讨新型冠状病毒(SARS-CoV-2)IgM和IgG抗体不同检测方法在新型冠状病毒肺炎(COVID-19)中的应用。方法选取25例COVID-19患者,以同期20例排除SARS-CoV-2感染的患者作为对照组,分别采用磁微粒化学发光法和胶体金法检测所有对象的血清SARS-CoV-2 IgM和IgG抗体。同时检测COVID-19患者血清降钙素原(PCT)、铁蛋白及C反应蛋白(CRP)。结果化学发光法检测血清SARSCoV-2 IgM和IgG抗体的敏感性分别为48%和56%,特异性均为100%,胶体金法检测血清SARS-CoV-2 IgM和IgG抗体的敏感性分别为88%和76%,临床特异性均为100%。2种方法检测血清SARS-CoV-2 IgM和IgG抗体总符合率分别为68.9%和73.3%。25例COVID-19患者中有36%的患者血清PCT升高、72%的患者血清CRP升高、84%的患者血清铁蛋白水平升高。结论SARS-CoV-2 IgM和IgG抗体不同检测方法之间差异较大,用于COVID-19患者的临床诊断时应综合考虑。     

Rapid Serological Tests for SARS-CoV-2: Diagnostic Performance of 4 Commercial Assays

ObjectiveTo assess the diagnostic performance of lateral flow immunochromatographic assays (LFAs) of 4 different manufacturers to identify SARS-CoV-2 antibodies (IgM, IgG, or total), comparing them with the nucleic acid amplification test (NAAT) or the clinical defined test (definite or probable SARS-CoV-2 infection, respectively).MethodsOne hundred nineteen serum samples were randomly selected by convenience and distributed in the following groups: (1) group with SARS-CoV-2 infection (n = 82; RT-qPCR positive [definite, n = 70] and probable [n = 12]); (2) other diseases (n = 27; other viruses identified [n = 8] and SARS of other etiologies [n = 19]); and (3) healthy control group (n = 10). LFAs of 4 manufacturers were compared: MedTest Coronavirus (COVID-19) IgG/IgM (MedLevensohn, Brazil); COVID-19 IgG/IgM ECO Test (Ecodiagnóstica, Brazil); Camtech COVID-19 IgM/IgG Rapid Test Kit (Camtech Diagnostics Pte Ltd, Singapore); and 1-Step COVID-19 Test for total antibodies (Guangzhou Wondfo Biotech Co., China).ResultsThe 4 tests studied showed high diagnostic performance characteristics for the diagnoses of definite or probable SARS-CoV-2 infection. The best measures were for the Wondfo test: sensitivity (86.59%; 95% CI: 77.26–93.11%), specificity (100%; 90.51–100%), DOR (257; 60–1,008), LR+ (33.43; 4.82–231.85), LR− (0.13; 0.08–0.23), accuracy (90.76%; 84.06–95.29%), and Matthews correlation coefficient (MCC) 0.82. Although considering only the probable SARS-CoV-2 infection (PCR−) cases, all the kits studied showed limited values.ConclusionOur data demonstrate the excellent performance of LFA for the diagnoses of definite or probable SARS-CoV-2 infection. There was substantial heterogeneity in sensitivities of IgM and IgG antibodies among the different kits. LFA tests cannot replace molecular diagnostics but should be used as an additional screening tool.     

胶体金免疫层析法检测SARS-CoV-2血清抗体的临床价值探讨

目的通过对新型冠状病毒(SARS-CoV-2)免疫球蛋白(Ig)M和总抗体(即IgM/IgG)的检测,探讨应用胶体金免疫层析法(GICA法)在新型冠状病毒肺炎(COVID-19)诊断中的应用价值。方法收集76例患者共计83份血清,其中32例为SARS-CoV-2核酸阳性患者(确诊组),44例为SARS-CoV-2核酸阴性患者(对照组)。确诊组中7例患者为两次时间点采集标本。采用GICA法检测SARS-CoV-2 IgM和总抗体。结果GICA法检测SARS-CoV-2 IgM的灵敏度50.00%(16/32),特异度90.91%(40/44),符合率73.68%(56/76),阳性预测值80.00%(16/20)、阴性预测值71.43%(40/56);SARS-CoV-2总抗体检测的灵敏度68.75%(22/32)、特异度97.73%(43/44)、符合率85.53%(65/76)、阳性预测值95.65%(22/23)、阴性预测值81.13%(43/53)。GICA法检测SARS-CoV-2 IgM和总抗体的特异度均大于90%,符合率均大于70%,满足临床需求。结论GICA法检测SARS-CoV-2 IgM和总抗体,标本采集易标准化,报告时间快,灵敏度不高,但特异度较高,有辅助诊断的价值。     

Clinical application of SARS-CoV-2 antibody detection and monoclonal antibody therapies against COVID-19

The purpose of this study was to investigate the clinical application of severe acute respiratory distress syndrome coronavirus-2(SARS-CoV-2) specific antibody detection and anti-SARS-CoV-2 specific monoclonal antibodies(m Abs) in the treatment of coronavirus infectious disease 2019(COVID-19). The dynamic changes of SARS-CoV-2 specific antibodies during COVID-19 were studied. Immunoglobulin M(Ig M) appeared earlier and lasted for a short time, while immunoglobulin G(Ig G) appeared later and last...     

Interpretations of SARS-CoV-2 IgM and IgG antibody titers in the seroepidemiological study of asymptomatic healthy volunteers

IntroductionThe usefulness of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests in asymptomatic individuals has not been well validated, although they have satisfied sensitivity and specificity in symptomatic patients. In this study, we investigated the significance of IgM and IgG antibody titers against SARS-CoV-2 in the serum of asymptomatic healthy subjects.MethodsFrom June 2020, we recruited 10,039 participants to the project named the University of Tokyo COVID-19 Antibody Titer Survey (UT-CATS), and measured iFlash-SARS-CoV-2 IgM and IgG (YHLO IgM and IgG) titers in the collected serum. For the samples with increased IgM or IgG titers, we performed additional measurements using Elecsys Anti-SARS-CoV-2 Ig (Roche total Ig) and Architect SARS-CoV-2 IgG (Abbott IgG) and investigated the reactivity to N, S1, and receptor binding domain (RBD) proteins.ResultsAfter setting the cutoff value at 5 AU/mL, 61 (0.61%) were positive for YHLO IgM and 104 (1.04%) for YHLO IgG. Few samples with elevated YHLO IgM showed reactivity to S1 or RBD proteins, and IgG titers did not increase during the follow-up in any samples. The samples with elevated YHLO IgG consisted of two groups: one reacted to S1 or RBD proteins and the other did not, which was reflected in the results of Roche total Ig.ConclusionsIn SARS-CoV-2 seroepidemiological studies of asymptomatic participants, sufficient attention should be given to the interpretation of the results of YHLO IgM and IgG, and the combined use of YHLO IgG and Roche total Ig might be more reliable.     

Epidemiological study using IgM and IgG antibody titers against SARS-CoV-2 in The University of Tokyo,Japan (UT-CATS)

IntroductionThe worldwide pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has continued to date. Given that some of the patients with coronavirus disease 2019 (COVID-19) are asymptomatic, antibody tests are useful to determine whether there is a previous infection with SARS-CoV-2. In this study, we measured IgM and IgG antibody titers against SARS-CoV-2 in the serum of asymptomatic healthy subjects in The University of Tokyo, Japan.MethodsFrom June 2020, we recruited participants, who were students, staff, and faculty members of The University of Tokyo in the project named The University of Tokyo COVID-19 Antibody Titer Survey (UT-CATS). Following blood sample collection, participants were required to answer an online questionnaire about their social and health information. We measured IgG and IgM titers against SARS-CoV-2 using iFlash-SARS-CoV-2 IgM and IgG detection kit which applies a chemiluminescent immunoassay (CLIA) for the qualitative detection.ResultsThere were 6609 volunteers in this study. After setting the cutoff value at 10 AU/mL, 32 (0.48%) were positive for IgG and 16 (0.24%) for IgM. Of six participants with a history of COVID-19, five were positive for IgG, whereas all were negative for IgM. The median titer of IgG was 0.40 AU/mL and 0.39 AU/mL for IgM. Both IgG and IgM titers were affected by gender, age, smoking status, and comorbidities.ConclusionsPositive rates of IgG and IgM titers were relatively low in our university. Serum levels of these antibodies were affected by several factors, which might affect the clinical course of COVID-19.     

High clinical performance and quantitative assessment of antibody kinetics using a dual recognition assay for the detection of SARS-CoV-2 IgM and IgG antibodies

ObjectivesSeveral serological SARS-CoV-2 immunoassays have been developed recently but require external validation before widespread use. This study aims at assessing the analytical and clinical performance of the iFlash® anti-SARS-CoV-2 chemiluminescence assay for the detection of both IgM and IgG antibodies. The kinetics of the antibody response was also evaluated.Design & MethodsThe precision, carry-over, linearity, limit of blank, detection and quantification were assessed. Sensitivity analysis was performed by using 178 sera collected from 154 RT-PCR confirmed COVID-19 patients. The specificity analysis was performed from 75 selected non-SARS-CoV-2 sera with a potential cross-reaction to the SARS-CoV-2 immunoassay.ResultsThis iFlash® SARS-CoV-2 assay showed excellent analytical performance. After 2 weeks since symptom onset, the sensitivities for IgM and IgG were 62.2% (95% CI: 52.3–71.2%) and 92.9%% (95% CI: 85.7–96.7%), respectively by using the cut-off provided by the manufacturer. After cut-off optimization (i.e. >2.81 for IgM and >4.86 for IgG), the sensitivity for IgM and IgG were 81.6 (95% CI: 72.7–88.1%) and 95.9% (95% CI: 89.4–98.7%), respectively. Optimized cut-off for IgG improved the sensitivity to reach 100% (95%CI: 87.6–100) from 28 days since symptom onset.ConclusionsThis study shows that the iFlash® SARS-CoV-2 assay from YHLO biotechnology, has satisfactory analytical performance. Nevertheless, the sensitivity of the IgM is limited for a proper clinical use compared to IgG. The determination of anti-SARS-CoV-2 IgG antibodies from 28 days since symptom onset was associated with high sensitivity, especially using optimized cut-offs (i.e. 100%).