Highly Prevalent SARS-CoV-2 Antigenemia in COVID-19 Patients.
Highly Prevalent SARS-CoV-2 Antigenemia in COVID-19 Patients.
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COVID-19患者中高度流行的SARS-CoV-2抗原血症
DOI：
10.1097/id9.0000000000000057
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发表时间：
2022-07
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中科院分区：
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许多问题，如严重程度评估和抗体反应，仍然需要迫切回答，以评估和了解COVID-19。免疫损伤是该病的重要发病机制之一。对SARS-CoV-2感染者进行抗原血症及相关性研究，将有助于对该病的认识。本研究共纳入2020年1 - 2月在合肥市第一人民医院或安徽省立医院住院的156例患者。采用NP-抗原捕获酶联免疫吸附试验、胶体金快速诊断和实时RT-PCR分别检测了3例COVID-19患者和另外153例COVID-19患者的连续血清中SARS-CoV-2核衣壳（NP）抗原、特异性IgM/IgG抗体和RNA。根据中国COVID-19诊断和治疗指南，COVID-19患者的临床类型分为无症状、轻度、中度、重度和危重。获得患者的人口统计学和临床数据进行可比性分析。从3例有典型临床症状的COVID-19患者连续采集的20份血清中，有5份检测到NP抗原，60.13%（92/153）的扩增样本在发病后17天内采集。 在这些血清中均未检测到SARS-CoV-2 RNA片段。发病后6 ~ 8d NP阳性率达高峰（84.85%，28/33）。NP浓度和阳性比例均随COVID-19临床严重程度的增加而增加。与NP阴性患者相比，NP阳性患者的年龄更大[岁，中位数NP特异性IgM阳性率较低[27.17%（25/92）vs. 59.02%（36/61）]，IgG抗体阳性率为21.74%（20/92）vs59.02%（36/61），从发病到痊愈的时间为24（10）vs 21（13）天。SARS-CoV-2 NP抗原血症发生于COVID-19，在疾病早期呈现高度流行。抗原血症与疾病的严重程度有关，可能是导致SARS-Cov-2 IgM检测延迟的原因。
Many issues, such as severity assessment and antibody responses, remain to be answered eagerly for evaluation and understanding of COVID-19. Immune lesion is one of key pathogenesis of the disease. It would be helpful to understand the disease if an investigation on antigenemia and association was conducted in the patients with SARS-CoV-2 infection. A total of 156 patients admitted to the First People's Hospital of Hefei or Anhui Provincial Hospital on January to February 2020 were involved in this study. SARS-CoV-2 nucleocapsid (NP) antigen, specific IgM/IgG antibodies, and RNA were detected in sequential sera from three COVID-19 patients, and additional 153 COVID-19 patients by means of NP-antigen capture enzyme-linked immunosorbent assay, colloidal gold quick diagnosis, and real-time RT-PCR, respectively. The clinical types of COVID-19 patients were classified into asymptomatic, mild, moderate, severe, and critical, following on the Chinese guideline of COVID-19 diagnosis and treatment. The demographic and clinical data of patients were obtained for comparable analysis. NP antigen was detected in 5 of 20 sequential sera collected from three COVID-19 patients with typically clinical symptoms, and 60.13% (92/153) expanded samples collected within 17 days after illness onset. No SARS-CoV-2 RNA segment was detected in these sera. The NP positive proportion reached a peak (84.85%, 28/33) on 6 to 8 days after illness onset. Both NP concentration and positive proportion were increased with the increase of clinical severity of COVID-19. Compared to NP negative patients, NP positive patients had older age [years, medians (interquartile ranges (IQR)), 49 (6) vs. 31 (11)], lower positive proportion of NP specific IgM [27.17% (25/92) vs. 59.02% (36/61)], and IgG [21.74% (20/92) vs. 59.02% (36/61)] antibodies, and longer duration [days, medians (IQR), 24 (10) vs. 21 (13)] from illness to recovery. SARS-CoV-2 NP antigenemia occurred in COVID-19, and presented highly prevalent at early stage of the disease. The antigenemia was related to clinical severity of the disease, and may be responsible for the delay of detectable SARS-Cov-2 IgM.