The Regularity and Clinical Manifestations of Throat Swab and Fecal Detoxification in New Coronavirus Infected Patients
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摘要:
目的 通过分析咽拭子、粪便新冠病毒核酸均阳性者的临床表现,探索其临床特征及排毒规律,为临床诊疗提供依据。 方法 回顾性分析昆明市第三人民医院2020年2月至12月收治的59例新冠病毒感染者临床症状、实验室指标、咽拭子及粪便新冠病毒排毒规律。 结果 粪便阳性组:潜伏感染7例,首次咽拭子核酸阳性至有症状3~8 d(中位数4 d),持续阳性5例,反复阳性2例;咽拭子阳性后1~28 d粪便呈阳性(中位数6 d)。无症状5例,咽拭子持续阳性2例,反复阳性2例;咽拭子阳性后4~21 d粪便呈阳性(中位数6 d)。21例有症状者发病至咽拭子阳性1~21 d(中位数5 d),8例持续阳性4~20 d,10例反复阳性8~26 d;咽拭子阳性后4~29 d粪便呈阳性(中位数15 d)。粪便阴性组:潜伏感染6例,咽拭子阳性至有症状4~10 d(中位数5 d),持续阳性2例、反复阳性2例;4例无症状者咽拭子持续阳性1例、反复阳性1例;16例有症状者发病至咽拭子阳性1~16 d(中位数5.5 d),持续阳性3例、反复阳性10例。2组咽拭子核酸持续阳性时间有统计学差异(P < 0.05)、反复阳性时间无统计学差异(P > 0.05);2组肺部CT表现有统计学差异(P < 0.05);2组临床表现、肝功、肾功、心肌酶、血常规、CRP、T淋巴细胞等均无统计学差异(P > 0.05)。 结论 2组症状体征、脏器功能损伤、炎症指标均无差异。病毒排毒规律性不强,但咽拭子及粪便均排毒者比仅咽拭子排毒者排毒持续时间更长,肺炎更多见。 Abstract:Objective To explor the clinical characteristics and detoxification rules of the patients with COVID-19 nucleic acid positive by analyzing their clinical manifestations of throat swabs and fecal, so as to provide the evidence for the clinical diagnosis and treatment. Methods The clinical symptoms, laboratory indexes, and the detoxification of throat swab and faecal in 59 patients with COVID-19 infection admitted to Kunming Third People’s Hospital from February 2020 to December were retrospectively analyzed. Result Fecal positive group: In 7 cases of latent infection, the first pharyngeal swab nucleic acid was positive to symptomatic for 3~8 days (median 4 days), 5 cases were continuously positive and 2 cases were repeatedly positive; The stool was positive 1~28 days after the pharyngeal swab was positive (median 6 days). 5 cases were asymptomatic, 2 cases were continuously positive and 2 cases were repeatedly positive; The stool was positive 4~21 days after the pharyngeal swab was positive (median 6 days). 21 symptomatic patients were positive for pharyngeal swab for 1~21 days (median 5 days), 8 cases were continuously positive for 4~20 days, and 10 cases were repeatedly positive for 8~26 days; The stool was positive 4~29 days after the pharyngeal swab was positive (median 15 days). Fecal negative group: In 6 cases of latent infection, pharyngeal swabs were positive to symptomatic for 4~10 days (median 5 days), 2 cases were continuously positive and 2 cases were repeatedly positive; In 4 asymptomatic patients, pharyngeal swabs were continuously positive in 1 case and repeatedly positive in 1 case; In 16 symptomatic patients, the pharyngeal swab was positive for 1~16 days (median 5.5 days), 3 cases were continuously positive and 10 cases were repeatedly positive. There was significant difference in the continuous positive time of the pharyngeal swab nucleic acid between the two groups (P < 0.05), and there was no significant difference in the repeated positive time (P > 0.05); There was significant difference in CT findings between the two groups (P < 0.05); There was no significant difference in clinical manifestations, liver function, renal function, myocardial enzymes, blood routine, CRP and T lymphocytes between the two groups (P > 0.05). Conclusion There is no difference in symptoms and signs, organ function injury and inflammatory indexes between the two groups. The regularity of virus detoxification is not strong, but those who detoxify with pharyngeal swabs and feces last longer than those who detoxify only with pharyngeal swabs, and pneumonia is more common. -
Key words:
- New Coronavirus infection /
- Pharyngeal swab /
- Faeces /
- Viral nucleic acid
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表 1 粪便新冠核酸阳性病例与阴性病例临床表现比较[n(%)] (1)
Table 1. Comparison of clinical manifestations between fecal COVID-19 positive cases and negative cases [n(%)] (1)
粪便 发热 畏寒 咽痛 咽干 全身酸痛 阳性组 16(48.48) 2(6.06) 9(27.27) 8(24.24) 6(18.18) 阴性组 13(50.00) 3(11.54) 8(30.77) 3(11.54) 6(23.08) χ2 0.01 0.56 0.09 1.54 0.22 P 0.91 0.65 0.77 0.21 0.64 n = 59。 表 1 粪便新冠核酸阳性病例与阴性病例临床表现比较[n(%)] (2)
Table 1. Comparison of clinical manifestations between fecal COVID-19 positive cases and negative cases [n(%)] (2)
粪便 咯痰 咳嗽 气促 SaO2(≤93%) CT示肺炎病例数 阳性组 12(36.36) 18(54.55) 5(15.15) 9(27.27) 28(84.85) 阴性组 8(30.77) 11(42.30) 6(23.08) 3(11.54) 16(61.54) χ2 0.20 0.87 0.60 2.22 4.17 P 0.65 0.35 0.44 0.14 0.04* n = 59,*P < 0.05。 表 2 粪便新冠核酸阳性病例与阴性病例实验室检查结果比较n = 59 [M(QR)]
Table 2. Comparison of laboratory test results between fecal COVID-19 positive cases and negative cases n = 59 [M(QR)]
项目(正常范围) 粪便核酸结果 [M(QR)] Z P 白细胞 + 4.94(1.79) −0.61 0.54 (4~10)×109/L − 5.62(30.70) 淋巴细胞计数 + 1.46(0.88) −0.53 0.60 (0.8~4)×109/L − 1.65(1.18) 中性粒细胞计数计数 + 3.09(2.33) −0.46 0.65 (2~7)×109/L − 3.09(2.75) 嗜酸性粒细胞计数 + 0.06(0.11) −0.38 0.71 (0.02~0.5) − 0.05(0.10) 血小板(×109/L) + 250(121.50) −1.79 0.07 (100~300)×109/L − 207(83) CRP + 1.30(4.87) −0.04 0.97 (0~6)mg/L − 1.35(12.04) CD4+计数 + 414.50(545.75) −1.58 0.11 (706~1125)个/μL − 495(531.75) CD3+计数 + 1004(640) −0.12 0.91 (1027~2086)个/μL − 1100(920.75) CD8+计数 + 371(306) −0.57 0.57 (323~836)个/μL − 382(340) 尿素氮 + 3.50(1.40) −1.72 0.09 (1.43~7.14) mmol/L − 3.10(1.27) 肌酐 + 63.10(28.40) −0.40 0.69 (35~97) μmol/L − 63.50(25.40) 尿酸 + 290.5(128) −0.91 0.37 (155~428) μmol/L − 267.350(143.53) r-谷氨酰氨基转移酶 + 25.20(20.90) −0.55 0.58 (7~50) U/L − 28.95(27.20) 丙氨酸氨基转移酶 + 22(13.50) −0.21 0.83 (5~40) U/L − 22.85(14.10) 门冬氨酸氨基转移酶 + 23(10.50) −0.54 0.59 (8~40) U/L − 23.5(10.50) 乳酸脱氢酶 + 176(26.50) −1.25 0.21 (109~245) U/L − 191(86.50) 肌酸激酶 + 79(47.10) −1.48 0.88 (26~174) U/L − 78.30(44) 肌红蛋白 + 17.44(10.02) −0.38 0.71 (0~68) ng/mL − 18.22(11.26) -
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