.jpg)
耀杰不凡丨第二刊：“肛拭子”頻頻上熱門？伯杰醫(yī)療邀你一起知其所以然
近日，采集“肛拭子樣本”用于新冠篩查的新聞成為大家熱議的焦點(diǎn)，事件的起因是1月20日
“耀杰不凡”致敬幕后抗疫英雄推文解讀活動(dòng)
第二刊：“肛拭子”頻頻上熱門？伯杰醫(yī)療邀你一起知其所以然
近日，采集“肛拭子樣本”用于新冠篩查的新聞成為大家熱議的焦點(diǎn)，事件的起因是1月20日，北京新冠防控新聞發(fā)布會(huì)介紹，其已對(duì)大興某新發(fā)病例所在學(xué)校全體學(xué)生、教職工等全部進(jìn)行鼻咽拭子、口咽拭子、肛拭子及血清檢測(cè)。
那么問題來了，此次北京大興為什么在篩查中增加了“肛拭子”檢測(cè)？其實(shí)，有關(guān)樣本類型檢出率這一議題，早先便有眾多學(xué)者對(duì)其進(jìn)行過討論。2020年8月公布的《新型冠狀病毒肺炎診療方案(試行第八版)》中也明確表示，可以在糞便、尿液中可分離到新冠病毒。
鼻咽拭子、口咽拭子、痰液、支氣管灌洗液及肛拭子這些不同類型的標(biāo)本與檢測(cè)結(jié)果之間到底存在著什么樣的聯(lián)系呢？不同的病程進(jìn)展情況下，上述各樣本類型是否存在檢出差異？且聽大咖見解，一一道來~
本研究成果由深圳市第三人民醫(yī)院的劉映霞教授、劉磊教授和中科院深圳先進(jìn)技術(shù)研究院的李亮教授團(tuán)隊(duì)在2020年5月16日發(fā)表于胃腸病學(xué)和肝病專業(yè)領(lǐng)域國(guó)際排名第一的醫(yī)學(xué)雜志《胃腸病學(xué)（Gastroenterology）》，研究主題為新冠肺炎患者的腸道排毒特征及規(guī)律。
圖1. 患者糞便中 SARS-CoV-2在病程不同時(shí)間（周）的檢測(cè)情況。
解讀文獻(xiàn)2：Laboratory Diagnosis and Monitoring the Viral Shedding of SARS-CoV-2 Infection
本期研究收集了410例患者的3,552份呼吸道標(biāo)本，包括559份口咽拭子，2,231份鼻咽拭子，696份痰標(biāo)本和66 份支氣管肺泡灌洗液（BALF）樣本。在這些患者中，90例為重癥患者，320例為輕度和中度患者。
圖2. 患者狀況分布圖
不同呼吸道樣本中檢測(cè)新冠病原體
上，下呼吸道的不同檢測(cè)結(jié)果
圖3. RNA病原體的檢測(cè)狀況
1.多種樣本檢測(cè)結(jié)果互為補(bǔ)充，能夠有效防止漏檢：根據(jù)實(shí)驗(yàn)結(jié)果，新冠不同疾病程度患者的痰樣本、鼻咽拭子、口咽拭子陽性率不同，痰液的檢出率相對(duì)較高。
2.重癥病例上呼吸道樣本檢出率低，需聯(lián)合其他輔助手段：經(jīng)過上，下呼吸道的樣本檢測(cè)，一些重癥病例的上呼吸道樣本中未檢測(cè)出病毒RNA但在痰液樣本中顯示為陽性。由此可見，盡管未在上呼吸道樣本中檢測(cè)到病毒RNA，但不應(yīng)將那些具有接觸史和臨床癥狀的可疑病例排除。在這種情況下，CT掃描可能為診斷COVID-19提供重要證據(jù)。
3.下呼吸道病毒脫落時(shí)間更長(zhǎng)：研究發(fā)現(xiàn)，下呼吸道的病毒脫落時(shí)間可持續(xù)長(zhǎng)達(dá)46天，這比先前發(fā)現(xiàn)的上呼吸道樣本的病毒脫落時(shí)間更長(zhǎng)。在制定治療和抗擊病毒傳播的策略時(shí)，應(yīng)謹(jǐn)慎對(duì)待新冠病毒的異常病毒脫落情況。
圖4. RNA病毒的脫落持續(xù)時(shí)長(zhǎng)
本文中所提及的學(xué)術(shù)研究所使用的檢測(cè)試劑，來自于上海伯杰醫(yī)療科技有限公司的新型冠狀病毒2019-nCoV核酸檢測(cè)試劑盒（熒光PCR法）。此番能夠在科研合作中出一份力，伯杰醫(yī)療深感榮幸。成立以來，伯杰醫(yī)療一直專注于傳染性病原體的診斷，秉承“勇于創(chuàng)新，質(zhì)量為先”的方針。助力檢驗(yàn)科研事業(yè)的發(fā)展，伯杰醫(yī)療責(zé)無旁貸！
參考文獻(xiàn)：
1. Zhu, N., Zhang, D., Wang, W., et al. (2020). A novel coronavirus from patients with pneumonia in China, 2019. N. Engl. J. Med. 382, 727–733.
2. Tan, W., Zhao, X., Ma, X., et al. (2020). A novel coronavirus genome identified in a cluster of pneumonia cases—Wuhan, China 2019–2020. China CDC Weekly 2, 61–62.
3. Xu, X.W., Wu, X.X., Jiang, X.G., et al. (2020). Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ 368, m606, https://doi.org/10.1136/bmj.m606.
4. Wang, D., Hu, B., Hu, C., et al. (2020). Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 323, 1061–1069.
5. Huang, C., Wang, Y., Li, X., et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395, 497–506.
6. Guan, W.J., Ni, Z.Y., Hu, Y., et al. (2020). Clinical characteristics of coronavirus disease 2019 in China. N. Engl. J. Med. 382, 1708–1720.
7. Chan, J.F., Yuan, S., Kok, K.H., et al. (2020). A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 395, 514–523.
8. Xu, Z., Shi, L., Wang, Y., et al. (2020). Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir. Med. 8, 420–422.
9. Rothe, C., Schunk, M., Sothmann, P., et al. (2020). Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N. Engl. J. Med. 382, 970–971.
10. Phan, L.T., Nguyen, T.V., Luong, Q.C., et al. (2020). Importation and human-to-human transmission of a novel coronavirus in Vietnam. N. Engl. J. Med. 382, 872–874.
12. Lei, J., Li, J., Li, X., et al. (2020). CT imaging of the 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 295, 18.
13. Li, Q., Guan, X., Wu, P., et al. (2020). Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N. Engl. J. Med. 382, 1199–1207.
14. Mackay, I.M., and Arden, K.E. (2015). MERS coronavirus: diagnostics, epidemiology and transmission. Virol. J. 12, 222, https://doi.org/10.1186/s12985-015-0439-5.
15. Chan, P.K.S., To, W.K., Ng, K.C., et al. (2004). Laboratory diagnosis of SARS. Emerg. Infect. Dis. 10, 825–831.
16. Zhang, W., Du, R.-H., Li, B., et al. (2020). Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg. Microbes Infect. 9, 386–389.
17. Zhang, J., Wang, S., and Xue, Y. (2020). Fecal specimen diagnosis 2019 novel coronavirus- infected pneumonia. J. Med. Virol. 92, 680–682.
18. Xiao, F., Tang, M., Zheng, X., et al. (2020). Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology 158, 1831–1833.e3.
19. Wang, W., Xu, Y., Gao, R., et al. (2020). Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 323, 1843–1844.
20. Ling, Y., Xu, S., Lin, Y., et al. (2020). Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients. Chin Med. J. (Engl). 133, 1039–1043.
21. Cai, J., Xu, J., Lin, D., et al. (2020). A case series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin. Infect. Dis. 71, 1547–1551.
22. Xu, D., Zhang, Z., Jin, L., et al. (2005). Persistent shedding of viable SARS-CoV in urine and stool of SARS patients during the convalescent phase. Eur. J. Clin. Microbiol. Infect. Dis. 24, 165–171.
23. Zhao, F., Yang, Y., Wang, Z., et al. (2020). The time sequences of oral and fecal viral shedding of coronavirus disease 2019 (COVID-19) patients. Gastroenterology 159, 1158–1160.
24. Yao, X., He, Z., Li, T., et al. (2020). Pathological evidence for residual SARS-CoV-2 in pulmonary tissues of a ready-for-discharge patient. Cell Res. 30, 541–543.
25. Chan, J.F.W., Lau, S.K.P., To, K.K.W., et al. (2015). Middle East respiratory syndrome coronavirus: another zoonotic betacoronavirus causing SARS-like disease. Clin. Microbiol. Rev. 28, 465–522.
26. Cheng, V.C.C., Lau, S.K.P., Woo, P.C.Y., et al. (2007). Severe acute respiratory syndrome coronavirus as an agent of emerging and reemerging infection. Clin. Microbiol. Rev. 20, 660–694.
27. He, X., Lau, E.H.Y., Wu, P., et al. (2020). Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat. Med. 26, 672–675.
28. Zhou, F., Yu, T., Du, R., et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 395, 1054–1062.
29. Yang, Y., Shen, C., Li, J., et al. (2020). Plasma IP-10 and MCP-3 levels are highly associated with disease severity and predict the progression of COVID-19. J. Allergy Clin. Immunol. 146, 119–127.e4.
30. Yang, Y., Wong, G., Yang, L., et al. (2019). Comparison between human infections caused by highly and low pathogenic H7N9 avian influenza viruses in Wave Five: clinical and virological findings. J. Infect. 78, 241–248.
31. Bi, Y., Tan, S., Yang, Y., et al. (2019). Clinical and immunological characteristics of human infections with H5N6 avian influenza virus. Clin. Infect. Dis. 68, 1100–1109.
32. Liu, Y., Zhang, C., Huang, F., et al. (2020). Elevated plasma level of selective cytokines in COVID-19 patients reflect viral load and lung injury. Natl. Sci. Rev. 7, 1003–1011.
上海伯杰醫(yī)療科技有限公司是一家致力于感染性病原體分子診斷試劑研發(fā)和應(yīng)用，深耕于多重?zé)晒釶CR診斷試劑和痕量病毒二代測(cè)序試劑及相關(guān)服務(wù)的國(guó)家高新技術(shù)企業(yè)。公司圍繞感染性病原體這一主線，從診斷試劑、診斷儀器、測(cè)序服務(wù)和醫(yī)檢所服務(wù)等多個(gè)面提供全套解決方案。公司秉承“勇于創(chuàng)新，質(zhì)量為先”的方針，為醫(yī)療機(jī)構(gòu)、疾控公衛(wèi)、高?？蒲械群献骰锇樘峁﹥?yōu)質(zhì)產(chǎn)品與服務(wù)。
全國(guó)客服電話：400-860-3688