COVID-19患者早期咽拭子病毒载量与临床特征的关联分析

Association of early virus nucleic acid in throat swabs and clinical characteristics in COVID-19 patients early in their illness

摘要:

目的：探讨新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）患者早期咽拭子病毒载量与临床症状及肺部影像学表现的关系。方法：回顾性分析2020年1月24日至2月9日在中南大学湘雅二医院确诊的30例COVID-19患者早期咽拭子病毒核酸载量与临床症状、肺部影像学特征的具体关联。结果：30例COVID-19患者就诊时，4例患者（13.33%）未出现临床症状，23例患者（76.67%）出现发热；20例患者（66.67%）出现COVID-19影像学改变，10例患者（33.33%）影像学无明显异常。COVID-19无症状患者的咽拭子病毒核酸Ct值与有症状患者相比差异无统计学意义；相比于影像学无异常的患者，出现肺炎影像学表现的患者咽拭子病毒核酸Ct值更大（P=0.001），体温更高（P=0.014）；通过logistic回归模型校正性别和年龄后，咽拭子病毒核酸Ct值与出现肺炎影像学特征呈独立正相关（OR=1.34，95%CI=1.07~1.66，P=0.009）。结论：早期无临床症状的COVID-19患者与有症状患者的咽拭子病毒载量水平相当；COVID-19患者早期咽拭子病毒载量与肺部影像学特征呈负向关联。

Abstract:

Objective：To investigate the relationship between early laboratory indexes and clinical manifestations and radiographic characteristics in coronavirus disease 2019（COVID-19）. Methods：In this retrospective study，30 confirmed cases of COVID-19 in Second Xiangya Hospital（Changsha） from January 24th to February 9th，2020 were enrolled，viral loads in throat swabs of the patients and their correlation with clinical manifestations and imaging characteristics were analyzed. Results：On admission，4 out of 30 COVID-19 patients（13.33%） had no clinical symptoms，23 patients（76.67%） had fever. Imaging findings were observed in 20 patients（66.67%），while no obvious abnormalities were observed in 10 patients（33.33%）. Ct value of viral nucleic acid in throat swabs of asymptomatic COVID-19 patientswas basically the same as in those patients with clinical symptoms. Compared with patients with no abnormality in imaging，patients with imaging manifestation of pneumonia had significantly increased Ct value（P=0.001） of viral nucleic acid and body temperature（P=0.014）. After adjusted for gender and age by logistic regression model，Ct value of viral nucleic acid in throat swabs was positively correlated with the imaging characteristics of pneumonia（OR=1.34，95%CI=1.07-1.66，P=0.009）. Conclusion：Asymptomatic COVID-19 patients had a similar level of viral load of throat swabs as symptomatic COVID-19 patients at an early stage. The viral load of throat swabs was negatively correlated with pulmonary imaging characteristics at an early stage of COVID-19 patients.