多次核酸检测两例新型冠状病毒肺炎病例的实验室确诊分析  

Laboratory confirmation analysis of two cases of COVID-19 by multiple nucleic acid tests

作　　者：卢桂兰[1] 严寒秋[1] 李仁清[1] 孙玉兰[1] 吕燕宁[1] 张代涛[1] 王小梅[1] 任烁 刘医萌[1] 赵佳琛[1] 张莉[1] 孙瑛[1] 马建新[2] 荆红波[3] 杨鹏[1] 陈丽娟[1] 王全意[1] LU Gui-lan;YAN Han-qiu;LI Ren-qing;SUN Yu-lan;LÜYan-ning;ZHANG Dai-tao;WANG Xiao-mei;REN Shuo;LIU Yi-meng;ZHAO Jia-chen;ZHANG Li;SUN Ying;MA Jian-xin;JING Hong-bo;YANG Peng;CHEN Li-juan;WANG Quan-yi(Beijing Centre for Disease Prevention and Control,Beijing 100013,China)

机构地区：[1]北京市疾病预防控制中心,100013 [2]北京市朝阳区疾病预防控制中心 [3]北京市顺义区疾病预防控制中心

出　　处：《首都公共卫生》2022年第4期216-220,共5页Capital Journal of Public Health

基　　金：北京市百千万人才工程项目(编号:2020A051)。

摘　　要：目的对两例无明确新型冠状病毒肺炎(coronavirus disease 2019,COVID-19,以下简称新冠肺炎)流行病学史,经多次核酸检测确诊的新冠肺炎病例实验室确诊过程进行总结分析,为新冠病毒核酸检测提供经验。方法收集北京市2020年1-2月两例无明确新冠肺炎流行病史,且经多次核酸检测确诊的新冠肺炎病例的流行病学、临床表现等资料和实验室检测结果进行回顾性分析。结果病例A,2020年1月19日发热伴全身疼痛、头痛,先后就诊2家医院,发热和肺炎病情未缓解。发病前有京外旅行史,2020年1月22日患者收入A_(2)医院隔离治疗,诊断为“肺炎待查”并上报为新冠肺炎疑似病例。当日采集样本送北京市疾病预防控制中心(CDC)实验室进行荧光RT-PCR检测,N基因阳性。按当时《新型冠状病毒肺炎防控方案(第二版)》规定,实验室要求继续采样。1月23日再次采集样本,荧光RT-PCR检测ORF1ab和N基因阳性,该病例为新冠肺炎确诊病例。病例B,2020年2月3日发热,先后就诊3家医院,发热伴全身疼痛、头晕头痛。患者于2月9日在B_(3)医院发热门诊就诊,并单间隔离治疗,上报为新冠肺炎疑似病例。2月10日和11日分别采集样本送北京市CDC实验室进行荧光PCR检测,ORF1ab和N基因阴性,但2月10日样本的N基因在反应后期显示出荧光值小于判定阈值线的微弱信号。2月12日再次采集样本检测,ORF1ab和N基因阳性,该病例为新冠肺炎确诊病例。结论因新冠肺炎临床表现无特异性,实验室病原学的核酸检测非常重要;如果新冠肺炎疑似病例首次样本检测结果阴性或可疑,建议再次采集多种类样本进行检测,以便尽可能早诊断。Objective This study retrospectively analyzed the laboratory confirmation process of 2 cases of COVID-19 pneumonia. Both cases of COVID- 19 with no clear epidemiological contact history were confirmed by multiple nucleic acid tests. The result will provide experience and insights COVID - 19 nucleic acid testing. Methods The data of two cases in Beijing from January 2020 to February 2020, without clear epidemiological history of COVID- 19 and confirmed by multiple nucleic acid tests, were collected for descriptive analysis. Data included epidemiological, clinical data and laboratory test result. Results Case A, being onset on January 19, 2020 with fever, body ache and headache, had visited two hospitals. The fever and symptoms of pneumonia were not relieved. The patient had a history of travel outside Beijing before the onset of symptoms. The patient was admitted to A_(2) hospital for isolation and treatment, diagnosed with “pneumonia to be investigated” and reported to Beijing Center for Prevention and Control (BJCDC) as a suspected case of COVID- 19 on the afternoon of January 22, 2020. Pharyngeal swab specimen was sent to the BJCDC laboratory on the same day. Real time PCR method showed that the N gene of 2019-nCoV was positive. According to the Regulations of the Prevention and Control Program (the second edition) at that time, the specimen should be obtained subsequently. Pharyngeal swab and sputum specimen were collected again on the next day, and both of ORF1ab and N gene of 2019-nCoV showed positive by real-time PCR. Case B, had fever on February 3, 2020, went to 3 hospitals and with fever accompanied with body pain, headache and dizziness. The patent was treated in the fever clinic of B_(3) hospital on the afternoon of February 9, and was isolated in a single room. Pharyngeal swabs were collected to BJCDC laboratory for testing on February 10 and 11, the result showed negative for 2019-nCoV virus, but the N gene of the specimen on February 10 showed a weak signal with fluorescence less than the thresh

关 键 词：新型冠状病毒肺炎 病例报告 核酸检测 实验室确诊 

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