Antar Annukka A R, Yu Tong, Demko Zoe O, Hu Chen, Tornheim Jeffrey A, Blair Paul W, Thomas David L, Manabe Yukari C
medRxiv. 2023 Jan 19:2023.01.18.23284742. doi: 10.1101/2023.01.18.23284742.
The incidence of long COVID is substantial, even in people who did not require hospitalization for acute COVID-19. The pathobiological mechanisms of long COVID and the role of early viral kinetics in its development are largely unknown. Seventy-three non-hospitalized adult participants were enrolled within approximately 48 hours of their first positive SARS-CoV-2 RT-PCR test, and mid-turbinate nasal and saliva samples were collected up to 9 times within the first 45 days after enrollment. Samples were assayed for SARS-CoV-2 using RT-PCR and additional test results were abstracted from the clinical record. Each participant indicated the presence and severity of 49 long- COVID symptoms at 1-, 3-, 6-, 12-, and 18-months post-COVID-19 diagnosis. Time from acute COVID-19 illness onset to SARS-CoV-2 RNA clearance greater or less than 28 days was tested for association with the presence or absence of each of 49 long COVID symptoms at 90+ days from acute COVID-19 symptom onset. Brain fog and muscle pain at 90+ days after acute COVID-19 onset were negatively associated with viral RNA clearance within 28 days of acute COVID-19 onset with adjustment for age, sex, BMI ≥ 25, and COVID vaccination status prior to COVID-19 (brain fog: aRR 0.46, 95% CI 0.22-0.95; muscle pain: aRR 0.28, 95% CI 0.08-0.94). This work indicates that at least two long COVID symptoms - brain fog and muscle pain - at 90+ days from acute COVID-19 onset are specifically associated with longer time to clearance of SARS-CoV-2 RNA from the upper respiratory tract.
长期新冠的发病率相当高，即使在那些因急性新冠病毒病（COVID-19）无需住院治疗的人群中也是如此。长期新冠的病理生物学机制以及早期病毒动力学在其发展过程中的作用在很大程度上尚不清楚。73名未住院的成年参与者在首次SARS-CoV-2逆转录聚合酶链反应（RT-PCR）检测呈阳性后的约48小时内入组，并在入组后的前45天内最多采集9次中鼻甲鼻拭子和唾液样本。使用RT-PCR对样本进行SARS-CoV-2检测，并从临床记录中提取其他检测结果。每位参与者在COVID-19诊断后的1个月、3个月、6个月、12个月和18个月时指出49种长期新冠症状的存在情况和严重程度。对从急性COVID-19发病到SARS-CoV-2 RNA清除时间大于或小于28天的情况进行检测，以确定其与急性COVID-19症状出现90多天后49种长期新冠症状中每种症状的存在与否之间的关联。在对年龄、性别、BMI≥25以及COVID-19之前的新冠疫苗接种状况进行调整后，急性COVID-19发病90多天后的脑雾和肌肉疼痛与急性COVID-19发病后28天内的病毒RNA清除呈负相关（脑雾：调整后相对危险度[aRR]为0.46，95%置信区间[CI]为0.22 - 0.95；肌肉疼痛：aRR为0.28，95%CI为0.08 - 0.94）。这项研究表明，急性COVID-19发病90多天后至少两种长期新冠症状——脑雾和肌肉疼痛——与上呼吸道中SARS-CoV-2 RNA清除时间较长存在特定关联。
