广州市新型冠状病毒肺炎病例密切接触者核酸检测灵敏度和特异度分析  

Sensitivity and specificity of nucleic acid testing in close contacts of COVID-19 cases in Guangzhou

作　　者：张文婷 刘丹 谢朝军[2] 申动[1] 陈宗遒[2] 李志浩 刘远[2] 张希如 陈沛良 钟文芳 杨佩 黄清湄 罗雷[2] 毛琛 Zhang Wenting;Liu Dan;Xie Chaojun;Shen Dong;Chen Zongqiu;Li Zhihao;Liu Yuan;Zhang Xiru;Chen Peiliang;Zhong Wenfang;Yang Pei;Huang Qingmei;Luo Lei;Mao Chen(Department of Epidemiology,School of Public Health,Southern Medical University,Guangzhou 510515,China;Guangzhou Municipal Center for Disease Control and Prevention,Guangzhou 511430,China)

机构地区：[1]南方医科大学公共卫生学院流行病学系,广州510515 [2]广州市疾病预防控制中心,511430

出　　处：《中华流行病学杂志》2021年第8期1347-1352,共6页Chinese Journal of Epidemiology

基　　金：广东省高等学校珠江学者岗位计划(2019);广东省高水平大学建设计划(G820332010,G618339167,G618339164);中国科协青年人才举托工程(2019QNRC001);国家自然科学基金(82041030);浙江大学COVID-19应急科研专项(K920330111)。

摘　　要：目的分析广州市新型冠状病毒肺炎(COVID-19)疫情防控不同阶段中,密切接触者新型冠状病毒(新冠病毒)核酸检测的灵敏度和特异度,为优化疫情防控策略提供科学依据。方法2020年2月21日至9月22日广州市COVID-19病例的密切接触者20348例,均已接受新冠病毒核酸检测。针对疫情防控的不同阶段,比较核酸检测的灵敏度和特异度。结果20348例密切接触者中,男性12462例(61.24%),年龄M(P25,P75)为31.0(23.0,43.0)岁,核酸检测次数M(P25,P75)为2.0(1.0,3.0)次,隔离天数M(P25,P75)为12.0(8.0,13.0)d。研究对象经过7次核酸检测后,共确诊病例256例。第1、2、3和第7次核酸检测的灵敏度与特异度分别为69.14%与99.99%(确诊177例)、89.84%与99.99%(确诊230例)、97.27%与99.99%(确诊249例)、100.00%与99.98%。基于我国COVID-19疫情防控分为3个阶段(国内输入、境外输入和境外输入关联),首次核酸检测的灵敏度分别为70.68%、68.00%和67.35%,特异度分别为99.98%、100.00%和100.00%。结论建议做核酸检测3次,可提高灵敏度并降低假阴性风险。对于广州市COVID-19疫情防控3个阶段,密切接触者核酸检测的灵敏度结果较为一致,但略有降低趋势,这可能与疫情防控后期阶段的无症状感染者比例增多相关。Objective To analyze the sensitivity and specificity of SARS-CoV-2 nucleic acid testing in 20348 close contacts of COVID-19 cases in different prevention and control stages in Guangzhou and to provide scientific evidence for optimizing epidemic response strategies.Methods A total of 20348 close contacts of COVID-19 cases in Guangzhou were traced between February 21 and September 22,2020.All the close contacts were tested for the nucleic acid of SARS-CoV-2.The sensitivity and specificity of nucleic acid testing and diagnosis in the different prevention and control stages were compared.Results In 20348 close contacts,12462 were males(61.24%),the median(P25,P75)of age of them was 31.0 years(23.0,43.0),the median number(P25,P75)of nucleic acid testing for them was 2.0(1.0,3.0),and the median(P25,P75)of their quarantine days was 12.0(8.0,13.0)days,respectively.A total of 256 COVID-19 cases were confirmed in the close contacts after seven nucleic acid tests.In the 1st,2nd,3rd and 7th nucleic acid testing,the sensitivity and specificity were 69.14%and 99.99%(177 cases confirmed),89.84%and 99.99%(230 cases confirmed),97.27%and 99.99%(249 cases confirmed),and 100.00%and 99.98%,respectively.In the three stages of COVID-19 prevention and control in China:domestic case stage,imported case stage,and imported case associated local epidemic stage,the sensitivity of the 1st nucleic acid testing was 70.68%,68.00%and 67.35%,and the specificity was 99.98%,100.00%and 100.00%,respectively.Conclusions The sensitivity of nucleic acid testing in the close contacts at the different stages were consistent with slight decrease,which might be related to the increased proportion of asymptomatic infections in the late stage of epidemic prevention and control with COVID-19 in Guangzhou.It is suggested to give three nucleic acid tests to improve the sensitivity and reduce false negative risk.

关 键 词：新型冠状病毒肺炎 核酸检测 诊断 灵敏度 特异度 

分 类 号：R563.1[医药卫生—呼吸系统] R181.8[医药卫生—内科学]