新型冠状病毒肺炎诊断的相关实验室检测技术应用

2019年底暴发的新型冠状病毒肺炎(COVID-19)已成全球蔓延态势,对世界公共卫生安全造成了重大威胁。实验室检测在COVID-19诊治全过程都具有重要价值。目前,严重急性呼吸综合征冠状病毒2(SARSCoV-2)核酸检测仍是诊断COVID-19的金标准。文章对COVID-19的确诊、鉴别诊断及辅助诊断相关实验室检测技术的原理、优缺点、现有研究情况、结果判读等问题进行综述,以期为临床医生及检验工作者提供参考。     

新型冠状病毒肺炎核酸检测中的假阴性分析及对策

新型冠状病毒肺炎(COVID-19)的疫情引发了全世界的关注。早期诊断对COVID-19的治疗、患者预后尤为关键。临床检验中发现早期的COVID-19患者核酸检测多次呈假阴性,特别是不同时间多次阴性结果后转为阳性,给临床诊断和疾病控制带来极大困扰。该文立足于疫情的早日防控,从临床、检验的不同视角,从标本采集、检测方法、产品稳定性等多方面剖析产生假阴性的可能原因,并且结合临床实践和检测技术,从整合特异性实验室指标,规范标本采集方式和过程,严格检测试剂的监管和审批等方面提出行之有效的方案,旨在为切实降低检测假阴性或假阳性率提供临床参考,为COVID-19临床准确诊断及疫情防控提供有力支撑。     

2019新型冠状病毒的研究进展

2019新型冠状病毒(2019-nCoV)是引起武汉新型冠状病毒肺炎(COVID-19)大爆发的一种病毒,其通过病毒外膜上的棘突蛋白(S蛋白)与血管紧张素转换酶2 (ACE2)受体结合而感染人体。COVID-19患者临床症状表现为高热、呼吸困难和肺部毛玻璃样病变。COVID-19轻症患者可出现"炎症因子风暴",继而导致病程急变甚至死亡。目前,对于COVID-19治疗缺乏特异治疗方法。本文梳理了最近关于2019-nCoV的文献,从流行病学、病毒学及医学、机制学的角度全面剖析2019-nCoV的特点,为目前的COVID-19疫情的有效控制提供参考。     

抗原交叉反应对新型冠状病毒血清特异性抗体检测的影响

新型冠状病毒肺炎(coronavirus disease 19,COVID-19)疫情发展迅速,早期诊断成为疫情防控的关键。2020年3月3日国家卫生健康委员会发布了最新版本的《新型冠状病毒肺炎诊疗方案(试行第七版)》,新版诊疗方案在原有的核酸检测确诊标准上新增了血清新型冠状病毒(SARS-CoV-2)特异性IgM和IgG抗体作为病原学诊断标准之一。然而,SARS-CoV-2血清抗体检测可受其他亚型的冠状病毒影响,从而造成检测结果的假阳性。该文针对新型冠状病毒的生物学特性、抗体的产生及检测方法等方面进行讨论,为COVID-19的辅助诊断提供参考。     

新型冠状病毒肺炎合并妊娠病例的临床与实验室指标分析

继2002年暴发的严重急性呼吸综合征冠状病毒(SARS-CoV)和2012年暴发的中东呼吸综合征冠状病毒(MERS-CoV)之后,新型冠状病毒(SARS-CoV-2)是引发人类重症肺炎的第3种跨物种屏障的致病冠状病毒[1]。2020年3月11日,世界卫生组织宣布新型冠状病毒肺炎(COVID-19)是全球性流行病事件。根据国家卫生健康委员会办公厅国家中医药管理局办公室发布的《新型冠状病毒肺炎诊疗方案(试行第七版)》,COVID-19患者的临床表现以发热、咳嗽、乏力为主,疾病早期白细胞计数及淋巴细胞计数正常或减少,肺部呈特征性影像学改变。危重型COVID-19患者可出现休克、呼吸衰竭、多器官功能衰竭。本文通过对3例妊娠合并COVID-19病例的临床特征、实验室检查结果、干预策略及妊娠结局进行分析,以期为临床医生诊断和治疗妊娠合并COVID-19患者提供参考。     

冠状病毒与肾脏损伤的研究进展

近年来,冠状病毒(CoV)对全球公共卫生造成巨大威胁。新型冠状病毒肺炎(COVID-19)患者主要表现为肺部损伤,但患者也存在全身多器官的损害,肾脏是常被累及的肺外器官之一。因此,需要对COVID-19患者肾脏损伤进一步研究,以便医疗人员调整治疗方案,改善疾病预后。本文对冠状病毒相关肾脏损伤的研究进展进行综述,以进一步认识冠状病毒相关肾脏损伤的机制、临床表现和可能有效的治疗方法。     

新型冠状病毒肺炎重症、危重症患者院内转运专家共识

新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者中,重症及危重症患者占5%~10%。此类患者在治疗与康复过程中,院内转运是必不可少的环节,为保障患者在转运过程中的安全,提高转运效率,COVID-19重症、危重症患者院内转运专家共识编写组在回顾已有证据基础上,通过多次讨论制定了《新型冠状病毒肺炎重症、危重症患者院内转运专家共识》,以期为COVID-19重症、危重症患者院内转运提供参考。     

新型冠状病毒肺炎相关国际疾病分类的更新与解读

在全球新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情大流行背景下,使用特定的国际疾病分类(international classification of diseases,ICD)编码将有助于对COVID-19相关情况开展标准化收集、分类和统计,有利于快速寻找疾病诊治规律、及时掌握流行变化趋势并评估预防治疗效果。本文对世界卫生组织最新发布的ICD-10及ICD-11中COVID-19相关分类标准进行梳理和解读,旨在为完善和丰富我国本土化的COVID-19相关ICD编码标准提供参考。     

1例COVID-19患者的实验室指标变化及意义

新型冠状病毒(SARS-CoV-2)是单链正义RNA病毒,属于β类冠状病毒,与严重急性呼吸综合征冠状病毒(SARS-CoV)和中东呼吸综合症冠状病毒(MERS-CoV)同种属^[1-2]。现有的研究结果显示,新型冠状病毒肺炎(COVID-19)的传染性和病死率都非常高,围绕该病毒的诊断和治疗亟待突破。尤其是对病毒感染免疫的研究将在实验室诊断和疫苗的研发中发挥至关重要的作用。本文就上海首例COVID-19患者整个诊治过程中的实验室指标变化进行报道,为COVID-19的诊断治疗提供信息。     

2例新型冠状病毒肺炎粪便SARS-CoV-2核酸阳性临床启示

目前中国新型冠状病毒肺炎(COVID-19)疫情仍十分严峻,及时、早期地识别COVID-19患者是控制疫情的关键步骤。而新型冠状病毒(SARS-CoV-2)核酸检测作为诊断COVID-19的金标准,不但对检测技术提出更高的要求,同时对不同病程患者如何选择标本类型也是一个挑战。本文报道2例COVID-19确诊病例的诊疗经过,并分析采用不同类型标本检测SARS-CoV-2核酸的检出情况,为临床诊断COVID-19时如何选择标本类型和如何提高核酸检出率提供参考。     

COVID-19 impact on the liver

The coronavirus disease 2019 (COVID-19) pandemic imposed arestructuring of global health systems by rethinking spaces used for the care of these patients and the additions of intensive care, infectious diseases and pneumology departments. This paper provides evidence on the presence of severe acute respiratory syndrome coronavirus 2 in hepatocytes and its direct cytopathic activity, as well as the degree of liver damage due to drug toxicity, inflammation and hypoxia in COVID-19. A review of clinical trials has quantified liver damage through both pathology and biochemistry studies. Additionally, we briefly present the results of a study conducted in our clinic on 849 patients admitted for COVID-19 treatment, of which 31 patients had pre-existing chronic liver disease and 388 patients had values above the normal limit for alanine aminotransferase, aspartate aminotransferase, and total bilirubin. It was observed that patients with abnormal liver tests were significantly statistically older, had more comorbidities and had a higher percentage of unfavourable evolution (death or transfer to intensive care). The conclusion of this paper is that the main causes of liver damage are direct viral aggression, coagulation dysfunction and endothelial damage, and patients with impaired liver function develop more severe forms of COVID-19 which requires special care by a multidisciplinary team that includes a hepatologist.     

Liver injury in COVID-19: Known and unknown

Since the first report of the coronavirus disease 2019 (COVID-19) in December 2019 in Wuhan, China, the outbreak of the disease is currently continuously evolving. Previous studies have shown varying degrees of liver damage in patients with COVID-19. However, the exact causes of liver injury and the relationship between COVID-19 and liver injury is unclear. This article describes liver injury induced by COVID-19, analyzes its causes, and discusses the treatment and prognosis of liver damage in patients with COVID-19.     

Liver injury in COVID-19: A minireview

In December 2019, an outbreak of unexplained pneumonia was reported in Wuhan, China. The World Health Organization officially named this disease as novel coronavirus disease 2019 (COVID-19). Liver injury was observed in patients with COVID-19, and its severity varied depending on disease severity, geographical area, and patient age. Systemic inflammatory response, immune damage, ischemia-reperfusion injury, viral direct damage, drug induce, mechanical ventilation, and underlying diseases may contribute to liver injury. Although, in most cases, mild liver dysfunction is observed, which is usually temporary and does not require special treatment, the importance of monitoring liver injury should be emphasized for doctors. The risk of COVID-19 infection of liver transplantation recipients caused more and more concerns. In this article, we aimed to review the available literature on liver injury in COVID-19 to highlight the importance of monitoring and treating liver injury in COVID-19.     

新型冠状病毒抗原快速检测专家共识(2022)

新型冠状病毒肺炎疫情持续时间长、流行范围广，给全球公共卫生带来了巨大负担。作为感染早期诊断和疫情防控的主要检测手段之一，新型冠状病毒抗原快速检测已在国内逐步开展临床应用。就目前医务人员和社会公众所关注的新型冠状病毒抗原检测相关问题，中国医院协会临床微生物实验室专业委员会组织医学检验、临床医学、感染控制、公共卫生及体外诊断产品研发等多领域专家，依据国内外最新研究进展和应用实践，共同制定了《新型冠状病毒抗原快速检测专家共识(2022)》。本共识介绍了目前新型冠状病毒抗原快速检测方法的技术原理、性能特点、结果解读及处置建议，并就不同场景下新型冠状病毒抗原快速检测应用策略和注意事项进行了解析，以期为临床诊疗和疫情防控中正确理解和应用这一检测技术提供参考建议。     

Frontiers of COVID-19-related myocarditis as assessed by cardiovascular magnetic resonance

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In some patients, COVID-19 is complicated with myocarditis. Early detection of myocardial injury and timely intervention can significantly improve the clinical outcomes of COVID-19 patients. Although endomyocardial biopsy (EMB) is currently recognized as the ‘gold standard’ for the diagnosis of myocarditis, there are large sampling errors, many complications and a lack of unified diagnostic criteria. In addition, the clinical methods of treating acute and chronic COVID-19-related myocarditis are different. Cardiac magnetic resonance (CMR) can evaluate the morphology of the heart, left and right ventricular functions, myocardial perfusion, capillary leakage and myocardial interstitial fibrosis to provide a noninvasive and radiation-free diagnostic basis for the clinical detection, efficacy and risk assessment, and follow-up observation of COVID-19-related myocarditis. However, for the diagnosis of COVID-19-related myocarditis, the Lake Louise Consensus Criteria may not be fully applicable. COVID-19-related myocarditis is different from myocarditis related to other viral infections in terms of signal intensity and lesion location as assessed by CMR, which is used to visualize myocardial damage, locate lesions and quantify pathological changes based on various sequences. Therefore, the standardized application of CMR to timely and accurately evaluate heart injury in COVID-19-related myocarditis and develop rational treatment strategies could be quite effective in improving the prognosis of patients and preventing potential late-onset effects in convalescent patients with COVID-19.     

新型冠状病毒肺炎疫情下检验医学临床服务管理的探索

2019 年年底以来,一种新型冠状病毒肺炎在我国大范围流行。检验医学作为临床医学的重要学科,应发挥自 己的专业特色,参与抗击新型冠状病毒肺炎的诊疗活动中。通过介绍河南中医药大学人民医院检验医师团队组成、临床 服务内容、方式等方面内容,阐述检验医学在抗击新型冠状病毒肺炎疫情的重要作用。     

Remarkable gastrointestinal and liver manifestations of COVID-19: A clinical and radiologic overview

The coronavirus disease 2019 (COVID-19) raging around the world still has not been effectively controlled in most countries and regions. As a severe acute respiratory syndrome coronavirus, in addition to the most common infectious pneumonia, it can also cause digestive system disease such as diarrhea, nausea, vomiting, liver function damage, etc. In medical imaging, it manifests as thickening of the intestinal wall, intestinal perforation, pneumoperitoneum, ascites and decreased liver density. Angiotensin-converting enzyme 2 has great significance in COVID-19-related digestive tract diseases. In this review, we summarized the data on the clinical and imaging manifestations of gastrointestinal and liver injury caused by COVID-19 so far and explored its possible pathogenesis.     

Contemporary use of cardiac imaging for COVID-19 patients: a three center experience defining a potential role for cardiac MRI

The pandemic of coronavirus disease 2019 (COVID-19) secondary to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has bestowed an unprecedented challenge upon us, resulting in an international public health emergency. COVID-19 has already resulted in >?1,600,000 deaths worldwide and the fear of a global economic collapse. SARS-CoV-2 is notorious for causing acute respiratory distress syndrome, however emerging literature suggests various dreaded cardiac manifestations associated with high mortality. The mechanism of myocardial damage in COVID-19 is unclear but thought to be multifactorial and mainly driven by the host’s immune response (cytokine storm), hypoxemia and direct myocardial injury by the virus. Cardiac manifestations from COVID-19 include but are not limited to, acute myocardial injury, cardiac arrhythmias, congestive heart failure and acute coronary syndrome. Cardiac imaging is paramount to appropriately diagnose and manage the cardiac manifestations of COVID-19. Herein, we present cardiac imaging findings of COVID-19 patients with biomarker and imaging confirmed myocarditis to provide insight regarding the variable manifestations of COVID-19 myocarditis via Cardiac MRI (CMR) coupled with CMR-edema education along with recommendations on how to incorporate advanced CMR into the clinicians’ COVID-19 armamentarium.