Cheung Ka Shing, Hung Ivan F N, Chan Pierre P Y, Lung K C, Tso Eugene, Liu Raymond, Ng Y Y, Chu Man Y, Chung Tom W H, Tam Anthony Raymond, Yip Cyril C Y, Leung Kit-Hang, Fung Agnes Yim-Fong, Zhang Ricky R, Lin Yansheng, Cheng Ho Ming, Zhang Anna J X, To Kelvin K W, Chan Kwok-H, Yuen Kwok-Y, Leung Wai K
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
Gastroenterology. 2020 Jul;159(1):81-95. doi: 10.1053/j.gastro.2020.03.065. Epub 2020 Apr 3.
BACKGROUND & AIMS: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been characterized by fever, respiratory, and gastrointestinal symptoms as well as shedding of virus RNA into feces. We performed a systematic review and meta-analysis of published gastrointestinal symptoms and detection of virus in stool and also summarized data from a cohort of patients with COVID-19 in Hong Kong.
We collected data from the cohort of patients with COVID-19 in Hong Kong (N = 59; diagnosis from February 2 through February 29, 2020),and searched PubMed, Embase, Cochrane, and 3 Chinese databases through March 11, 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We analyzed pooled data on the prevalence of overall and individual gastrointestinal symptoms (loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort) using a random effects model.
Among the 59 patients with COVID-19 in Hong Kong, 15 patients (25.4%) had gastrointestinal symptoms, and 9 patients (15.3%) had stool that tested positive for virus RNA. Stool viral RNA was detected in 38.5% and 8.7% among those with and without diarrhea, respectively (P = .02). The median fecal viral load was 5.1 log copies per milliliter in patients with diarrhea vs 3.9 log copies per milliliter in patients without diarrhea (P = .06). In a meta-analysis of 60 studies comprising 4243 patients, the pooled prevalence of all gastrointestinal symptoms was 17.6% (95% confidence interval [CI], 12.3-24.5); 11.8% of patients with nonsevere COVID-19 had gastrointestinal symptoms (95% CI, 4.1-29.1), and 17.1% of patients with severe COVID-19 had gastrointestinal symptoms (95% CI, 6.9-36.7). In the meta-analysis, the pooled prevalence of stool samples that were positive for virus RNA was 48.1% (95% CI, 38.3-57.9); of these samples, 70.3% of those collected after loss of virus from respiratory specimens tested positive for the virus (95% CI, 49.6-85.1).
In an analysis of data from the Hong Kong cohort of patients with COVID-19 and a meta-analysis of findings from publications, we found that 17.6% of patients with COVID-19 had gastrointestinal symptoms. Virus RNA was detected in stool samples from 48.1% patients, even in stool collected after respiratory samples had negative test results. Health care workers should therefore exercise caution in collecting fecal samples or performing endoscopic procedures in patients with COVID-19, even during patient recovery.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染可导致2019冠状病毒病（COVID-19），其特征为发热、呼吸道和胃肠道症状，以及病毒RNA排至粪便中。我们对已发表的胃肠道症状及粪便中病毒检测情况进行了系统评价和荟萃分析，并总结了香港一组COVID-19患者的数据。
我们收集了香港COVID-19患者队列（N = 59；2020年2月2日至2月29日确诊）的数据，并根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，检索了截至2020年3月11日的PubMed、Embase、Cochrane和3个中文数据库。我们使用随机效应模型分析了总体及个体胃肠道症状（食欲不振、恶心、呕吐、腹泻以及腹痛或不适）患病率的汇总数据。
在香港的59例COVID-19患者中，15例（25.4%）有胃肠道症状，9例（15.3%）粪便病毒RNA检测呈阳性。腹泻患者和未腹泻患者的粪便病毒RNA检测阳性率分别为38.5%和8.7%（P = 0.02）。腹泻患者的粪便病毒载量中位数为每毫升5.1 log拷贝，未腹泻患者为每毫升3.9 log拷贝（P = 0.06）。在一项纳入4243例患者的60项研究的荟萃分析中，所有胃肠道症状的汇总患病率为17.6%（95%置信区间[CI]，12.3 - 24.5）；非重症COVID-19患者中有11.8%有胃肠道症状（95% CI，4.1 - 29.1），重症COVID-19患者中有17.1%有胃肠道症状（95% CI，6.9 - 36.7）。在荟萃分析中，粪便样本病毒RNA检测阳性的汇总患病率为48.1%（95% CI，38.3 - 57.9）；其中，呼吸道标本病毒转阴后采集的样本中有70.3%病毒检测呈阳性（95% CI，49.6 - 85.1）。
在对香港COVID-19患者队列数据的分析以及对已发表研究结果的荟萃分析中，我们发现17.6%的COVID-19患者有胃肠道症状。48.1%的患者粪便样本中检测到病毒RNA，即使是在呼吸道样本检测结果为阴性后采集的粪便样本中。因此，医护人员在为COVID-19患者采集粪便样本或进行内镜检查时应谨慎，即使在患者康复期间也是如此。
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