新型冠状病毒肺炎重型和危重型患者病毒转阴时间的影响因素分析

Analysis of Factors Influencing Viral Shedding Time in Severe and Critical COVID-19 Patients

摘要: 目的：探讨新型冠状病毒肺炎重型和危重型患者病毒转阴时间的影响因素。方法：回顾性收集28例新型冠状病毒肺炎重型和危重型患者的临床资料，分析影响患者病毒转阴时间的因素。结果：28例患者的病毒转阴平均时间为24.0 ± 9.0天，最长和最短转阴时间分别为41天和12天。病毒转阴时间 ≥ 24天和<24天患者分别为13例和15例，两组患者的空腹血糖(P = 0.001)、D-二聚体(P = 0.025)、淋巴细胞计数(P = 0.049)、中性粒细胞率(P = 0.019)、临床分型(P = 0.006)、糖尿病患者数(P = 0.029) 6项指标差异具有统计学意义。空腹血糖与病毒转阴时间正相关，相关系数为0.468，P = 0.012。多因素Logistic回归分析提示，患者转入重症24小时内的空腹血糖偏高是影响病毒转阴时间的独立危险因素(OR = 1.680, 95% CI为1.011~2.792，P = 0.045)。空腹血糖预测病毒转阴时间 ≥ 24天的曲线下面积(AUC)为0.887 (95% CI为0.711~0.975，P < 0.001)，最佳截断值为7.33 mmol/L，敏感度和特异度分别为84.6%和86.7%。结论：新型冠状病毒肺炎重型和危重型患者转入重症24小时内空腹血糖高是影响病毒转阴时间的危险因素，临床救治该类患者时应该给予关注。

Abstract: Objective: To investigate the factors influencing the time of viral shedding in severe and critical COVID-19 patients. Methods: Clinical data of 28 patients with severe and critical COVID-19 were collected retrospectively to analyze the factors affecting the time of viral shedding. Results: This study observed the mean duration of 2019-nCov RNA shedding was 24.0 ± 9.0 days in survivor patients, the longest and shortest observed duration of viral shedding were 41 days and 12 days. There were 13 and 15 patients with viral shedding time ≥ 24 and <24 days, respectively. Significant statistically differences were observed in blood glucose (P = 0.001), D-dimer (P = 0.025), lymphocyte count (P = 0.049), neutrophil rate (P = 0.019), clinical typing (P = 0.006), and number of patients with diabetes (P = 0.029) between the two groups. There was a positive correlation between fasting blood glucose and viral shedding time, with a correlation coefficient of 0.468, P = 0.012. Multivariate Logistic regression analysis suggested that high fasting blood glucose within the first 24 hours after the patients were transferred to intensive care unit was an independent risk factor which affects the time of viral shedding (OR = 1.680, 95% CI = 1.011~2.792, P = 0.045). According to ROC curve analysis, the area under the curve (AUC) for fasting blood glucose to predict viral shedding time ≥ 24 days was 0.887 (95% CI was 0.711~0.975, P < 0.001), the cut-off value was 7.33 mmol/L, and the sensitivity and specificity were 84.6% and 86.7%, respectively. Conclusion: High fasting blood glucose within 24 hours after the patients were transferred to intensive care unit is a risk factor affecting the viral shedding time, which should be paid attention in the clinical treatment of such patients.