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Viral kinetics and factors associated with rapid viral clearance during lopinavir/ritonavir-based combination therapy in non-severe COVID-19 patients.

非重症新型冠状病毒肺炎患者基于洛匹那韦/利托那韦的联合治疗期间病毒动力学和与快速病毒清除相关的因素。

  • 影响因子:2.21
  • DOI:10.26355/eurrev_202005_21373
  • 作者列表:"Ding JG","Li J","Hong L","Yu XQ","Ye EL","Sun GQ","Zhang XX","Chen L","Sun QF
  • 发表时间:2020-05-01
Abstract

OBJECTIVE:Lopinavir/ritonavir has modest antiviral activity against severe acute respiratory syndrome coronavirus 2. The aim was to investigate the viral kinetics and factors associated with viral clearance during lopinavir/ritonavir-based combination treatment in non-severe patients. PATIENTS AND METHODS:Sixty-four patients were retrospectively enrolled. Viral RNA was detected by real-time RT-PCR assay from sputum or throat swab samples at different time points. The patterns of viral kinetics were characterized, and factors associated with rapid viral clearance, which was defined as viral RNA undetectable within two weeks, were analyzed using multivariate logistic regression analyses. RESULTS:All patients achieved viral RNA negativity and were discharged from the hospital. Furthermore, 48 (75%) and 16 (25%) patients achieved rapid and delayed viral clearance, respectively. The lymphocyte counts of rapid viral clearance patients (1.40 [1.20-1.80] × 109/L) were higher, when compared to delayed viral clearance patients (1.00 [0.70-1.47] × 109/L) (p=0.024). The multivariate logistic analysis revealed that high lymphocyte count (≥1.3×109/L) is an independent factor associated with rapid viral clearance (OR=7.62, 95% CI=1.15-50.34, p=0.035). CONCLUSIONS:The viral shedding exhibited different patterns during treatment. Immune insufficiency is responsible for the delayed viral clearance, suggesting that an immunomodulator should be considered to promote viral clearance in patients with low lymphocyte counts.

摘要

目的: 洛匹那韦/利托那韦对新型冠状病毒具有适度的抗病毒活性。目的是研究洛匹那韦/利托那韦联合治疗非重症患者的病毒动力学和病毒清除相关因素。 患者和方法: 回顾性入组 64 例患者。不同时间点的痰液或咽拭子样本采用real-time RT-PCR法检测病毒RNA。对病毒动力学模式进行了表征,并使用多变量logistic回归分析与快速病毒清除 (定义为两周内检测不到病毒RNA) 相关的因素。 结果: 所有患者均达到病毒RNA阴性,出院。此外,48 (75%) 和 16 (25%) 患者分别达到快速和延迟病毒清除。快速病毒清除患者 (1.40 [1.20-1.80] × 109/L) 的淋巴细胞计数较高,与延迟病毒清除患者相比 (1.00 [0.70-1.47] × 109/L) (p = 0.024)。多因素logistic分析显示,高淋巴细胞计数 (≥ 1.3 × 109/L) 是快速清除病毒的独立相关因素 (OR = 7.62,95% CI = 1.15 ~ 50.34,p = 0.035)。 结论: 治疗过程中病毒脱落表现不同。免疫功能不全是导致病毒清除延迟的原因,提示应考虑使用免疫调节剂来促进淋巴细胞计数低的患者的病毒清除。

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翻译标题与摘要 下载文献
影响因子:2.48
发表时间:2020-04-01
来源期刊:Infection
DOI:10.1007/s15010-020-01401-y
作者列表:["Cheng ZJ","Shan J"]

METHODS::There is a current worldwide outbreak of a new type of coronavirus (2019-nCoV), which originated from Wuhan in China and has now spread to 17 other countries. Governments are under increased pressure to stop the outbreak spiraling into a global health emergency. At this stage, preparedness, transparency, and sharing of information are crucial to risk assessments and beginning outbreak control activities. This information should include reports from outbreak sites and from laboratories supporting the investigation. This paper aggregates and consolidates the virology, epidemiology, clinical management strategies from both English and Chinese literature, official news channels, and other official government documents. In addition, by fitting the number of infections with a single-term exponential model, we report that the infection is spreading at an exponential rate, with a doubling period of 1.8 days.

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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