Wuhan Huoshenshan Hospital, Wuhan, China.
Chinese PLA Center for Disease Control and Prevention, Beijing, China.
J Med Virol. 2021 May;93(5):2782-2789. doi: 10.1002/jmv.26617. Epub 2021 Mar 1.
Coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. A total of 1578 patients admitted into a newly built hospital specialized for COVID-19 treatment in Wuhan, China, were enrolled. Clinical features and the levels of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (Ig)M and IgG were analyzed. In total, 1532 patients (97.2%) were identified as laboratory-confirmed cases. Seventy-seven patients were identified as asymptomatic carriers (n = 64) or SARS-CoV-2 RNA positive before symptom onset (n = 13). The positive rates of SARS-CoV-2 IgM and IgG were 80.4% and 96.8%, respectively. The median of IgM and IgG titers were 37.0A U/ml (interquartile range [IQR]: 13.4-81.1 AU/ml) and 156.9 AU/ml (IQR: 102.8-183.3 AU/ml), respectively. The IgM and IgG levels of asymptomatic patients (median titers, 8.3 AU/ml and 100.3 AU/ml) were much lower than those in symptomatic patients (median titers, 38.0 AU/ml and 158.2 AU/ml). A much lower IgG level was observed in critically ill patients 42-60 days after symptom onset. There were 153 patients with viral RNA shedding after IgG detection. These patients had a higher proportion of critical illness during hospitalization (p < .001) and a longer hospital stay (p < .001) compared to patients with viral clearance after IgG detection. Coronary heart disease (odds ratio [OR], 1.89 [95% confidence interval [CI], 1.11-3.24]; p = .020), and intensive care unit admission (OR, 2.47 [95% CI, 1.31-4.66]; p = .005) were independent risk factors associated with viral RNA shedding after IgG detection. Symptomatic patients produced more antibodies than asymptomatic patients. The patients who had SARS-CoV-2 RNA shedding after developing IgG were more likely to be sicker patients.
新型冠状病毒肺炎（COVID-19）迅速演变为全球大流行。共纳入中国武汉一家专门收治 COVID-19 患者的新建医院的 1578 例患者。分析了临床特征和严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）免疫球蛋白（Ig）M 和 IgG 的水平。共有 1532 例（97.2%）患者被确诊为实验室确诊病例。77 例被确定为无症状携带者（n=64）或症状发作前 SARS-CoV-2 RNA 阳性（n=13）。SARS-CoV-2 IgM 和 IgG 的阳性率分别为 80.4%和 96.8%。IgM 和 IgG 滴度中位数分别为 37.0AU/ml（四分位距[IQR]：13.4-81.1AU/ml）和 156.9AU/ml（IQR：102.8-183.3AU/ml）。无症状患者的 IgM 和 IgG 水平（中位数滴度，8.3AU/ml 和 100.3AU/ml）明显低于有症状患者（中位数滴度，38.0AU/ml 和 158.2AU/ml）。在症状发作后 42-60 天，重症患者的 IgG 水平明显降低。IgG 检测后有 153 例患者出现病毒 RNA 脱落。与 IgG 检测后病毒清除的患者相比，这些患者住院期间发生重症的比例更高（p<.001），住院时间更长（p<.001）。冠心病（比值比[OR]，1.89[95%置信区间[CI]，1.11-3.24]；p=.020）和入住重症监护病房（OR，2.47[95%CI，1.31-4.66]；p=.005）是 IgG 检测后病毒 RNA 脱落的独立危险因素。有症状的患者比无症状的患者产生更多的抗体。产生 IgG 后有 SARS-CoV-2 RNA 脱落的患者更有可能是病情较重的患者。
