Serologic Detection of SARS-CoV-2 Infections in Hemodialysis Centers: A Multicenter Retrospective Study in Wuhan, China.
Serologic Detection of SARS-CoV-2 Infections in Hemodialysis Centers: A Multicenter Retrospective Study in Wuhan, China.
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血液透析中心 SARS-CoV-2 感染的血清学检测：中国武汉的多中心回顾性研究
DOI：
10.1053/j.ajkd.2020.06.008
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发表时间：
2020-10
期刊：
影响因子：
--
通讯作者：
Zhang C
中科院分区：
文献类型：
--
作者：
Tang H;Tian JB;Dong JW;Tang XT;Yan ZY;Zhao YY;Xiong F;Sun X;Song CX;Xiang CG;Tu C;Lei CT;Liu J;Su H;Huang J;Qiu Y;Miao XP;Zhang C
接受维持性血液透析（MHD）的患者极易感染严重急性呼吸综合征冠状病毒2 （SARS-CoV-2）。本研究旨在通过核酸检测（NAT）和抗体检测评估中国MHD患者SARS-CoV-2感染的流行情况。横断面研究。2019年12月1日至2020年3月31日，中国武汉市5个大型血液透析中心共纳入1027例MHD患者。通过症状和初始胸部CT检查筛查患者是否感染SARS-CoV-2。如果患者在最初筛查为阴性后出现症状，则进行重复CT检查。对疑似感染SARS-CoV-2的患者连续2次咽拭子检测病毒RNA。2020年3月中旬，对所有MHD患者进行了SARS-CoV-2抗体检测。SARS-CoV-2的NAT和抗体检测结果。发病率、临床特征、实验室和放射学表现。组间差异采用t检验或Mann-Whitney U检验，将未感染组与感染组进行比较，将NAT检测出感染的组与血清学检测结果阳性的组进行比较。在1027名接受MHD治疗的患者中，有99人被确定为SARS-CoV-2感染，患病率为9.6%。在99例病例中，52例（53%）经NAT阳性初步诊断为SARS-CoV-2感染；47例（47%）后来通过抗SARS-CoV-2免疫球蛋白G （IgG）或IgM抗体阳性鉴定。这47例患者有多种抗体谱：IgM抗体5例（11%），IgG抗体35例（74%），IgM和IgG抗体均有7例（15%）。99例病例中，51%在疫情期间无症状；61%的患者胸部CT表现为磨玻璃或斑片状影，而未感染患者为11.6% （P < 0.001）。高血压肾病患者更常被发现有SARS-CoV-2感染，并且比其他主要肾衰竭原因的患者更容易出现症状。NAT和抗体检测可能出现假阳性和假阴性结果；可能缺乏对其他透析人群的普遍性。MHD患者中有一半的SARS-CoV-2感染是亚临床的，没有通过胸部普遍CT和选择性NAT发现。血清学检测可能有助于评估总体患病率，并了解感染SARS-CoV-2的MHD患者临床病程的多样性。
Patients receiving maintenance hemodialysis (MHD) are highly vulnerable to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The current study was designed to evaluate the prevalence of SARS-CoV-2 infection based on both nucleic acid testing (NAT) and antibody testing in Chinese patients receiving MHD. Cross-sectional study. From December 1, 2019, to March 31, 2020, a total of 1,027 MHD patients in 5 large hemodialysis centers in Wuhan, China, were enrolled. Patients were screened for SARS-CoV-2 infection by symptoms and initial computed tomography (CT) of the chest. If patients developed symptoms after the initial screening was negative, repeat CT was performed. Patients suspected of being infected with SARS-CoV-2 were tested with 2 consecutive throat swabs for viral RNA. In mid-March 2020, antibody testing for SARS-CoV-2 was obtained for all MHD patients. NAT and antibody testing results for SARS-CoV-2. Morbidity, clinical features, and laboratory and radiologic findings. Differences between groups were examined using t test or Mann-Whitney U test, comparing those not infected with those infected and comparing those with infection detected using NAT with those with infection detected by positive serology test results. Among 1,027 patients receiving MHD, 99 were identified as having SARS-CoV-2 infection, for a prevalence of 9.6%. Among the 99 cases, 52 (53%) were initially diagnosed with SARS-CoV-2 infection by positive NAT; 47 (47%) were identified later by positive immunoglobulin G (IgG) or IgM antibodies against SARS-CoV-2. There was a spectrum of antibody profiles in these 47 patients: IgM antibodies in 5 (11%), IgG antibodies in 35 (74%), and both IgM and IgG antibodies in 7 (15%). Of the 99 cases, 51% were asymptomatic during the epidemic; 61% had ground-glass or patchy opacities on CT of the chest compared with 11.6% among uninfected patients (P < 0.001). Patients with hypertensive kidney disease were more often found to have SARS-CoV-2 infection and were more likely to be symptomatic than patients with another primary cause of kidney failure. Possible false-positive and false-negative results for both NAT and antibody testing; possible lack of generalizability to other dialysis populations. Half the SARS-CoV-2 infections in patients receiving MHD were subclinical and were not identified by universal CT of the chest and selective NAT. Serologic testing may help evaluate the overall prevalence and understand the diversity of clinical courses among patients receiving MHD who are infected with SARS-CoV-2.
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1.7
作者：
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