SARS-CoV-2核酸复阳患者临床特点及不同标本核酸检测结果分析

目的了解SARS-CoV-2核酸复阳的2019新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者临床特征,为实行针对性管理提供参考依据。方法分析SARS-CoV-2核酸复阳COVID-19患者的临床表现和实验室检查结果,对该类患者住院期间和出院后呼吸道及粪便标本病毒核酸持续时间进行分析评估。结果43例患者中有15例在住院期间SARS-CoV-2核酸检测短暂转阴后又出现“复阳”(复阳组),复阳比例为34.9%,均为普通型患者。与病毒核酸未出现复阳患者(未复阳组)相比,复阳组在入院时多表现为轻度发热,咳痰持续时间更短,ESR、CRP、血清淀粉样蛋白A水平更低(P均<0.05);2组患者鼻咽拭子标本病毒核酸初始转阴时间差异无统计学意义,但与未复阳组相比,复阳组鼻咽拭子病毒最长脱落时间显著延长,痰液中病毒脱落时间显著延长,粪便核酸阳性率更高(P均<0.05)。呼吸道标本病毒核酸复阳和粪便标本中病毒核酸持续阳性患者均未发现胸部CT较前改变。结论SARS-CoV-2核酸复阳COVID-19患者多表现为轻症感染和病毒持续阳性的特征,同时该类患者存在痰液标本病毒脱落时间延长和粪便标本病毒核酸持续阳性的特点,因而对病毒核酸复阳患者应给予特别关注和更长时间的医学观察,以预防和控制疫情的再次传播。

Analysis of clinical characteristics of re-detectable SARS-CoV-2 nucleic acid positive patients and results of nucleic acid test in different specimens

Objective To understand the clinical characteristics of COVID-19 patients with re-detectable positive in SARSCoV-2 nucleic acid test,and provide reference for the implementation of targeted management.Methods The clinical manifestations and laboratory test results of COVID-19 patients with re-detectable positive in SARS-CoV-2 nucleic acid test were analyzed.The duration of viral nucleic acid test in both respiratory tracts and fecal excretions in patients during hospitalization and after discharge was analyzed and evaluated.Results Among the 43 patients,15 patients were tested positive in SARS-CoV-2 nucleic acid test after a negative result for a short time during hospitalization(positive group).The re-detectable positive rate was 34.9%and the severity of the disease was common type.Compared with patients without re-detectable viral nucleic acid positive test(non-positive group),patients in positive group showed mild fever,shorter duration of expectoration,lower levels of ESR,CRP and serum amyloid A protein(P<0.05).There was no difference between 2 groups in the initial negative conversion time of viral nucleic acid test in nasopharyngeal swab specimens,but the maximum shedding time in nasopharyngeal swabs was significantly prolonged.The virus shedding time in sputum was significantly prolonged,and the nucleic acid positive rate of fecal excretions was increased in patients of positive group,compared to non-positive group(P<0.05).No changes of chest CT were founded in the patients tested positive in viral nucleic acid test of respiratory tract specimens and continuously positive in fecal excretions.Conclusions Patients with re-detectable positive in SARS-CoV-2 nucleic acid test are predominantly manifested with mild infection and continuously positive of viral nucleic acid.At the same time,such patients have the characteristics of prolonged virus shedding time in sputum specimens and continuously positive of viral nucleic acid in fecal specimens.Therefore,special attention and longer medical observation should be given to patients with redetectable positive of viral nucleic acid,so as to prevent and control the recurrence of the epidemic.