Department of Clinical Laboratory, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China.
Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China.
Infection. 2021 Feb;49(1):57-61. doi: 10.1007/s15010-020-01485-6. Epub 2020 Jul 28.
The viral persistence in patients with Coronavirus Disease 2019 (COVID-19) remains to be investigated.
We investigated the viral loads, therapies, clinical features, and immune responses in a 70-year patient tested positive for SARS-CoV-2 for 3 months.
The patient exhibited the highest prevalence of abnormal indices of clinical features and immune responses at the first admission, including fever (38.3 ℃), decreased lymphocytes (0.83 × 10/L) and serum potassium (3.1 mmol/L), as well as elevated serum creatinine (115 µmol/L), urea (8.6 mmol/L), and C-reactive protein (80 mg/L). By contrast, at the second and the third admission, these indices were all normal. Through three admissions, IL-2 increased from 0.14 pg/mL, 0.69 pg/mL, to 0.91 pg/mL, while IL-6 decreased from 11.78 pg/mL, 1.52 pg/mL, to 0.69 pg/mL, so did IL-10 from 5.13 pg/mL, 1.85 pg/mL, to 1.75 pg/mL. The steady declining trend was also found in TNF-α (1.49, 1.15, and 0.85 pg/mL) and IFN-γ (0.64, 0.42, and 0.27 pg/mL). The threshold cycle values of RT-PCR were 26.1, 30.5, and 23.5 for ORFlab gene, and 26.2, 30.6, and 22.7 for N gene, showing the patient had higher viral loads at the first and the third admission than during the middle term of the disease. The patient also showed substantially improved acute exudative lesions on the chest CT scanning images.
The patient displayed declining immune responses in spite of the viral shedding for 3 months. We inferred the declining immune responses might result from the segregation of the virus from the immune system.
新型冠状病毒病 2019（COVID-19）患者的病毒持续存在仍待研究。
我们研究了一位 70 岁 SARS-CoV-2 检测阳性患者的病毒载量、治疗、临床特征和免疫反应，该患者的病毒持续阳性时间为 3 个月。
该患者在首次入院时表现出最高比例的异常临床特征和免疫反应指标，包括发热（38.3℃）、淋巴细胞减少（0.83×10/L）和血清钾降低（3.1mmol/L），以及血清肌酐升高（115μmol/L）、尿素（8.6mmol/L）和 C 反应蛋白升高（80mg/L）。相比之下，在第二次和第三次入院时，这些指标均正常。通过三次入院，IL-2 从 0.14pg/mL、0.69pg/mL 增加到 0.91pg/mL，而 IL-6 从 11.78pg/mL、1.52pg/mL 降低到 0.69pg/mL，IL-10 也从 5.13pg/mL、1.85pg/mL 降低到 1.75pg/mL。TNF-α（1.49、1.15 和 0.85pg/mL）和 IFN-γ（0.64、0.42 和 0.27pg/mL）也呈现出稳定下降的趋势。ORFlab 基因的 RT-PCR 阈值循环值分别为 26.1、30.5 和 23.5，N 基因分别为 26.2、30.6 和 22.7，表明患者在第一次和第三次入院时的病毒载量高于疾病中期。患者的胸部 CT 扫描图像上的急性渗出性病变也明显改善。
尽管该患者病毒持续排出 3 个月，但免疫反应呈下降趋势。我们推断，免疫反应下降可能是由于病毒与免疫系统分离所致。
