Chronological Changes of Viral Shedding in Adult Inpatients With COVID-19 in Wuhan, China
Chronological Changes of Viral Shedding in Adult Inpatients With COVID-19 in Wuhan, China
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中国武汉市成人 COVID-19 住院患者病毒排毒的时间变化
DOI：
10.1093/cid/ciaa631
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发表时间：
2020-10-15
影响因子：
11.8
通讯作者：
Li, Yan
中科院分区：
文献类型：
--
作者：
Huang, Jing-Tao;Ran, Ruo-Xi;Li, Yan
摘要背景2019年12月，武汉市爆发由严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）。COVID-19患者的流行病学和临床特征已有报道，但实验室特征与病毒载量之间的关系尚未得到全面描述。方法选取武汉大学人民医院住院的COVID-19成人患者（≥18岁），均接受多次（≥ 5次）鼻咽拭子核酸检测，其中普通患者70例，重症患者195例，危重症患者43例。从电子病历中提取实验室数据、人口统计学和临床数据。用拟合的多项式曲线探讨病毒载量与病情严重程度的关系。结果SARS-CoV-2病毒载量在入院后第2-4天达到高峰，随后沿着病毒反弹迅速下降。重症患者的病毒载量最高，而一般患者的病毒载量最低。痰液中的病毒载量高于鼻和咽拭子（p=0.026）。呼吸道标本的阳性率明显高于胃肠道标本（P<0.001）。SARS-CoV-2病毒载量与血常规、淋巴细胞亚群部分指标呈负相关，与心血管系统实验室指标呈正相关。结论病毒载量监测可反映患者在住院期间病毒的整体脱落和治疗期间病毒的死灰复燃，可用于病情严重程度的预警，从而提高抗病毒干预水平。
Abstract Background In December 2019, the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) broke out in Wuhan. Epidemiological and clinical characteristics of patients with COVID-19 have been reported, but the relationships between laboratory features and viral load has not been comprehensively described. Methods Adult inpatients (≥18 years old) with COVID-19 who underwent multiple (≥ 5 times) nucleic acid tests with nasal and pharyngeal swabs were recruited from Renmin Hospital of Wuhan University, including general patients (n=70), severe patients (n=195) and critical patients (n=43). Laboratory data, demographic and clinical data were extracted from electronic medical records. The fitted polynomial curve was used to explore the association between serial viral loads and illness severity. Results Viral load of SARS-CoV-2 peaked within the first few days (2-4 days) after admission, then decreased rapidly along with virus rebound under treatment. Critical patients had the highest viral loads, in contrast to the general patients showing the lowest viral loads. The viral loads were higher in sputum compared with nasal and pharyngeal swab (p=0.026). The positive rate of respiratory tract samples was significantly higher than that of gastrointestinal tract samples (p<0.001). The SARS-CoV-2 viral load was negatively correlated with portion parameters of blood routine and lymphocyte subsets, and was positively associated with laboratory features of cardiovascular system. Conclusions The serial viral loads of patients revealed whole viral shedding during hospitalization and the resurgence of virus during the treatment, which could be used for early warning of illness severity, thus improve antiviral interventions.