Yıldırım Fatma, Gulhan Pinar Yildiz, Diken Özlem Ercen, Capraz Aylin, Simsek Meltem, Yildirim Berna Botan, Taysi Muhammet Ridvan, Ozturk Sakine Yilmaz, Demirtas Nurcan, Ergil Julide, Dirican Adem, Uzar Tugce, Karaman Irem, Ozkaya Sevket
Department of Pulmonary and Critical Care Medicine, University of Health Sciences Diskapi Yildirim Beyazit Research and Education Hospital, Ankara 06110, Turkey.
Department of Pulmonary Medicine, Düzce University, Faculty of Medicine, Düzce 81100, Turkey.
World J Exp Med. 2021 Sep 20;11(4):44-54. doi: 10.5493/wjem.v11.i4.44.
Although the detection of viral particles by reverse transcription polymerase chain reaction (RT-PCR) is the gold standard diagnostic test for coronavirus disease 2019 (COVID-19), the false-negative results constitute a big challenge.
To examine a group of patients diagnosed and treated as possible COVID-19 pneumonia whose multiple nasopharyngeal swab samples were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by RT-PCR but then serological immunoglobulin M/immunoglobulin G (IgM/IgG) antibody against SARS-CoV-2 were detected by rapid antibody test.
Eighty possible COVID-19 patients who had at least two negative consecutive COVID-19 RT-PCR test and were subjected to serological rapid antibody test were evaluated in this study.
The specific serological total IgM/IgG antibody against SARS-CoV-2 was detected in twenty-two patients. The mean age of this patient group was 63.2± 13.1-years-old with a male/female ratio of 11/11. Cough was the most common symptom (90.9%). The most common presenting chest computed tomography findings were bilateral ground glass opacities (77.2%) and alveolar consolidations (50.1%). The mean duration of time from appearance of first symptoms to hospital admission, to hospital admission, to treatment duration and to serological positivity were 8.6 d, 11.2 d, 7.9 d, and 24 d, respectively. Compared with reference laboratory values, serologically positive patients have shown increased levels of acute phase reactants, such as C-reactive protein, ferritin, and procalcitonin and higher inflammatory markers, such as erythrocyte sedimentation rate, lactate dehydrogenase enzyme, and fibrin end-products, such as D-dimer. A left shift on white blood cell differential was observed with increased neutrophil counts and decreased lymphocytes.
Our study demonstrated the feasibility of a COVID-19 diagnosis based on rapid antibody test in the cases of patients whose RT-PCR samples were negative. Detection of antibodies against SARS-CoV-2 with rapid antibody test should be included in the diagnostic algorithm in patients with possible COVID-19 pneumonia.
尽管通过逆转录聚合酶链反应（RT-PCR）检测病毒颗粒是2019冠状病毒病（COVID-19）的金标准诊断测试，但假阴性结果构成了巨大挑战。
检查一组被诊断并作为可能的COVID-19肺炎进行治疗的患者，其多个鼻咽拭子样本经RT-PCR检测严重急性呼吸综合征冠状病毒2（SARS-CoV-2）呈阴性，但随后通过快速抗体检测检测到针对SARS-CoV-2的血清免疫球蛋白M/免疫球蛋白G（IgM/IgG）抗体。
本研究评估了80例可能的COVID-19患者，这些患者至少连续两次COVID-19 RT-PCR检测呈阴性，并接受了血清学快速抗体检测。
22例患者检测到针对SARS-CoV-2的特异性血清总IgM/IgG抗体。该患者组的平均年龄为63.2±13.1岁，男女比例为11/11。咳嗽是最常见的症状（90.9%）。最常见的胸部计算机断层扫描表现是双侧磨玻璃影（77.2%）和肺泡实变（50.1%）。从首次出现症状到入院、入院到治疗持续时间以及血清学阳性的平均时间分别为8.6天、11.2天、7.9天和24天。与参考实验室值相比，血清学阳性患者的急性期反应物水平升高，如C反应蛋白、铁蛋白和降钙素原，以及更高的炎症标志物，如红细胞沉降率、乳酸脱氢酶和纤维蛋白终产物，如D-二聚体。观察到白细胞分类出现左移，中性粒细胞计数增加，淋巴细胞减少。
我们的研究证明了在RT-PCR样本为阴性的患者中基于快速抗体检测进行COVID-19诊断的可行性。对于可能患有COVID-19肺炎的患者，诊断算法中应包括通过快速抗体检测检测针对SARS-CoV-2的抗体。
