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Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study.

2020 年 1-3 月浙江省SARS-CoV-2 患者病毒载量动态和疾病严重程度: 回顾性队列研究。

  • 影响因子:0
  • DOI:10.1136/bmj.m1443
  • 作者列表:"Zheng S","Fan J","Yu F","Feng B","Lou B","Zou Q","Xie G","Lin S","Wang R","Yang X","Chen W","Wang Q","Zhang D","Liu Y","Gong R","Ma Z","Lu S","Xiao Y","Gu Y","Zhang J","Yao H","Xu K","Lu X","Wei G","Zhou J","Fang Q","Cai H","Qiu Y","Sheng J","Chen Y","Liang T
  • 发表时间:2020-04-21
Abstract

OBJECTIVE:To evaluate viral loads at different stages of disease progression in patients infected with the 2019 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first four months of the epidemic in Zhejiang province, China. DESIGN:Retrospective cohort study. SETTING:A designated hospital for patients with covid-19 in Zhejiang province, China. PARTICIPANTS:96 consecutively admitted patients with laboratory confirmed SARS-CoV-2 infection: 22 with mild disease and 74 with severe disease. Data were collected from 19 January 2020 to 20 March 2020. MAIN OUTCOME MEASURES:Ribonucleic acid (RNA) viral load measured in respiratory, stool, serum, and urine samples. Cycle threshold values, a measure of nucleic acid concentration, were plotted onto the standard curve constructed on the basis of the standard product. Epidemiological, clinical, and laboratory characteristics and treatment and outcomes data were obtained through data collection forms from electronic medical records, and the relation between clinical data and disease severity was analysed. RESULTS:3497 respiratory, stool, serum, and urine samples were collected from patients after admission and evaluated for SARS-CoV-2 RNA viral load. Infection was confirmed in all patients by testing sputum and saliva samples. RNA was detected in the stool of 55 (59%) patients and in the serum of 39 (41%) patients. The urine sample from one patient was positive for SARS-CoV-2. The median duration of virus in stool (22 days, interquartile range 17-31 days) was significantly longer than in respiratory (18 days, 13-29 days; P=0.02) and serum samples (16 days, 11-21 days; P<0.001). The median duration of virus in the respiratory samples of patients with severe disease (21 days, 14-30 days) was significantly longer than in patients with mild disease (14 days, 10-21 days; P=0.04). In the mild group, the viral loads peaked in respiratory samples in the second week from disease onset, whereas viral load continued to be high during the third week in the severe group. Virus duration was longer in patients older than 60 years and in male patients. CONCLUSION:The duration of SARS-CoV-2 is significantly longer in stool samples than in respiratory and serum samples, highlighting the need to strengthen the management of stool samples in the prevention and control of the epidemic, and the virus persists longer with higher load and peaks later in the respiratory tissue of patients with severe disease.

摘要

前言: 目的: 探讨病毒载量不同阶段的疾病进展的患者感染了 2019 新型冠状病毒 (SARS-CoV-2) 前四个月的流行浙江省 [j]. 设计: 回顾性队列研究。 单位: 浙江省新型冠状病毒肺炎患者定点医院。 研究对象: 96 例连续入院的实验室确诊SARS-CoV-2 感染患者: 轻症 22 例,重症 74 例。数据收集时间为 2020 年 1 月 19 日至 20 20 年 3 月 20 日。 主要观察指标: 在呼吸、粪便、血清和尿液样本中测定核糖核酸 (RNA) 病毒载量。循环阈值,核酸浓度的测量值,绘制在基于标准品构建的标准曲线上。通过电子病历中的数据收集表格获得流行病学、临床和实验室特征以及治疗和结局数据,并分析临床数据与疾病严重程度之间的关系。 结果: 患者入院后采集了 3497 份呼吸道、粪便、血清和尿液样本,评估SARS-CoV-2 RNA病毒载量。所有患者均通过检测痰液和唾液样本确诊感染。在 55 例 (59%) 患者的粪便和 39 例 (41%) 患者的血清中检测到RNA。1 例患者的尿液样本为SARS-CoV-2 阳性。粪便中病毒的中位持续时间 (22 天,四分位数间距 17-31 天) 显著长于呼吸系统 (18 天,13-29 天; P = 0.02) 和血清样本 (16 天,11-21 天; P<0.001)。重症患者呼吸道样本中病毒的中位持续时间 (21 天,14-30 天) 明显长于轻症患者 (14 天,10-21 天; P = 0.04)。在轻度组中,病毒载量在发病后第二周的呼吸样本中达到高峰,而在重度组中病毒载量在第三周持续较高。60 岁以上患者和男性患者病毒持续时间较长。 结论: 粪便标本SARS-CoV-2 时间明显长于呼吸道和血清标本,突出了在疫情防控中加强粪便标本管理的必要性,病毒在重症患者呼吸道组织中持续时间较长,负荷较高,高峰较晚。

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呼吸道感染方向

呼吸道感染分为上呼吸道感染与下呼吸道感染。上呼吸道感染是指自鼻腔至喉部之间的急性炎症的总称,是最常见的感染性疾病。下呼吸道感染是最常见的感染性疾患,治疗时必须明确引起感染的病原体以选择有效的抗生素。

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