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浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2020, Vol. 49 Issue (2): 270-274    DOI: 10.3785/j.issn.1008-9292.2020.03.11
    
Follow-up testing of viral nucleic acid in discharged patients with moderate type of COVID-19
LI Youjiang1(),HU Yingying2,ZHANG Xiaodong1,YU Yuanyuan2,LI Bin3,WU Jianguo1,WU Yingping1,XIA Xiaoping1,XU Jian2,*()
1. Clinical Laboratory, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
2. Department of Gynecology and Obstetrics, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
3. Department of Infection Diseases, the Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, Zhejiang Province, China
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Abstract  

Objective: To investigate the clinical outcome of patients with moderate type of coronavirus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid. Methods: Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantined in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the quarantined period, the symptoms and signs were documented, and sputum or nasal swab and feces samples were collected to test SARS-CoV-2 nucleic acid by RT-PCR method. Results: There was no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-CoV-2 nucleic acid at 5 to 7 days after they met the discharge criteria. Conclusion: There is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.

Key words： Coronavirus disease 2019      Severe acute respiratory syndrome coronavirus 2      Novel coronavirus pneumonia      Discharge criteria      Nucleic acid test      Follow-up     
Received: 11 March 2020      Published: 27 March 2020
CLC:  R512.99  
Corresponding Authors: XU Jian     E-mail: liyoujiang26@zju.edu.cn;xuj@zju.edu.cn
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LI Youjiang
HU Yingying
ZHANG Xiaodong
YU Yuanyuan
LI Bin
WU Jianguo
WU Yingping
XIA Xiaoping
XU Jian
Cite this article:

LI Youjiang,HU Yingying,ZHANG Xiaodong,YU Yuanyuan,LI Bin,WU Jianguo,WU Yingping,XIA Xiaoping,XU Jian. Follow-up testing of viral nucleic acid in discharged patients with moderate type of COVID-19. J Zhejiang Univ (Med Sci), 2020, 49(2): 270-274.

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http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.03.11     OR     http://www.zjujournals.com/med/Y2020/V49/I2/270


七例2019冠状病毒病(COVID-19)普通型患者出院后病毒核酸随访结果

目的: 随访研究2019冠状病毒病（COVID-19）患者在达到出院标准后病毒核酸检测结果，为医疗机构对出院患者随访管理提供决策依据。方法: 对浙江大学医学院附属第四医院经治疗后已符合出院标准的COVID-19患者采取院内继续隔离观察7 d，再居家隔离4周，期间记录患者每日临床体征，定期送检痰液行病毒核酸检测，评估患者病情变化。结果: 已符合现有出院标准的7例患者中有3例在5~7 d后再次出现痰液病毒核酸检测阳性，持续阳性2~6 d后再次转阴；复查患者血常规、C反应蛋白、血生化以及胸部CT结果均无明显异常，也无明显临床症状。其余4例患者随访4周，痰液病毒核酸检测均为阴性，未出现COVID-19相关临床症状，实验室和影像学检查结果无异常。结论: COVID-19患者按现有标准出院后复阳的比例较高，建议有条件的医疗机构对满足现行出院标准的患者继续院内隔离观察7 d并进行连续的病毒核酸监测。


关键词： 2019冠状病毒病,  严重急性呼吸综合征冠状病毒2,  新型冠状病毒肺炎,  出院标准,  核酸检测,  随访 
项目 病例1 病例2 病例3 病例4 病例5 病例6 病例7
  COVID-19：2019冠状病毒病；ALT：丙氨酸转氨酶；AST：天冬氨酸转氨酶.
性别 女性 女性 女性 女性 女性 男性 男性
年龄(岁) 24 72 71 56 37 37 73
暴露情况 与武汉回义乌人员接触 与武汉回义乌人员接触 否认有暴露史 与武汉回义乌人员接触 武汉回义乌人员 武汉回义乌人员 与武汉回义乌人员接触
首发症状日期 1月23日 1月23日 1月20日 1月22日 1月23日 1月23日 1月15日
确诊日期 2月2日 1月30日 2月6日 1月23日 1月26日 1月26日 1月28日
符合出院标准日期 2月17日 2月19日 2月17日 2月11日 2月11日 2月17日 2月11日
发热 是 是 是 是 否 是 是
咳嗽 否 是 是 否 否 是 是
肌肉酸痛 否 否 否 是 否 是 否
乏力 否 否 是 否 否 是 否
咽痛 是 否 否 否 是 是 否
呼吸困难 否 否 否 否 否 否 否
腹泻 否 否 否 否 否 否 否
白细胞计数正常或减少(9.5× 109/L以下) 是 否 是 是 是 是 是
淋巴细胞计数减少 是 否 是 是 是 是 否
ALT超过45 U/L 否 否 否 否 否 否 否
AST超过35 U/L 否 否 否 否 否 否 否
C反应蛋白超过6 mg/L 否 否 是 否 否 否 否
CT表现典型病毒感染特征 是 是 是 是 是 是 是
出院时肺部影像 炎症明显吸收 炎症明显吸收 炎症明显吸收 炎症明显吸收 炎症明显吸收 炎症明显吸收 炎症明显吸收
鼻导管氧气支持 否 是 是 否 否 否 是
抗病毒药物 是 是 是 是 是 是 是
抗菌药物 否 是 否 否 否 是 否
糖皮质激素 否 否 否 否 否 否 否
Tab 1 Demographics and baseline characteristics of 7 patients with COIVD-19
Fig 1 Recurrence of SARS-CoV-2 nucleic acid in 3 patients after discharge
[1]   广东省政府新闻办疫情防控第三十一场新闻发布会[EB/OL].(2020-02-25)[2020-02-25].http://gdio.southcn.com/g/2020-02/25/content_190429333.htm.
The 31st press conference on epidemic prevention and control from Guangdong Provincial Government Information Office[EB/OL].(2020-02-25)[2020-02-25]. http://gdio.southcn.com/g/2020-02/25/content_190429333.htm. (in Chinese)
[2]   中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[A/OL].国卫办医涵〔2020〕145号.(2020-02-18)[2020-02-28].http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel coronavirus pneumonia (trial version 6)[A/OL]. No. 145〔2020〕of the General Office of the National Health Commission. (2020-02-18)[2020-02-28]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml. (in Chinese)
[3]   LAN L, XU D, YE G, et al. Positive RT-PCR test results in patients recovered from COVID-19[J/OL]. JAMA, 2020: e202783. DOI: 10.1001/jama.2020.2783.
[4]   CHAN J F W , YUAN S F , KOK K H et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster[J]. Lancet, 2020, 395 (10223): 514- 523
doi: 10.1016/S0140-6736(20)30154-9
[5]   ZHANG W , DU RH , LI B et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes[J]. Emerg Microbes Infect, 2020, 9 (1): 386- 389
doi: 10.1080/22221751.2020.1729071
[6]   YANG Y, YANG M, SHEN C, et al. Laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections[J/OL]. medRxiv, 2020. DOI: 10.1101/2020.02.11.20021493.
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