Improving Detection Efficiency of SARS-CoV-2 Nucleic Acid Testing.
Improving Detection Efficiency of SARS-CoV-2 Nucleic Acid Testing.
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提高 SARS-CoV-2 核酸检测的检测效率
DOI：
10.3389/fcimb.2020.558472
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发表时间：
2020
影响因子：
5.7
通讯作者：
Jiang L
中科院分区：
文献类型：
--
作者：
Zhang J;Li K;Zheng L;Zhang J;Ren Z;Song T;Yu H;Yang Z;Wang L;Jiang L
在本次大流行期间，SARS-CoV-2核酸检测（NAT）已被常规用于COVID-19诊断；然而，它的高假阴性率一直令人担忧。我们通过一项大型COVID-19队列研究分析了其检测效率。对四川省532例不同病情严重程度、状态、分期、不同标本类型和数量的新冠肺炎患者4275份标本进行SARS-CoV-2 NAT阳性率分析。4275份标本总阳性率为37.5%。在7种标本类型中，BALF的阳性率为77.8%，其次是上呼吸道标本（38.5%）、痰液（39.8%）和粪便/直肠拭子（34.1%）。危重病例标本阳性率为43.4%，明显高于其他重症标本。稳定状态患者标本中SARS-CoV-2阳性率为40.6%，明显高于好转状态（17.1%），但低于加重状态（61.5%）。值得注意的是，COVID-19患者标本的阳性率在症状出现前后3天的85% - 95%之间，在症状出现后18天左右的20%之间变化明显。此外，检出率从检测1个咽拭子后的72.1%上升到连续检测3个呼吸道样本后的93.2%。SARS-CoV-2 NAT检出率随患者病情严重程度和状态、标本类型、标本数量，特别是疾病进展而变化。尽可能在接近症状出现的时间取样，并连续采集多个呼吸道标本，可有效提高SARS-CoV-2 NAT检测效率。
SARS-CoV-2 nucleic acid testing (NAT) has been routinely used for COVID-19 diagnosis during this pandemic; however, there have been concerns about its high false negative rate. We dissected its detection efficiency with a large COVID-19 cohort study. We analyzed SARS-CoV-2 NAT positive rates of 4,275 specimens from 532 COVID-19 patients in Sichuan Province with different disease severities, statuses, and stages, as well as different types and numbers of specimens. The total positive rate of the 4,275 specimens was 37.5%. Among seven specimen types, BALF generated a 77.8% positive rate, followed by URT specimens (38.5%), sputum (39.8%), and feces/rectal swabs (34.1%). Specimens from critical cases generated a 43.4% positive rate, which was significantly higher than that of other severities. With specimens from patients at stable status, the SARS-CoV-2 positive rate was 40.6%, which was significantly higher than that of improved status (17.1%), but lower than that of aggravated status (61.5%). Notably, the positive rate of specimens from COVID-19 patients varied significantly from 85 to 95% during 3 days before and after symptom onset, to 20% at around 18 days after symptom onset. In addition, the detection rate increased from 72.1% after testing one throat swab, to 93.2% after testing three consecutive respiratory specimens from each patient. SARS-CoV-2 NAT detection rates vary with patient disease severity and status, specimen type, number of specimens, and especially disease progression. Sampling as close to symptom onset as possible, and consecutively collecting more than one respiratory specimen could effectively improve SARS-CoV-2 NAT detection efficiency.