Oropharyngeal Secretion as Alternative for SARS-CoV-2 Detection
Oropharyngeal Secretion as Alternative for SARS-CoV-2 Detection
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口咽分泌物作为 SARS-CoV-2 检测的替代方法
DOI：
10.1177/0022034520940292
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发表时间：
2020
影响因子：
7.6
通讯作者：
Ma J.
中科院分区：
文献类型：
--
作者：
Yu C.;Li L.;Tuersun Y.;Zhao X.;Feng Q.;Zhang T.;Tay F. R.;Ma J.
本研究旨在确定口咽分泌物（OS）采样是否有助于通过核酸扩增检测来提高对潜在COVID-19患者的SARS-CoV-2 RNA检测。第一项前瞻性研究包括75名准备出院的COVID-19患者，他们对鼻咽拭子（NPS）采集的病毒样本进行核酸扩增检测（NAAT），连续2次结果为阴性。由于在该队列中检测到了潜在的假阴性，因此在第二项前瞻性研究中使用了另外50名COVID-19新兵在恢复期的配对OS和ESTA样本的NAAT结果，以比较2种病毒RNA采样方法的诊断价值。为了确定采样方法之间的不一致频率，McNemar检验用于差异分析，Kappa统计用于一致性分析。在第一项研究中，从75名参与者中的2名获得的OS对SARS-CoV-2核酸产生阳性结果。均为男性，年龄> 60岁。随后的化学发光酶免疫分析表明，他们的SARS-CoV-2 IgM和IgG抗体呈阳性。在第二项研究中，对于OS和ESTA样本的平行NAAT，McNemar检验表明OS和ESTA不一致部分的频率之间的差异具有统计学意义（P = 0.021）。科恩的kappa系数为0.244，这是公平的一致性。抗病毒测试有风险送回家更多的患者（59%）谁仍然有感染，而OS测试将在较少的患者（14%）这样的错误。尽管OS采样提高了SARS-CoV-2核酸检测的准确性，但不得不强调的是，这一结论是基于非常小的样本量。从患者分泌物中检测到病毒RNA并不能证实病毒的感染性。
This study aimed to determine if sampling of oropharyngeal secretions (OSs) helps improves detection of SARS-CoV-2 RNA by nucleic acid amplification testing of potential patients with COVID-19. The first prospective study consisted of 75 patients with COVID-19 who were ready for discharge and who had 2 consecutive negative results per nucleic acid amplification testing (NAAT) of viral samples retrieved with nasopharyngeal swabs (NPSs). Because of detection of potential false negatives in that cohort, the NAAT results of paired OS and NPS samples from 50 additional recruits with COVID-19 during their recovery stage were used in a second prospective study to compare the diagnostic values of the 2 viral RNA sampling methods. For identification of the frequency of inconsistency between the sampling methods, the McNemar’s test was used for difference analysis and the kappa statistic for consistency analysis. OSs obtained from 2 of the 75 participants in the first study yielded positive results for SARS-CoV-2 nucleic acid. Both were male and aged >60 y. Subsequent chemiluminescence enzyme immunoassays indicated that they were positive for the SARS-CoV-2 IgM and IgG antibodies. For parallel NAAT of OS and NPS samples in the second study, McNemar’s test indicated that the difference between the frequencies of inconsistent parts of OS and NPS was statistically significant (P = 0.021). Cohen’s kappa coefficient for OS and NPS was 0.244, which is indicative of fair consistency. The NPS test has a risk of sending home more patients (59%) who still have the infection, while the OS test will make such an error in fewer patients (14%). Although OS sampling improves the accuracy of SARS-CoV-2 nucleic acid testing, it has to be emphasized that this conclusion is based on a very small sample size. Detection of viral RNA from a patient’s secretions is not confirmative of viral infectivity.