Herbert Carly, Antar Annukka A R, Broach John, Wright Colton, Stamegna Pamela, Luzuriaga Katherine, Hafer Nathaniel, McManus David D, Manabe Yukari C, Soni Apurv
Program in Digital Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
University of Massachusetts Center for Clinical and Translational Science, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
Clin Infect Dis. 2025 Feb 5;80(1):82-90. doi: 10.1093/cid/ciae539.
The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics during acute infection and the development of long coronavirus disease 2019 (COVID-19), or "long COVID," is largely unknown.
Between October 2021 and February 2022, 7361 people not known to have COVID-19 self-collected nasal swab samples for SARS-CoV-2 reverse-transcription polymerase chain reaction testing every 24-48 hours for 10-14 days. Participants whose first known SARS-CoV-2 infection was detected were surveyed for long COVID in August 2023. Their slopes of viral clearance were modeled using linear mixed effects models with random slopes and intercepts, and the relative risk (RR) of long COVID based on viral slopes was calculated using a log binomial model, adjusted for age, symptoms, and variant. Sex-based interaction terms were also evaluated for significance.
A total of 172 participants were eligible for analyses, and 59 (34.3%) reported long COVID. The risk of long COVID with 3-4 symptoms (adjusted RR, 2.44 [95% confidence interval, .88-6.82]) and ≥5 symptoms (4.97 [1.90-13.0]) increased with each unit increase in slope of viral clearance. While the probability of long COVID increased with slowed viral clearance among women, the same relationship was not observed among men (interaction term: P = .02). Acute SARS-CoV-2 symptoms of abdominal pain (adjusted RR, 5.41 [95% confidence interval, 2.44-12.0]), nausea (3.01 [1.31-6.89]), and body aches (2.58 [1.26-5.30]) were most strongly associated with long COVID.
We observed that slower viral clearance rates during acute COVID-19 were associated with increased risk and more symptoms of long COVID . Early viral-host dynamics appear to be mechanistically linked to the development of long COVID.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）急性感染期间的病毒动力学与长期冠状病毒病2019（COVID-19）即“长新冠”的发展之间的关系在很大程度上尚不清楚。
在2021年10月至2022年2月期间，7361名未知感染新冠病毒的人每24 - 48小时自行采集鼻拭子样本进行SARS-CoV-2逆转录聚合酶链反应检测，持续10 - 14天。2023年8月对首次检测出感染SARS-CoV-2的参与者进行了长新冠调查。使用具有随机斜率和截距的线性混合效应模型对他们的病毒清除斜率进行建模，并使用对数二项模型计算基于病毒斜率的长新冠相对风险（RR），并根据年龄、症状和病毒变体进行调整。还评估了基于性别的交互项的显著性。
共有172名参与者符合分析条件，其中59人（34.3%）报告患有长新冠。随着病毒清除斜率每增加一个单位，出现3 - 4种症状（调整后的RR，2.44 [95%置信区间，0.88 - 6.82]）和≥5种症状（4.97 [1.90 - 13.0]）的长新冠风险增加。虽然女性中长新冠的概率随着病毒清除减慢而增加，但在男性中未观察到相同的关系（交互项：P = 0.02）。腹痛（调整后的RR，5.41 [95%置信区间，2.44 - 12.0]）、恶心（3.01 [1.31 - 6.89]）和身体疼痛（2.58 [1.26 - 5.30]）等急性SARS-CoV-2症状与长新冠的关联最为密切。
我们观察到，急性COVID-19期间较慢的病毒清除率与长新冠风险增加和更多症状相关。早期病毒与宿主的动力学似乎在机制上与长新冠的发展有关。
