新型冠状病毒肺炎核酸复阳患者与未复阳患者临床特征比较

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目的:分析新型冠状病毒(新冠病毒)肺炎(COVID-19)病毒核酸检测“复阳”患者的临床特征分析,并与未“复阳”患者进行比较。方法:选取2020年2―4月在武汉市金银潭医院和泉州市定点治疗医院收治的98例COVID-19患者为研究对象,男55例,女43例,年龄15~83岁,中位年龄为57.5岁,均为普通型,其中20例伴有基础疾病。98例中15例住院治疗好转出院后复查咽拭子新冠病毒核酸阳性。收集患者的一般情况、临床症状、实验室检查及胸部CT影像学特征,并根据核酸检测结果将患者分为新冠病毒“复阳”组与未“复阳”组,“复阳”组男10例,女5例;非“复阳”组男45例,女38例,性别无统计学差异(χ2=0.800,n P=0.371);“复阳”组平均年龄为(57±21)岁,未“复阳”组为(53±17)岁;“复阳”组中8例伴有基础疾病,未“复阳”组12例。检测2组的血常规、IL-6、C反应蛋白(CRP)、降钙素原(PCT)、ESR、B型钠尿肽(BNP)、生化全套、新冠病毒 IgG和IgM抗体等指标,并进行比较。n 结果:(1)98例患者出院后2周内有15例(15.3%)患者病毒核酸检测“复阳”。(2)“复阳”患者均在定点隔离场所复查病毒核酸阳性后再次入院治疗,自觉症状轻微,其中5例发热,6例咳嗽,5例咳痰,2例稍感气促。症状出现在出院后平均(5.7±2.8) d。(3)“复阳”患者PCT(均0.05)。(4)“复阳”组再次入院时胸部CT表现为磨玻璃影、渗出性或实变病灶,少数出现纤维化。(5)“复阳”患者在定点医院密切观察期间均未发现引起二代病例。n 结论:“复阳”患者常合并基础疾病,胸部影像学显示肺部活动性病灶,不排除仍存在病毒复制的可能性,但患者临床表现较轻,可能仍处于病情恢复期,未发现具有传染性的证据。“,”Objective:To analysis the clinical characteristics of“recurrence”RNA positive patients with Coronavirus disease 2019 (COVID-19) and compared with those without“recurrence”.Methods:98 patients with COVID-19 in Wuhan Jinyintan Hospital and designated treatment hospitals in Quanzhou were included in this study from February 2020 to April 2020. There were 55 males and 43 females, aged from15 to 83 years, with a median age of 57.5 years, in which 20 cases were complicated with basic diseases. 15 of these patients had been diagnosed and hospitalized had been found as“recurrence”2019-nCoV RNA positive after discharge while the other 83 cases were all negative. The clinical classification of all patients was common type. Clinical data of the COVID-19 RNA“recurrence”patients were collected, and general situations, symptoms, laboratory examinations and CT images were also observed and analyzed. The patients were divided into 2019-nCoV“recurrent”group and 2019-nCoV“non-recurrent”group. There are 10 males and 5 females in 2019-nCoV“recurrent”group while 45 males and 38 females in“non-recurrent”group (n χ2=0.800,n P=0.371). The age of 2019-nCoV“recurrent”group (57±21) was higher than that of“non-recurrent”group(53±17). 8 of 15 the COVID-19“recurrent”group patients and 12 of 83“non-recurrent”patients have basic diseases. IgG and IgM of 2019-nCoV, IL-6, procalcitonin, ESR, CRP, BNP and other serum biochemical index levels were measured and compared between groups.n Results:(1) The proportion of patients with common type of COVID-19 was 15.3% during 2-week medical observation after discharge. (2) All of the 2019-nCoV“recurrent”patients were hospitalized due to COVID-19 RNA positive, when they were quarantined after discharged from hospital. All the patients with mild symptoms which were clarified as common type, including 5 cases of fever, 6 cases of cough, 5 cases of expectoration, and 2 cases of slight shortness of breath. The time of symptoms appeared on (5.73±2.82) days after discharge. (3) The serum procalcitonin of all 2019-nCoV“recurrent”group patients were normal(all0.05). (4) In“recurrent”group, ground glass, exudative or solid lesions could be found in most of the chest CT performed on re-admission. Meanwhile, fibrosis lesion was relatively rare. (5) There were no secondary transmissions were found to be caused by the 2019-nCoV“recurrent”group patients.n Conclusions:Most of the 2019-nCoV patients had underlying diseases and active lesions were still found in CT images, so the possibility of virus replication may still exist. All“recurrent”patients had mild illness which may suggest that they were in recovery stage, and no evidence of transmission is found.
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