Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil; Sociedade Brasileira de Pediatria, Departamento Científico de Imunologia Clínica, Rio de Janeiro, RJ, Brazil; Associação Brasileira de Alergia e Imunologia, Brazil.
J Pediatr (Rio J). 2021 Jan-Feb;97(1):7-12. doi: 10.1016/j.jped.2020.08.001. Epub 2020 Aug 31.
This was a non-systematic review of the literature on the laboratory diagnosis of COVID-19.
Searches in PubMed and Google Scholar for articles made available in 2020, using the terms "diagnosis" OR "diagnostic" OR "diagnostic tests" OR "tests" AND "COVID-19" OR "SARS-CoV-2" in the title.
Tests for the etiological agent identify genetic material of SARS-CoV-2 or humoral responses to it. The gold standard for diagnosis is the identification of viral genome targets by real-time polymerase chain reaction (RT-PCR) in respiratory tract materials during the first week of symptoms. Serological tests should be indicated from the second week of symptoms onwards. A wide range of different tests is available, with variable sensitivity and specificity, most of which require validation. Laboratory tests such as complete blood count, C-reactive protein (CRP), D-dimer, clotting tests, lactic dehydrogenase (LDH), ferritin, and procalcitonin identify risk of disease with greater severity, thromboembolic complications, myocardial damage, and/or worse prognosis. Imaging tests may be useful for diagnosis, especially when there is a compatible clinical picture, and other tests presented negative results or were unavailable.
The identification of genetic material of the virus by RT-PCR is the gold standard test, but its sensitivity is not satisfactory. The diagnosis of COVID-19 should be based on clinical data, epidemiological history, tests for etiological diagnosis, and tests to support the diagnosis of the disease and/or its complications. New diagnostic methods with higher sensitivity and specificity, as well as faster results, are necessary.
这是对 COVID-19 实验室诊断文献的非系统性综述。
在 PubMed 和 Google Scholar 中搜索 2020 年可用的文章，使用标题中的术语“诊断”或“诊断”或“诊断测试”或“测试”和“COVID-19”或“SARS-CoV-2”进行搜索。
针对病原体的测试可识别 SARS-CoV-2 的遗传物质或针对其的体液反应。诊断的金标准是在症状出现的第一周内通过呼吸道材料中的实时聚合酶链反应（RT-PCR）识别病毒基因组靶标。应从症状出现后的第二周开始进行血清学检测。有广泛的不同测试可供选择，其敏感性和特异性各不相同，大多数都需要验证。实验室测试，如全血细胞计数、C 反应蛋白（CRP）、D-二聚体、凝血测试、乳酸脱氢酶（LDH）、铁蛋白和降钙素，可识别疾病严重程度、血栓栓塞并发症、心肌损伤和/或预后较差的风险。影像学检查可能对诊断有用，尤其是在有相符的临床图像时，而其他检查呈阴性结果或不可用时。
通过 RT-PCR 鉴定病毒的遗传物质是金标准测试，但它的敏感性并不令人满意。COVID-19 的诊断应基于临床数据、流行病学史、病因诊断测试以及支持疾病及其并发症诊断的测试。需要具有更高敏感性和特异性以及更快结果的新诊断方法。
