82例新型冠状病毒肺炎确诊病例呼吸道和血液标本检测结果分析

目的 分析研究常德市82例新型冠状病毒肺炎(简称新冠肺炎)确诊病例呼吸道标本和血液标本检测结果,发现更多关于新型冠状病毒(简称新冠病毒)的特征和流行规律,为制定科学高效的防控策略提供依据。 方法 根据国家卫健委《新型冠状病毒感染的肺炎防控方案(第五版)》要求,收集常德市2020年1月24日—2月22日确诊的82例新冠肺炎确诊病例呼吸道标本和血液标本,进行新冠病毒和流感病毒核酸检测、血液常规及抗体检测,分析比较不同标本不同方法的检测结果,并进行统计分析。 结果 82例确诊病例标本中,呼吸道标本新冠病毒核酸检测阳性率为93.9%,流感病毒A/B核酸均为阴性,新冠病毒核酸阳性标本中,大部分标本Ct值分布在较高区间,病毒载量较低,重症病例Ct值与普通病例差异无统计学意义(P均＞0.05);血液标本新冠病毒IgM阳性率64.6%,IgG阳性率78.0%,阳性率明显低于核酸检测(χ²=24.059,P＜0.001);血液标本中C反应蛋白普遍偏高,白细胞总数正常或偏低,淋巴细胞总数正常或偏低,白细胞和淋巴细胞在不同性别间差异有统计学意义(χ² =7.165和χ² =3.998,P均＜0.05);血液标本中新冠病毒核酸检测结果均为阴性。 结论 新冠肺炎确诊病例发病早期呼吸道标本病毒载量不高,容易漏检,重症和普通病例标本病毒载量无差异,将呼吸道标本核酸检测和血液样本抗体检测及血常规分析等方法联合使用,可以相互补充,对疫情的有效防控和病例疗效观察具有重要作用。

Detection results of respiratory and blood specimens from 82 confirmed cases of COVID-19

Objective To analyze the detection results of respiratory and blood samples from 82 confirmed cases of COVID-19 in Changde City, to find more characteristics and epidemic rules of severe acute respiratory syndrome coronavirus2(SARS-CoV-2), and to provide a basis for formulating scientific and highly effective prevention and control strategies. Methods We collected respiratory and blood specimens from 82 confirmed cases of COVID-19 in Changde City from January 24 to February 22, 2020 according to the requirements of the Prevention and Control Plan of Novel Coronavirus Pneumonia (the 5th Edition) issued by National Health Commission, and then performed SARS-CoV-2 and influenza virus nucleic acid tests, blood routine test and antibody test. The test results of different specimens and methods were compared, and statistical analysis was performed. Results Among specimens from the 82 confirmed cases, the positive rate of nucleic acid test for SARS-CoV-2 in respiratory specimens was 93.9%, and the influenza virus A/B nucleic acids were both negative. Among the specimens positive for SARS-CoV-2, the Ct values of most specimens were distributed in a higher interval. The viral load of SARS-Cov-2 was low, and no statistically significant difference was found in the Ct value between severe and ordinary cases (P>0.05). The positive rates of SARS-CoV-2 specific IgM and IgG antibodies in blood specimens were 64.6% and 78.0%, respectively, and the positive rate ofblood specimens was significantly lower than that of nucleic acid detection (χ²=24.059,P＜0.001). C-reactive protein was generally high in blood specimens, the total number of white blood cells and the total number of lymphocytes were normal or low, and there were statistically significant differences in white blood cells and lymphocytes between male and female groups (χ²=7.165, χ²=3.998, both P<0.05). All results of nucleic acid test for SARS-CoV-2 in blood specimens showed negative. Conclusion The SARS-CoV-2 viral load of respiratory specimens from the confirmed cases of COVID-19 in the early stage is not high, and hence, it is easy to miss. No statistically significant difference is found in the viral load between severe and ordinary cases. The combined use of nucleic acid detection of respiratory specimens, antibody detection of blood specimens and routine blood analysis can complement each other, and plays an important role in effective prevention and control of the epidemic and observation of therapeutic efficacy of the cases.