首页|Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients

扫码查看
原文链接
  • 国家科技期刊平台
  • NETL
  • NSTL
  • 万方数据
  • 维普
Background:A patient's infectivity is determined by the presence of the virus in different body fluids,secretions,and excreta.The persistence and clearance of viral RNA from different specimens of patients with 2019 novel coronavirus disease (COVID-19) remain unclear.This study analyzed the clearance time and factors influencing 2019 novel coronavirus (2019-nCoV) RNA in different samples from patients with COVID-19,providing further evidence to improve the management of patients during convalescence.Methods:The clinical data and laboratory test results of convalescent patients with COVID-19 who were admitted to from January 20,2020 to February 10,2020 were collected retrospectively.The reverse transcription polymerase chain reaction (RT-PCR) results for patients' oropharyngeal swab,stool,urine,and serum samples were collected and analyzed.Convalescent patients refer to recovered non-febrile patients without respiratory symptoms who had two successive (minimum 24 h sampling interval) negative RT-PCR results for viral RNA from oropharyngeal swabs.The effects of cluster of differentiation 4 (CD4)+ T lymphocytes,inflammatory indicators,and glucocorticoid treatment on viral nucleic acid clearance were analyzed.Results:In the 292 confirmed cases,66 patients recovered after treatment and were included in our study.In total,28 (42.4％) women and 38 men (57.6％) with a median age of 44.0 (34.0-62.0) years were analyzed.After in-hospital treatment,patients' inflammatory indicators decreased with improved clinical condition.The median time from the onset of symptoms to first negative RT-PCR results for oropharyngeal swabs in convalescent patients was 9.5 (6.0-11.0) days.By February 10,2020,11 convalescent patients (16.7％) still tested positive for viral RNA from stool specimens and the other 55 patients' stool specimens were negative for 2019-nCoV following a median duration of 11.0 (9.0-16.0) days after symptom onset.Among these 55 patients,43 had a longer duration until stool specimens were negative for viral RNA than for throat swabs,with a median delay of 2.0 (1.0-4.0) days.Results for only four (6.9 ％) urine samples were positive for viral nucleic acid out of 58 cases;viral RNA was still present in three patients' urine specimens after throat swabs were negative.Using a multiple linear regression model (F =2.669,P =0.044,and adjusted R2 =0.122),the analysis showed that the CD4+ T lymphocyte count may help predict the duration of viral RNA detection in patients' stools (t =-2.699,P =0.010).The duration of viral RNA detection from oropharyngeal swabs and fecal samples in the glucocorticoid treatment group was longer than that in the nonglucocorticoid treatment group (15 days vs.8.0 days,respectively;t =2.550,P =0.013) and the duration of viral RNA detectionin fecal samples in the glucocorticoid treatment group was longer than that in the non-glucocorticoid treatment group (20 days vs.11 days,respectively;t=4.631,P ＜ 0.001).There was no statistically significant difference in inflammatory indicators between patients with positive fecal viral RNA test results and those with negative results (P ＞ 0.05).Conclusions:In brief,as the clearance of viral RNA in patients' stools was delayed compared to that in oropharyngeal swabs,it is important to identify viral RNA in feces during convalescence.Because of the delayed clearance of viral RNA in the glucocorticoid treatment group,glucocorticoids are not recommended in the treatment of COVID-19,especially for mild disease.The duration of RNA detection may relate to host cell immunity.

COVID-192019-nCoVNucleic acid detectionGlucocorticoid

Yun Lina、Shui-Bao Xu、Yi-Xiao Lin、Di Tian、Zhao-Qin Zhu、Fa-Hui Dai、Fan Wu、Zhi-Gang Song、Wei Huang、Jun Chen、Bi-Jie Hu、Sheng Wang、En-Qiang Mao、Lei Zhu、Wen-Hong Zhang、Hong-Zhou Lu

展开 >

Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai 201508, China

Department of Infectious Disease and Immunology, Shanghai Public Health Clinical Center, Shanghai 201508, China

Department of Hepatology, Shanghai Public Health Clinical Center, Shanghai 201508, China

Department of Infectious Disease, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Department of Critical Care Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China

Department of Emergency, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China

Department of Pulmonology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai 200041, China

Shanghai Medical College of Fudan University, Shanghai 200032, China

展开 >

work was supported by grants from the First-class university and first-class discipline building project of the Fudan Univerand the Scientific research for special subjects on 2019 novel coronavirus

IDF1620052019-nCoV of the Shanghai Pub

2020

中华医学杂志(英文版)
中华医学会

中华医学杂志(英文版)

CSTPCDCSCDSCI
影响因子：0.838
ISSN：0366-6999
年,卷(期)：2020.133(9)
  • 42
  • 14