广州地区新型冠状病毒肺炎出院病例核酸再次阳性的临床特征  

The clinical characteristics of recovered patients with corona virus disease 2019 who retested positive for the virus in Guangzhou

作　　者：罗纯[1] 温学良 谭颖[2] 林路平[1] 谢敏[1] 陈凤娟[3] 谭行华[1] LUO Chun;WEN Xue-liang;TAN Ying;LIN Lu-ping;XIE Min;CHEN Feng-juan;TAN Xing-hua(Department of Isolated Disease Area 4,Guangzhou Eighth People's Hospital^Guangzhou 510060,Guangdong,China;不详)

机构地区：[1]广州市第八人民医院隔离病区四区,广东广州510060 [2]广州市第八人民医院肝病科,广东广州510060 [3]广州市第八人民医院医务科,广东广州510060

出　　处：《广东医学》2020年第13期1297-1301,共5页Guangdong Medical Journal

基　　金：广东省科技创新专项资金(广东省防控新型冠状病毒感染科技攻关应急专项)项目(2020B111115001);广东省中医药局新冠肺炎中医药防治临床研究应急项目(2020ZYYJ01)。

摘　　要：目的初步探讨广州地区新型冠状病毒肺炎出院病例核酸再次阳性(简称复阳人员)的临床特征。方法收集确诊病例临床治愈出院后在医学隔离观察期核酸检测再次阳性病例,共计20例,包括一般资料(性别、年龄、基础疾病等)、临床分型、既往用药情况、实验室检查结果和影像学检查结果。纳入标准:按《新型冠状病毒肺炎诊疗方案》确诊为新型冠状病毒肺炎,临床治愈出院后由广州市疾病预防控制中心集中随访取样检测新型冠状病毒核酸。观察复阳人员的临床特征、实验室检查和抗病毒治疗方面是否存在统计学差异。结果复阳人员其中男10例(50%),女10例(50%),年龄12~77岁,中位年龄44岁。复阳组在出院前和再次入院后白细胞和淋巴细胞均在正常范围内波动,少数患者出院时D-二聚体稍高于正常值,二次入院后均恢复正常水平,氧合指数均在正常范围内,复阳组二次住院时间缩短一半,差异有统计学意义(P<0.05)。临床症状仅1例存在轻度咳嗽无痰,所有复阳人员均无二次发热及气促等呼吸道感染症状。所有复阳人员复查胸部CT,与出院时比较,其中12例(60%)肺部炎症继续吸收,6例(30%)肺部已无炎症表现,2例(10%)肺部炎症较出院时无变化。复阳人员有2例抗病毒药物不详,3例无抗病毒治疗,15例使用抗病毒治疗,抗病毒平均时长(10.65±4.15)d。抗病毒药物主要洛匹那韦利托那韦11例(64.71%),阿比多尔5例(29.41%),奥司他韦6例(35.29%),氯喹1例(5.88%)。结论本组新型冠状病毒肺炎20例复阳人员临床症状、实验室结果和肺部影像学表现暂不支持二次感染,绝大多数病例呈现恢复期表现。实验室检查和抗病毒药物使用的差异无法解释核酸复阳,复阳现象的原因仍需进一步研究。Objective To investigate the clinical characteristics of recovered patients with coronavirus disease 2019(COVID-19) who retested positive for the virus in Guangzhou. Methods The general data of confirmed cases were collected. Among them, 20 recovered and discharged patients retested positive for the virus. The data of these patients, including general information(gender, age, underlying diseases, and etc.), clinical classification, medication status, laboratory tests and imaging results, were analyzed. The inclusion criteria included proven diagnosed with COVID-19 according to the guidelines of the COVID-19 Diagnosis and Treatment Plan, and followed up by the CDC department after discharge. Results There were 10 males(50%) and 10 females(50%) in the retested positive group. The maximum age was 77 years, the minimum age was 12 years, and the median age was 44 years. In re-tested positive group, leukocytes and lymphocytes fluctuated in the normal range before discharge and after readmission. D-dimers in a few patients was slightly higher than the normal value at discharge. After readmission, the D-dimers returned to the normal level, and oxygenation index was in the normal range in these patients. In retested positive group, the readmitted hospital stay was significantly shortened by half(P<0.05). The clinical manifestations were only mild cough in 1 patients, mainly dry cough, without fever or respiratory distress. In the retested positive group, chest CT was performed in all patients. Compared with at discharge, 12 cases(60%) had continuous improvement in lung inflammation, 6 cases(30%) had no lung inflammation, and 2 cases(10%) had no change in lung inflammation. The antiviral treatment duration in the retested positive group was(10.65±4.15) days. The main antiviral drugs were Lopinavir/Ritonavir in 11 cases(64.71%), Arbidol in 5 cases(29.41%), Oseltamivir in 6 cases(35.29%), and Chloroquine in 1 case(5.88%). Conclusion The clinical symptoms and laboratory test results of 20 retested positive cases do not suppo

关 键 词：新型冠状病毒肺炎 出院病例 核酸复阳 临床特征 

分 类 号：R563.1[医药卫生—呼吸系统] R446[医药卫生—内科学]