新冠病毒阳性、血清转换和疾病严重程度之间的动态关系：一项回顾性研究。

Dynamics and Correlation Among Viral Positivity, Seroconversion, and Disease Severity in COVID-19 : A Retrospective Study.

机构信息

National Clinical Research Center for Gynecology and Obstetrics and Cancer Biology Research Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (Y.F., E.G., L.H., J.L., B.Y., F.L., Z.W., Y.L., R.X., C.L., Y.H., X.W., F.L., L.Y., T.Q., K.L., P.W., D.M., C.S., G.C.).

Key Laboratory of Tropical Translational Medicine of Ministry of Education, College of Biomedical Informatics and Engineering, Hainan Medical University, Haikou, and College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, China (Y.L.).

出版信息

Ann Intern Med. 2021 Apr;174(4):453-461. doi: 10.7326/M20-3337. Epub 2020 Dec 8.

DOI:10.7326/M20-3337

PMID:33284684

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7745119/

Abstract

BACKGROUND

The understanding of viral positivity and seroconversion during the course of coronavirus disease 2019 (COVID-19) is limited.

OBJECTIVE

To describe patterns of viral polymerase chain reaction (PCR) positivity and evaluate their correlations with seroconversion and disease severity.

DESIGN

Retrospective cohort study.

SETTING

3 designated specialty care centers for COVID-19 in Wuhan, China.

PARTICIPANTS

3192 adult patients with COVID-19.

MEASUREMENTS

Demographic, clinical, and laboratory data.

RESULTS

Among 12 780 reverse transcriptase PCR tests for severe acute respiratory syndrome coronavirus 2 that were done, 24.0% had positive results. In 2142 patients with laboratory-confirmed COVID-19, the viral positivity rate peaked within the first 3 days. The median duration of viral positivity was 24.0 days (95% CI, 18.9 to 29.1 days) in critically ill patients and 18.0 days (CI, 16.8 to 19.1 days) in noncritically ill patients. Being critically ill was an independent risk factor for longer viral positivity (hazard ratio, 0.700 [CI, 0.595 to 0.824]; 0.001). In patients with laboratory-confirmed COVID-19, the IgM-positive rate was 19.3% in the first week, peaked in the fifth week (81.5%), and then decreased steadily to around 55% within 9 to 10 weeks. The IgG-positive rate was 44.6% in the first week, reached 93.3% in the fourth week, and then remained high. Similar antibody responses were seen in clinically diagnosed cases. Serum inflammatory markers remained higher in critically ill patients. Among noncritically ill patients, a higher proportion of those with persistent viral positivity had low IgM titers (<100 AU/mL) during the entire course compared with those with short viral positivity.

LIMITATION

Retrospective study and irregular viral and serology testing.

CONCLUSION

The rate of viral PCR positivity peaked within the initial few days. Seroconversion rates peaked within 4 to 5 weeks. Dynamic laboratory index changes corresponded well to clinical signs, the recovery process, and disease severity. Low IgM titers (<100 AU/mL) are an independent risk factor for persistent viral positivity.

PRIMARY FUNDING SOURCE

None.

摘要

背景

目前对于 2019 冠状病毒病（COVID-19）病程中病毒阳性率和血清转换的理解有限。

目的

描述病毒聚合酶链反应（PCR）阳性率的模式，并评估其与血清转换和疾病严重程度的相关性。

设计

回顾性队列研究。

地点

中国武汉的 3 家专门的 COVID-19 护理中心。

参与者

3192 例成人 COVID-19 患者。

测量方法

人口统计学、临床和实验室数据。

结果

在进行的 12780 次严重急性呼吸综合征冠状病毒 2 的逆转录酶 PCR 检测中，有 24.0%呈阳性。在 2142 例实验室确诊的 COVID-19 患者中，病毒阳性率在最初的 3 天内达到峰值。危重症患者的病毒阳性中位持续时间为 24.0 天（95%CI，18.9 至 29.1 天），非危重症患者为 18.0 天（CI，16.8 至 19.1 天）。危重症是病毒持续阳性时间延长的独立危险因素（危险比，0.700[CI，0.595 至 0.824]；P<0.001）。在实验室确诊的 COVID-19 患者中，第 1 周 IgM 阳性率为 19.3%，第 5 周达到峰值（81.5%），然后在第 9 至 10 周稳定下降至约 55%。第 1 周 IgG 阳性率为 44.6%，第 4 周达到 93.3%，然后保持高位。临床诊断病例也出现了类似的抗体反应。血清炎症标志物在危重症患者中仍保持较高水平。在非危重症患者中，与病毒持续阳性的患者相比，在整个病程中，病毒持续阳性患者的 IgM 滴度较低（<100 AU/mL）的比例更高。