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新型冠状病毒肺炎确诊患者出院后抗体水平的初步研究

[Preliminary study of the antibody level in confirmed patients with COVID-19 after discharge].

作者信息

Shen G, Yang G, Zeng Z Y, Hu Y, Li Q, Liu Z G, Fu H Y, Hu J Y, Zhu P, Huang J H, Lu Q Q, Shi S J, He Y, Xie X B

机构信息

Medical Laboratory,Loudi Center for Diseases Prevention and Control of Hunan, Loudi 417000, China.

Medical Laboratory and Pathology Center,the First Hospital of Hunan University of Chinese Medicine, Changsha 410007, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2020 Dec 6;54(12):1448-1452. doi: 10.3760/cma.j.cn112150-20200603-00819.

Abstract

To analyze the antibody levels and dynamic changes in patients infected with 2019-novel coronavirus(2019-nCoV). The average age of 72 corona virus disease 2019 (COVID-19) patients was (45.53±16.74)years(median age:47 year), including (44.88±17.09) years(median age:46 year) for 38 males and (46.32±16.52)years (median age:46 year) for 34 females in Loudi City, Hunan Province. There is no significant difference in genders between the severe and mild groups (χ²=0.916, >0.05). There is a significant difference in the age between the severe and mild groups (=3.315, <0.05). The blood samples of 72 discharged patients were collected and the consistence of IgM and IgG antibodies were detected by chemiluminescence method. SPSS25.0 was used for gender, age, case type and antibody analysis of variance, χ test and other analysis. The average time of the serum samples collection of 72 patients was (34.89±9.02)days (median time: 34 days) from onset of COVID-19, and (14.53±8.35) days (median time: 14 days) from discharge. The positive rate of IgM or IgG was 97.22% (70/72), and the positive rate of IgM and IgG was 48.61% (35/72) and 97.22% (70/72) respectively. Serum COVID-19 antibodies were detected in 72 patients from 1st to 40th days after discharge. The average concentration of IgM in 1-7 days, 8-14 days, 15-21 days, 22-28 days, above 29 days were 21.91(7.07-52.84)AU/ml, 14.16(6.19-32.88)AU/ml, 11.36(6.65-42.15)AU/ml, 8.15(3.66-30.12)AU/ml, 2.98(0.46-6.37)AU/ml. There was no significant difference in the time of IgM antibody concentration (= 8.439, >0.05). The average concentrations of IgG in 1-7 days, 8-14 days, 15-21 days, 22-28 days, 29 days and above were 169.90 (92.06-190.91) AU/ml, 163.89 (91.19-208.02) AU/ml, 173.31 (95.06-191.28) AU/ml, 122.84 (103.19-188.34) AU/ml, 101.98 (43.75-175.30) AU/ml, respectively, (=2.232, >0.05). The IgM becomes negative after the 3rd week of discharge and decreases rapidly with time. The IgG concentration higher than IgM during the same period, and keep at high level without any change, and decrease in the fourth week. Among them, 5 cases developed "re-infection" within 1-3 weeks after discharge, and the rate of "re-infection" was 6.94% (5/72 cases). After the COVID-19 patients are discharged from the hospital, the level of antibodies produced varies greatly among individuals, but the overall changes in antibodies have a certain pattern. It is recommended to strengthen the antibody monitoring during hospitalization and after discharge from the hospital to reduce the "re-infection" rate and potential risk of infection.

摘要

分析新型冠状病毒2019(2019 - nCoV)感染患者的抗体水平及动态变化。湖南省娄底市72例新型冠状病毒肺炎(COVID - 19)患者的平均年龄为(45.53±16.74)岁(中位数年龄:47岁),其中男性38例,平均年龄为(44.88±17.09)岁(中位数年龄:46岁),女性34例,平均年龄为(46.32±16.52)岁(中位数年龄:46岁)。重症组与轻症组性别间差异无统计学意义(χ² = 0.916,P>0.05)。重症组与轻症组年龄间差异有统计学意义(t = 3.315,P<0.05)。采集72例出院患者的血液样本,采用化学发光法检测IgM和IgG抗体的一致性。应用SPSS25.0对性别、年龄、病例类型及抗体进行方差分析、χ检验等分析。

72例患者血清样本采集的平均时间为自COVID - 19发病起(34.89±9.02)天(中位数时间:34天),自出院起(14.53±8.35)天(中位数时间:14天)。IgM或IgG阳性率为97.22%(70/72),IgM和IgG阳性率分别为48.61%(35/72)和97.22%(70/72)。出院后1至40天对72例患者进行血清COVID - 19抗体检测。1 - 7天、8 - 14天、15 - 21天、22 - 28天、29天及以上IgM的平均浓度分别为21.91(7.07 - 52.84)AU/ml、14.16(6.19 - 32.88)AU/ml、11.36(6.65 - 42.15)AU/ml、8.15(3.66 - 30.12)AU/ml、2.98(0.46 - 6.37)AU/ml。IgM抗体浓度在时间上差异无统计学意义(F = 8.439,P>0.05)。1 - 7天、8 - 14天、15 - 21天、22 - 28天、29天及以上IgG的平均浓度分别为169.90(92.06 - 190.91)AU/ml、163.89(91.19 - 208.02)AU/ml、173.31(95.06 - 191.28)AU/ml、122.84(103.19 - 188.34)AU/ml、101.98(43.75 - 175.30)AU/ml,(F = 2.232,P>0.05)。出院第3周后IgM转阴,且随时间迅速下降。同期IgG浓度高于IgM,并保持在较高水平无明显变化,第4周开始下降。其中,5例患者在出院后1 - 3周内发生“再感染”,“再感染”率为6.94%(5/72例)。COVID - 19患者出院后,个体产生的抗体水平差异较大,但抗体的总体变化有一定规律。建议加强住院期间及出院后的抗体监测,以降低“再感染”率及潜在感染风险。

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