Zhou Miao, Yu Fei-Fei, Tan Li, Zhu Yu-Dan, Ma Ning, Song Li-Jun, Li Qi, Liu Yang, Zou Zui, Xu Tian-Ying, Yu Chao
Department of Anesthesiology and SICU, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University Shanghai 200092, P. R. China.
Naval Medical Center of PLA Shanghai 200052, P. R. China.
Am J Transl Res. 2020 Oct 25;12(10):6954-6964. eCollection 2020.
To delineate the clinical characteristics associated with long-term viral shedding (>21 days) in patients with coronavirus disease 2019 (COVID-19).
In this retrospective study, factors associated with long-term (>21 days) severe acute respiratory coronavirus 2 (SARS-CoV-2) RNA shedding were evaluated in a conhort of 609 patients from two hospitals in Wuhan.
The median duration of SARS-CoV-2 viral shedding was 19 days (interquartile range, 10-28 days) among all patients. There were 42% of patients having prolonged viral shedding time (>21 days), in which the longest viral shedding time was 58 days. When comparing patients with early (≤21 days) and late viral RNA clearance (>21 days), prolonged viral shedding was associated with age <65 (P=0.015), female sex (P=0.028), cough (P=0.025), fatigue (P=0.035), sore throat (P=0.013), aspartate aminotransferase (P=0.038), procalcitonin (P=0.010), albumin (P=0.003), D-dimer (P=0.011), lung involvement (P=0.014), reticular shadow (P<0.001) and lung consolidation (P=0.004). Age range (<65 years) (odds ratio [OR], 1.46 [95% CI, 1.05-2.03]) and female sex (odds ratio [OR], 1.40 [95% CI, 1.00-1.94]) were independent risk factors.
Long-term viral shedding (>21 days) is not a rare phenomenon among COVID-19 infectious patients. Age range (<65) and female sex are independent risk factors for long-term viral shedding. Early antiviral treatment should be considered for COVID-19 patients with such risk factors. Further study should be conducted to know the infectivity of patients with long-term viral shedding in order to develop reasonable control measures.
明确2019冠状病毒病（COVID-19）患者长期病毒脱落（>21天）相关的临床特征。
在这项回顾性研究中，对武汉两家医院609例患者队列中与长期（>21天）严重急性呼吸综合征冠状病毒2（SARS-CoV-2）RNA脱落相关的因素进行了评估。
所有患者中SARS-CoV-2病毒脱落的中位持续时间为19天（四分位间距，10 - 28天）。42%的患者病毒脱落时间延长（>21天），其中最长病毒脱落时间为58天。比较病毒RNA早期（≤21天）清除和晚期清除（>21天）的患者时，长期病毒脱落与年龄<65岁（P = 0.015）、女性（P = 0.028）、咳嗽（P = 0.025）、疲劳（P = 0.035）、咽痛（P = 0.013）、天冬氨酸转氨酶（P = 0.038）、降钙素原（P = 0.010）、白蛋白（P = 0.003）、D - 二聚体（P = 0.011）、肺部受累（P = 0.014）、网状阴影（P<0.001）和肺实变（P = 0.004）相关。年龄范围（<65岁）（比值比[OR]，1.46[95%置信区间，1.05 - 2.03]）和女性（比值比[OR]，1.40[95%置信区间，1.00 - 1.94]）是独立危险因素。
长期病毒脱落（>21天）在COVID-19感染患者中并非罕见现象。年龄范围（<65岁）和女性是长期病毒脱落的独立危险因素。对于有此类危险因素的COVID-19患者应考虑早期抗病毒治疗。应进一步开展研究以了解长期病毒脱落患者的传染性，从而制定合理的控制措施。
