成人印度尼西亚患者肛拭子 RT-PCR 检测 COVID-19 的价值。
The value of anal swab RT-PCR for COVID-19 diagnosis in adult Indonesian patients.
机构信息
Gastroenterology, Pancreatobilliary, and Endoscopy Division, Internal Medicine Department, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Special Capital Region of Jakarta, Indonesia.
Indonesia Medical Education and Research Institute - Human Cancer Research Center, University of Indonesia Faculty of Medicine, Central Jakarta, Special Capital Region of Jakarta, Indonesia.
出版信息
BMJ Open Gastroenterol. 2021 May;8(1). doi: 10.1136/bmjgast-2020-000590.
OBJECTIVE
This study will test the performance of the anal swab PCR test when compared with the nasopharyngeal swab PCR test as a diagnostic tool for COVID-19.
DESIGN
An observational descriptive study which included hospitalised suspected, or probable cases of hopitalised COVID-19 patients, conducted in Dr. Cipto Mangunkusumo National Hospital, Ciputra Hospital, Mitra Keluarga Depok Hospital and Mitra Keluarga Kelapa Gading Hospital, Indonesia. Epidemiological, clinical, laboratory and radiology data were obtained. Nasopharyngeal and anal swabs specimens were collected for SARS-CoV-2 RNA detection.
RESULTS
We analysed 136 subjects as part of this study. The clinical spectrum of COVID-19 manifesation in this study was typical of hospitalised patients, with 25% classified as mild cases, 14.7% in severe condition and 12.5% of subjects classified as having acute respiratory distress syndrome. When compared with nasopharyngeal swab as the standard specimen for reverse transcription polymerase chain reaction (RT-PCR) detection of SARS-CoV-2 antigen, the sensitivity and specificity of the anal swab was 36.7% and 93.8%, respectively. The positive and negative predictive value were 97.8% and 16.5 %, respectively. The performance of the anal swab remained similar when only the subgroup of patients with gastrointestinal symptoms (n=92, 67.6%) was analysed (sensitivity 40% and specificity 91.7%). Out of all the subjects included in analysis, 67.6% had gastrointestinal symptoms. Similarly, 73.3% of patients in the anal swab-positive group had gastrointestinal symptoms. The two most common gastrointestinal symptoms in the subjects' population were nausea and anorexia.
CONCLUSION
Anal swab specimen has low sensitivity (36.7%) but high specificity (93.8%) for detecting SARS-CoV-2 antigen by RT-PCR. Only one additional positive result was found by anal swab among the nasopharyngeal swab-negative group. Anal swab may not be needed as an additional test at the beginning of a patient's diagnostic investigation and nasopharyngeal swab RT-PCR remains as the standard diagnostic test for COVID-19.
目的
本研究旨在比较直肠拭子 PCR 检测与鼻咽拭子 PCR 检测在 COVID-19 诊断中的性能。
设计
本研究为观察性描述性研究，纳入了印度尼西亚 Dr. Cipto Mangunkusumo 国家医院、Ciputra 医院、Mitra Keluarga Depok 医院和 Mitra Keluarga Kelapa Gading 医院收治的疑似或可能 COVID-19 住院患者。收集流行病学、临床、实验室和影像学数据。采集鼻咽和直肠拭子标本进行 SARS-CoV-2 RNA 检测。
结果
本研究共纳入 136 例患者。本研究中 COVID-19 临床表现的临床谱与住院患者典型表现一致，25%的患者为轻症，14.7%为重症，12.5%的患者为急性呼吸窘迫综合征。与鼻咽拭子作为 SARS-CoV-2 抗原逆转录聚合酶链反应（RT-PCR）检测的标准标本相比，直肠拭子的敏感性和特异性分别为 36.7%和 93.8%。阳性和阴性预测值分别为 97.8%和 16.5%。仅分析有胃肠道症状的患者亚组（n=92，67.6%）时，直肠拭子的性能相似（敏感性 40%，特异性 91.7%）。纳入分析的所有患者中，67.6%有胃肠道症状。同样，直肠拭子阳性组中 73.3%的患者有胃肠道症状。在研究人群中，最常见的两种胃肠道症状是恶心和厌食。
结论
直肠拭子标本检测 SARS-CoV-2 抗原的 RT-PCR 敏感性（36.7%）较低，但特异性（93.8%）较高。在鼻咽拭子阴性组中，仅发现 1 例额外的阳性结果。在患者的诊断性检查开始时，直肠拭子可能不需要作为额外的检查，鼻咽拭子 RT-PCR 仍然是 COVID-19 的标准诊断性检测。
Zotero 插件