Nasopharyngeal Swabs Are More Sensitive Than Oropharyngeal Swabs for COVID-19 Diagnosis and Monitoring the SARS-CoV-2 Load
Nasopharyngeal Swabs Are More Sensitive Than Oropharyngeal Swabs for COVID-19 Diagnosis and Monitoring the SARS-CoV-2 Load
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DOI：
10.3389/fmed.2020.00334
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发表时间：
2020-06-18
影响因子：
3.9
通讯作者：
Xu, Shu-yun
中科院分区：
文献类型：
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作者：
Wang, Huan;Liu, Qian;Xu, Shu-yun
目的：口咽拭子和鼻咽拭子检测SARS-CoV-2是控制新冠肺炎疫情的重要手段。目前尚不清楚两种抽样方法的检测率、敏感度和医疗提供者暴露的风险有何不同。方法：在这项前瞻性研究中，收集了120例新冠肺炎住院患者的NPS和OPS配对标本。用实时荧光定量RT-PCR检测拭子中SARS-CoV-2核酸。从NPS和OPS两个方面分析SARS-CoV-2的检出率、敏感性和病毒载量。对患者报告的采样不适进行评估。结果：非典型肺炎患者SARS-CoV-2的检出率为46.7%(56/120)，明显高于非传染性非典型肺炎患者的10.0%(12/120)(P<；0.001)。NPS的敏感性也显著高于OPS(P<；0.001)。在抽样时，与OPS相比，NPS可检测到SARS-CoV-2的时间中位数(分别为25.0天和20.5天)和最长持续时间(分别为41天和39天)更长。NPS的平均周期阈值(Ct值)(37.8，95%CI：37.0~38.6)显著低于OPS(39.4，95%CI：38.9~39.8)1.6(95%CI 1.0~2.2，P<；0.001)，表明NPS标本中SARS-CoV-2载量显著高于OPS。在两种抽样方法中，患者的不适感都很低。在NPS抽样期间，患者发生恶心和呕吐的可能性显著降低。结论：NPS的SARS-CoV-2检出率、敏感性和病毒载量均显著高于OPS。NPS可以减少拭子过程中液滴的产生。对于新冠肺炎的诊断和SARS-CoV-2病毒载量的监测，应推荐NPS。
Objective:Detection of SARS-CoV-2 by oropharyngeal swabs (OPS) and nasopharyngeal swabs (NPS) is an essential method for coronavirus disease 2019 (COVID-19) management. It is not clear how detection rate, sensitivity, and the risk of exposure for medical providers differ in two sampling methods. Methods:In this prospective study, 120 paired NPS and OPS specimens were collected from 120 inpatients with confirmed COVID-19. SARS-CoV-2 nucleic acid in swabs were detected by real-time RT-PCR. The SARS-CoV-2 detection rate, sensitivity, and viral load were analyzed with regards NPS and OPS. Sampling discomfort reported by patients was evaluated. Results:The SARS-CoV-2 detection rate was significantly higher for NPS [46.7% (56/120)] than OPS [10.0% (12/120)] (P< 0.001). The sensitivity of NPS was also significantly higher than that of OPS (P< 0.001). At the time of sampling, the time of detectable SARS-CoV-2 had a longer median duration (25.0 vs. 20.5 days, respectively) and a longer maximum duration (41 vs. 39 days, respectively) in NPS than OPS. The mean cycle threshold (Ct) value of NPS (37.8, 95% CI: 37.0-38.6) was significantly lower than that of OPS (39.4, 95% CI: 38.9-39.8) by 1.6 (95% CI 1.0-2.2,P< 0.001), indicating that the SARS-CoV-2 load was significantly higher in NPS specimens than OPS. Patient discomfort was low in both sampling methods. During NPS sampling, patients were significantly less likely to have nausea and vomit. Conclusions:NPS had significantly higher SARS-CoV-2 detection rate, sensitivity, and viral load than OPS. NPS could reduce droplets production during swabs. NPS should be recommended for diagnosing COVID-19 and monitoring SARS-CoV-2 load.