咽拭子新型冠状病毒核酸检测的临床价值  

Clinical value of pharyngeal swab nucleic acid test of SARS-CoV-2

作　　者：李佳[1] 李霖 李春辉[2] 尹路 胡霞 阳瑶 盛懿 王爱民[1] LI Jia;LI Lin;LI Chun-hui;YIN Lu;HU Xia;YANG Yao;SHENG Yi;WANG Ai-min(Department of Emergency, Xiangya Hospital, Central South University, Changsha 410008, China;Center for Healthcare -associated Infection Control, Xiangya Hospital, Central South University, Changsha 410008, China;Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China)

机构地区：[1]中南大学湘雅医院急诊科,湖南长沙410008 [2]中南大学湘雅医院医院感染控制中心,湖南长沙410008 [3]中国医学科学院北京协和医院急诊科,北京100730

出　　处：《中国感染控制杂志》2020年第7期585-590,共6页Chinese Journal of Infection Control

基　　金：湖南省自然科学基金(2018JJ2652)。

摘　　要：目的了解某院新型冠状病毒肺炎(COVID-19)患者的临床资料及咽拭子检查结果,评价咽拭子新型冠状病毒(SARS-CoV-2)核酸检测的临床价值,为临床诊断COVID-19提供参考。方法回顾性收集中南大学湘雅医院2020年1月23日—2月18日经SARS-CoV-2核酸检测确诊COVID-19患者病历资料,分析患者临床资料、病毒核酸检测的取样次数、取样方法、标本类型、检测手段等信息。结果28例确诊患者平均年龄(43.78±14.46)岁,男女比例为2.5∶1,46.42%的患者有武汉/湖北旅居史,14.29%的患者与确诊COVID-19患者有密切接触史。患者临床表现以发热(78.57%)、咳嗽(53.57%)为主,实验室检查可见白细胞计数正常(71.43%),淋巴细胞计数下降(53.57%),肺部CT呈多发磨玻璃影(92.59%)及斑片影(70.37%)。28例确诊病例中,发病至确诊的中位时间为5.5 d。首次采集标本SARS-CoV-2检测阳性者18例(64.29%),首次可疑阳性1例;首次阴性(包括可疑阳性),第二次采集阳性者5例(17.86%);前两次采集阴性,第三次采集阳性者2例(7.14%);经四次检测阳性者1例(3.57%);经五次检测后阳性者2例(7.14%)。鼻/口咽拭子采样26例(92.86%),诱导排痰2例(7.14%),经鼻咽拭子、咽拭子、痰标本RT-PCR确诊27例(96.43%),痰标本NGS测序确诊1例(3.57%)。结论COVID-19临床常表现有发热及干咳,但无特异性,仍需依赖SARS-CoV-2核酸检测才能确诊。咽拭子作为发热门诊首选的SARS-CoV-2核酸采集方式具有简便易行的优势,但检测结果呈阴性并不能排除SARS-CoV-2感染。Objective To understand the clinical data and pharyngeal swab test results of patients with coronavirus disease 2019(COVID-19)in a hospital,evaluate the clinical value of pharyngeal swab nucleic acid test of SARS-CoV-2,and provide reference for clinical diagnosis of COVID-19.Methods Clinical data of patients who were confirmed with COVID-19 by nucleic acid test of SARS-CoV-2 in Xiangya Hospital of Central South University from January 23 to February 18,2020 were collected,patients’clinical data,sampling frequency,sampling method,specimen type,and testing method for nucleic acid test were analyzed.Results The average age of 28 confirmed patients was(43.78±14.46)years,male-female ratio was 2.5∶1,46.42%of the patients had a history of living/traveling in Wuhan/Hubei,14.29%had a history of close contact with COVID-19 patients.The main clinical manifestations of patients were fever(78.57%)and cough(53.57%),laboratory examination showed normal white blood cell count(71.43%)and decreased lymphocyte count(53.57%),pulmonary CT showed multiple ground-glass opacity(92.59%)and patchy opacity(70.37%).Among 28 confirmed cases,the median time from onset to confirmed diagnosis was 5.5 days.18 cases(64.29%)were positive and 1 case was suspected positive for SARS-CoV-2 for the first test,5 cases(17.86%)were negative for the first test(including suspected positive)and positive for the second test,2 cases(7.14%)were negative for the first two test and positive for the third test;1 case(3.57%)was positive for the fourth test;2 cases(7.14%)was positive for the fifth test.26 cases(92.86%)were taken specimen through nasal/oropharyngeal swabs,2 cases(7.14%)were induced sputum excretion,27 cases(96.43%)were confirmed by RT-PCR of nasopharyngeal swabs,pharyngeal swabs and sputum specimens,and 1 case(3.57%)was confirmed by next-generation sequencing technology(NGS).Conclusion COVID-19 is usually characterized by fever and dry cough,but there is no specificity,and confirm of diagnosis still rely on nucleic acid test of SARS-CoV-2.Pharyn

关 键 词：新型冠状病毒 新型冠状病毒肺炎 咽拭子 核酸检测 

分 类 号：R563.1[医药卫生—呼吸系统] R44[医药卫生—内科学]