Nat Med：新冠病毒经粪便排毒期可能比呼吸道中更持久！

2020-03-14 学术经纬学术经纬

《自然-医学》今天上线了一篇有关新型冠状病毒（SARS-CoV-2）的儿童病例研究报告。来自中国广州市妇女儿童医疗中心、广州医科大学、澳门科技大学和广州再生医学与健康广东实验室的作者团队，

《自然-医学》今天上线了一篇有关新型冠状病毒（SARS-CoV-2）的儿童病例研究报告。来自中国广州市妇女儿童医疗中心、广州医科大学、澳门科技大学和广州再生医学与健康广东实验室的作者团队，回顾了10例确诊患儿的流行病学和临床特征分析。尽管这些患儿的临床症状都比较轻，但值得注意的是，多人肛拭子的核酸检测结果持续阳性，提示我们有必要重视粪便传播的可能。这项研究的通讯作者为夏慧敏教授、唐金陵教授、张康教授和龚四堂主任。

这项研究纳入了截至2020年2月20日在广州指定治疗中心收治入院的全部10名儿童，年龄从2个月到15岁不等，都是因为有相关病例接触史或武汉暴露史，经筛查鼻咽拭子核酸检测结果为阳性而确诊。

临床表现上，入院时最常见的症状是发热（7人），但体温均未超过39 ℃；其次为咳嗽（5人）、喉咙痛（4人）、腹泻（3人）和鼻塞（2人）；有1名孩子完全无症状。而在成年人病例中常见的疲劳、恶心呕吐、呼吸困难等症状则没有出现。

胸部影像学的结果显示出与成人感染者的明显差别，10例儿童患者的X光片检查结果均没有肺炎的明确体征。CT扫描显示5例在正常范围，5例有单发或多发磨玻璃样混浊。

实验室检查结果则显示，10名患儿中有9人在血液生化等各项测试上都正常，而成人患者中常见的淋巴细胞减少、白细胞减少、转氨酶升高等也很少在这些儿童患者中出现。

治疗方面，所有患儿都接受了α-干扰素口腔喷雾剂的抗病毒治疗，只有第1例患儿在确诊时还接受了连续多日的阿奇霉素治疗。没有患儿需要呼吸支持或重症监护病房护理。

药明康德内容团队制图

患儿入院后，研究人员连续采集了每个患儿的鼻咽拭子和肛拭子样本，通过核酸检测，追踪从呼吸道和胃肠道排出的病毒。

大部分患者在出现症状后不久就显示出鼻咽拭子阳性的检测结果。有一例患儿尽管始终无临床症状，但多次测试均为阳性。

10名患儿中，8人的肛拭子核酸检测为阳性，提示病毒可能会通过粪便释放出体外。此外，有8名患者在鼻咽测试转阴后，肛拭子的核酸检测结果仍持续显示阳性。

▲患者入院后肛拭子（左）和鼻咽拭子（右）随时间推移的检测结果（图片来源：参考资料[1]）

在已出院的患者中，有一名患者在连续2次核酸阴性后出院，但出院后的第13天再次出现肛拭子阳性结果，提示排毒仍未停止。截至20日还在留院隔离观察的患儿，都已经恢复，没有临床症状，但肛拭子检测呈阳性，研究作者因此建议，在判断治疗结果和确定解除隔离时间时，肛拭子的测试结果可能比鼻咽拭子更有用。

基于感染SARS-CoV-2的儿童患者的结果，研究作者认为，消化系统的病毒排毒期可能比呼吸道中更持久，并且病毒可能经粪便传播。不过作者也指出，粪便样本中的病毒是否具有复制能力还没有证据，因此新冠病毒是否具有粪口传播的能力仍有待确认。

原始出处：

Xu, Y., Li, X., Zhu, B. et al. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding.10.1038/s41591-020-0817-4

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2020-09-01 liye789132251

#Nat#

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2020-08-01 hunizi005

#排毒期#

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2020-03-16 zhmscau

#呼吸道#

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2020-03-16 Homburg

#粪便#

33 0
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2020-03-16 ms3994565386320060

#Med#

37 0
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2020-03-14 公卫新人

新冠肺炎，疫情何时才能消失

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Nat Med：新冠病毒经粪便排毒期可能比呼吸道中更持久！

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