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新型冠状病毒肺炎及其相关并发症的诊断方法

Diagnostic Approaches for COVID-19 and Its Associated Complications.

作者信息

Wang Ivan E, Cooper Grant, Mousa Shaker A

机构信息

The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, 1 Discovery Drive, Rensselaer, NY 12144, USA.

出版信息

Diagnostics (Basel). 2021 Nov 9;11(11):2071. doi: 10.3390/diagnostics11112071.

Abstract

With almost 4 million deaths worldwide from the COVID-19 pandemic, the efficient and accurate diagnosis and identification of COVID-19-related complications are more important than ever. Scales such as the pneumonia severity index, or CURB-65, help doctors determine who should be admitted to the hospital or the intensive care unit. To properly treat and manage admitted patients, standardized sampling protocols and methods are required for COVID-19 patients. Using PubMed, relevant articles since March 2020 on COVID-19 diagnosis and its complications were analyzed. Patients with COVID-19 had elevated D-dimer, thrombomodulin, and initial factor V elevation followed by decreased factor V and factor VII and elevated IL-6, lactate dehydrogenase, and c-reactive protein, which indicated coagulopathy and possible cytokine storm. Patients with hypertension, newly diagnosed diabetes, obesity, or advanced age were at increased risk for mortality. Elevated BUN, AST, and ALT in severe COVID-19 patients was associated with acute kidney injury or other organ damage. The gold standard for screening COVID-19 is reverse transcriptase polymerase chain reaction (RT-PCR) using sputum, oropharyngeal, or nasopharyngeal routes. However, due to the low turnover rate and limited testing capacity of RT-PCR, alternative diagnostic tools such as CT-scan and serological testing (IgM and IgG) can be considered in conjunction with symptom monitoring. Advancements in CRISPR technology have also allowed the use of alternative COVID-19 testing, but unfortunately, these technologies are still under FDA review and cannot be used in patients. Nonetheless, increased turnover rates and testing capacity allow for a bright future in COVID-19 diagnosis.

摘要

在全球范围内,新冠疫情导致近400万人死亡,高效准确地诊断和识别与新冠相关的并发症比以往任何时候都更加重要。诸如肺炎严重程度指数或CURB-65等量表有助于医生确定哪些患者应住院或入住重症监护病房。为了妥善治疗和管理住院患者,新冠患者需要标准化的采样方案和方法。利用PubMed,对2020年3月以来关于新冠诊断及其并发症的相关文章进行了分析。新冠患者的D-二聚体、血栓调节蛋白升高,最初因子V升高,随后因子V和因子VII降低,白细胞介素-6、乳酸脱氢酶和C反应蛋白升高,这表明存在凝血病和可能的细胞因子风暴。患有高血压、新诊断的糖尿病、肥胖症或高龄的患者死亡风险增加。重症新冠患者血尿素氮、谷草转氨酶和谷丙转氨酶升高与急性肾损伤或其他器官损伤有关。新冠筛查的金标准是使用痰液、口咽或鼻咽途径进行逆转录聚合酶链反应(RT-PCR)。然而,由于RT-PCR的周转速度低和检测能力有限,可以结合症状监测考虑使用CT扫描和血清学检测(IgM和IgG)等替代诊断工具。CRISPR技术的进步也使得可以使用替代的新冠检测方法,但不幸的是,这些技术仍在接受美国食品药品监督管理局(FDA)的审查,不能用于患者。尽管如此,周转速度和检测能力的提高为新冠诊断带来了光明的未来。

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