Shi L Y, Cai Y P, Zhang Y X, Lin Y L, Lin L S, Ding J Z, Guo J X, Zhuang X B, Chen X Y, Zeng Y M
Department of Pulmonary and Critical Care Medicine, the Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, China.
Department of Infectious Diseases, Wuhan Jinyintan Hospital, Wuhan 430040, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Dec 12;43(12):1066-1070. doi: 10.3760/cma.j.cn112147-20200602-00668.
To analysis the clinical characteristics of"recurrence"RNA positive patients with Coronavirus disease 2019 （COVID-19） and compared with those without"recurrence". 98 patients with COVID-19 in Wuhan Jinyintan Hospital and designated treatment hospitals in Quanzhou were included in this study from February 2020 to April 2020. There were 55 males and 43 females， aged from15 to 83 years， with a median age of 57.5 years， in which 20 cases were complicated with basic diseases. 15 of these patients had been diagnosed and hospitalized had been found as"recurrence"2019-nCoV RNA positive after discharge while the other 83 cases were all negative. The clinical classification of all patients was common type. Clinical data of the COVID-19 RNA"recurrence"patients were collected， and general situations， symptoms， laboratory examinations and CT images were also observed and analyzed. The patients were divided into 2019-nCoV"recurrent"group and 2019-nCoV"non-recurrent"group. There are 10 males and 5 females in 2019-nCoV"recurrent"group while 45 males and 38 females in"non-recurrent"group （0.800，=0.371）. The age of 2019-nCoV"recurrent"group （57±21） was higher than that of"non-recurrent"group（53±17）. 8 of 15 the COVID-19"recurrent"group patients and 12 of 83"non-recurrent"patients have basic diseases. IgG and IgM of 2019-nCoV， IL-6， procalcitonin， ESR， CRP， BNP and other serum biochemical index levels were measured and compared between groups. （1） The proportion of patients with common type of COVID-19 was 15.3% during 2-week medical observation after discharge. （2） All of the 2019-nCoV"recurrent"patients were hospitalized due to COVID-19 RNA positive， when they were quarantined after discharged from hospital. All the patients with mild symptoms which were clarified as common type， including 5 cases of fever， 6 cases of cough， 5 cases of expectoration， and 2 cases of slight shortness of breath. The time of symptoms appeared on （5.73±2.82） days after discharge. （3） The serum procalcitonin of all 2019-nCoV"recurrent"group patients were normal（all<0.05 ng/ml）. The BNP of"recurrent"group （151±171） ng/L， was higher than that of"non-recurrent"group （63±78） ng/L （ = 3.207， = 0.000）. There was no significant difference in laboratory tests like leukocyte ［（6.17±2.4） and （6.04±2.41）×10/L］， lymphocyte［（1.59±0.52） and （1.32±0.64）×10/L］， CRP ［（12.54±28.20） and （21.74±25.63）mg/L］， ESR ［（31.07±28.72） and （34.10±22.16）mm/1 h］， AST ［（24.73±9.15） and （30.24±23.20）U/L］， ALT ［（22.60±12.82） and （36.47±34.12）U/L）， LDH ［（268±208） and （270±164）U/L］， D-dimer ［（0.60±0.50） and （0.84±0.98）μg/L］， ferritin ［（294±195） and （395±319）μg/L］， IL-6 ［（9.17±6.42） and （14.28±17.74）ng/L］ and BUN （5.77±2.66） and （4.74±2.81）U/L］ between"recurrent"and"non-recurrent"groups （all >0.05）. （4） In"recurrent"group， ground glass， exudative or solid lesions could be found in most of the chest CT performed on re-admission. Meanwhile， fibrosis lesion was relatively rare. （5） There were no secondary transmissions were found to be caused by the 2019-nCoV"recurrent"group patients. Most of the 2019-nCoV patients had underlying diseases and active lesions were still found in CT images， so the possibility of virus replication may still exist. All"recurrent"patients had mild illness which may suggest that they were in recovery stage, and no evidence of transmission is found.
分析新型冠状病毒肺炎（COVID-19）“复阳”RNA阳性患者的临床特征，并与未“复阳”患者进行比较。本研究纳入了2020年2月至2020年4月期间武汉金银潭医院及泉州定点收治医院的98例COVID-19患者。其中男性55例，女性43例，年龄15至83岁，中位年龄57.5岁，其中20例合并基础疾病。这些患者中，15例出院后确诊并住院时被发现2019-nCoV RNA“复阳”，其余83例均为阴性。所有患者的临床分型均为普通型。收集COVID-19 RNA“复阳”患者的临床资料，观察并分析其一般情况、症状、实验室检查及CT影像。将患者分为2019-nCoV“复阳”组和2019-nCoV“未复阳”组。2019-nCoV“复阳”组中男性10例，女性5例；“未复阳”组中男性45例，女性38例（P=0.800，χ²=0.371）。2019-nCoV“复阳”组患者年龄（57±21）岁，高于“未复阳”组（53±17）岁。15例COVID-19“复阳”组患者中有8例，83例“未复阳”患者中有12例有基础疾病。检测并比较两组患者2019-nCoV的IgG和IgM、IL-6、降钙素原、血沉、C反应蛋白、脑钠肽等血清生化指标水平。（1）出院后2周医学观察期间，COVID-19普通型患者比例为15.3%。（2）所有2019-nCoV“复阳”患者均因出院后隔离期间COVID-19 RNA阳性再次住院。所有患者症状较轻，明确为普通型，其中发热5例，咳嗽6例，咳痰5例，轻度气短2例。症状出现时间为出院后（5.73±2.82）天。（3）所有2019-nCoV“复阳”组患者血清降钙素原均正常（均<0.05 ng/ml）。“复阳”组脑钠肽（151±171）ng/L，高于“未复阳”组（63±78）ng/L（t=3.207，P=0.000）。两组患者白细胞［（6.17±2.4）和（6.04±2.41）×10⁹/L］、淋巴细胞［（1.59±0.52）和（1.32±0.64）×10⁹/L］、C反应蛋白［（12.54±28.20）和（21.74±25.63）mg/L］、血沉［（31.07±28.72）和（34.10±22.16）mm/1 h］、谷草转氨酶［（24.73±9.15）和（30.24±23.20）U/L］、谷丙转氨酶［（22.60±12.82）和（36.47±34.12）U/L］、乳酸脱氢酶［（268±208）和（270±164）U/L］、D-二聚体［（0.60±0.50）和（0.84±0.98）μg/L］、铁蛋白［（294±195）和（395±319）μg/L］、IL-6［（9.17±6.42）和（14.28±17.74）ng/L］及血尿素氮［（5.77±2.66）和（4.74±2.81）U/L］等实验室检查结果比较，差异均无统计学意义（均P>0.05）。（4）“复阳”组再次入院时胸部CT检查多数可见磨玻璃、渗出或实变影。同时，纤维化影相对少见。（5）未发现2019-nCoV“复阳”组患者造成二代传播。多数2019-nCoV患者有基础疾病，CT影像仍可见活动性病灶，因此病毒仍可能复制。所有“复阳”患者病情较轻，提示可能处于恢复期，且未发现传播证据。
