新型冠状病毒奥密克戎变异株感染患儿呼吸道病毒核酸载量的循环阈值变化及其影响因素  

Trajectory and impact factors of cycle threshold values of virus load in respiratory tract in children infected with severe acute respiratory syndrome coronavirus 2 Omicron variants

作　　者：陈乡 周建国 卢燕鸣[2] 陈轶维 张婷[4] 俞蕙王 立波 周文浩 Chen Xiang;Zhou Jianguo;Lu Yanming;Chen Yiwei;Zhang Ting;Yu Hui;Wang Libo;Zhou Wenhao(Department of Neonatology,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Pediatrics,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 201112,China;Department of Cardiology,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Gastroenterology,Hepatology and Nutrition,Shanghai Children's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of Infectious Disease,Children's Hospital of Fudan University,Shanghai 201102,China;Department of Respiratory Medicine,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院新生儿科,上海201102 [2]上海交通大学医学院附属仁济医院儿科,上海201112 [3]上海交通大学医学院附属上海儿童医学中心心内科,上海200127 [4]上海交通大学医学院附属上海儿童医院消化感染科,上海200127 [5]复旦大学附属儿科医院感染传染科,上海201102 [6]复旦大学附属儿科医院呼吸科,上海201102

出　　处：《中华传染病杂志》2023年第2期111-115,共5页Chinese Journal of Infectious Diseases

基　　金："十四五"国家重点研发计划(2021YFC2701800)。

摘　　要：目的探究新型冠状病毒奥密克戎变异株感染儿童病例的特点及影响病毒核酸循环阈值(Ct值)达≥35所需时间的因素。方法纳入2022年4月7日至6月2日上海市新型冠状病毒感染者定点收治医院(上海交通大学医学院附属仁济医院南部院区)收治的0~14岁奥密克戎变异株感染且有临床症状的患儿。通过聚合酶链反应,每日检测鼻咽拭子新型冠状病毒核酸,结果以Ct值表示。将症状起始或核酸检测首次阳性(以较早时间为准)至开放阅读框1ab基因Ct值≥特定数值(x)定义为"Ct值达x所需时间",即T_(Ct≥x)。收集患儿年龄、性别、疫苗接种情况、基础疾病等资料。采用Cox模型分析TCt≥35的相关影响因素。结果共收治儿童病例871例,中位年龄为2岁,范围为1月龄至14岁,其中474例(54.4%)为男童,89例(10.2%)合并基础疾病,主要包括先天性心脏病、实体肿瘤和癫痫等。轻型病例572例(65.7%),普通型298例(34.2%),重型1例(0.1%),无危重型病例和死亡病例。T_(Ct≥35)为12(10,14)d。Cox模型分析示,与1~12月龄组患儿相比,37~84月龄和85~168月龄患儿的T_(Ct≥35)均较短[风险比(HR)=1.55、1.84,均P<0.001]。矫正年龄后,与未接种疫苗患儿相比,接种1或2剂疫苗患儿的T_(Ct≥35)缩短[矫正后的风险比(aHR)=1.49,P=0.011];与轻型患儿相比,普通型患儿T_(Ct≥35)延长(aHR=0.78,P=0.002);有基础疾病患儿较无基础疾病患儿的T_(Ct≥35)延长(aHR=0.38,P<0.001)。无基础疾病的患儿T_(Ct≥28)、T_(Ct≥30)、T_(Ct≥33)、T_(Ct≥35)分别为7(6,9)d、9(7,10)d、10(8,11)d和12(10,14)d。结论年龄、疫苗接种、疾病临床分型、是否合并基础疾病是奥密克戎变异株感染儿童病例核酸转阴(Ct值≥35)所需时间的影响因素。Objective To investigate the clinical characteristics of children infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)Omicron variants,and the impact factors of duration of cycle threshold(Ct)values turning to≥35 detected by nucleotide test.Methods Children aged 0 to 14 years with clinical symptoms of Omicron variants infection who admitted to designated hospital in Shanghai City(Renji Hospital,South Branch,Shanghai Jiao Tong University School of Medicine)from April 7 to June 2,2022 were enrolled.The daily nasopharyngeal swab specimens were used for SARS-CoV-2 nucleic acid detecting by polymerase chain reaction and the results were expressed as Ct values.The T_(Ct≥x) was defined as from the symptom onset or first positive nucleic acid test results(the earlier data)to Ct≥x of the open reading frame 1ab(ORF1ab)gene,which was the time duration from the initial to a specific Ct value.Clinical data were collected,including age,sex,vaccination and comorbidities.Cox model was performed to analyzed the impact factors of T_(Ct≥35).Results A total of 871 pediatric cases with a median age of two years(ranging from one month to 14 years old)were included.Among them,474 cases(54.4%)were male,and 89 cases(10.2%)had underlying diseases including congenital heart disease,solid tumors and epilepsy.There were 572(65.7%)mild cases,298(34.2%)common cases,one(0.1%)severe case and no critical cases or deaths.The T_(Ct≥35) was 12(10,14)days.Cox model indicated that compared to children aged one to 12 months,children aged 37 to 84 months and 85 to 168 months had shorter T_(Ct≥35)(hazard ratio(HR)=1.55 and 1.84,respectively,both P<0.001).After adjusted with age,comparing to unvaccinated patients,patients with one or two shots vaccine had shorter T_(Ct≥35)(adjected hazard ratio(aHR)=1.49,P=0.011),and common patients had longer T_(Ct≥35) than mild patients(aHR=0.78,P=0.002),and patients with comorbidities had longer T_(Ct≥35)than patients without comorbidities(aHR=0.38,P<0.001).The duration of T_(Ct�

关 键 词：新型冠状病毒 儿童 病毒载量 循环阈值 

分 类 号：R512.99[医药卫生—内科学]