SARS-CoV-2 Real-Time RT-PCR 양성 환자에서 추적 PCR 검사 결과 분석
Analysis of Follow-up Real-Time RT-PCR Results from SARS-CoV-2-Positive Patients
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초록
배경: 코로나 유행 초기에는 COVID-19로 입원한 환자에 대한 퇴원 지침이 명확하지 않아서 많은 환자들이 SARS-COV-2 real-time reverse transcription-PCR (rRT-PCR) 결과가 음성으로 나올 때까지 퇴원이 보류되었다. 저자들은 COVID-19 환자에서 연속적으로시행한 rRT-PCR 검사 결과의 변화 양상을 분석하고자 한다. 방법: 2020년 대구가톨릭대학교병원에서 COVID-19로 진단받은84명 환자의 rRT-PCR 결과를 분석하였다. PowerCheck 2019-nCoV 키트(KogeneBiotech, Korea)와 CFX 96 Real-Time System (Bio- Rad Laboratories, USA)이 사용되었으며, PCR의 델타 Ct 값과 임상특징을 후향적으로 분석하였다. 결과: 환자들은 38.5일 동안 9번의 SARS-CoV-2 rRT-PCR 검사를 시행하였으며, PCR 음성으로 전환되기까지 평균 28일이 소요되었다. 지속적으로 음성을 보인 그룹에서 음성 전환 소요일의 중간값은27.5일이었고, 재양성 그룹에서 중간값은 37.0일이었다. 입원 첫날부터 25일째까지 E 및 RdRp 유전자의 초기 Ct 값에서부터 델타 Ct 값은 계속 증가하였고, 입원 25일 이후 두 유전자의 델타 Ct 수치는감소하였다. 결론: 지속적으로 음성을 보인 그룹에 비해 재양성 그룹은 SARSCoV- 2 rRT-PCR에서 음성 전환까지 10일이 더 소요되었다. 임상적으로 양호한 경과를 보이는 환자에서 4주 경과 후 SARS-CoV-2 rRT-PCR 추적 검사는 환자의 실제 바이러스 농도를 반영할 수 없을 것이다
Abstract
Background: In the early days of the coronavirus disease 2019 (COVID-19) pandemic, unclear discharge guidelines for hospitalized COVID-19 patients resulted in numerous individuals being kept in the hospital until their real-time reverse transcription-polymerase chain reaction (rRT-PCR) results showed negativity. The objective of this study was to analyze the variations in repeated follow-up rRT-PCR results among hospitalized patients. Methods: We analyzed rRT-PCR results from 84 patients diagnosed with COVID-19 at Daegu Catholic University Medical Center in 2020. The PowerChek 2019-nCoV Real-time PCR Kit (KogeneBiotech, Korea) and CFX96 Real-Time PCR Detection System (Bio-Rad Laboratories, USA) were used, and the delta cycle threshold (ΔCt) values were retrospectively analyzed alongside the clinical features. Results: The patients underwent nine repeat rRT-PCR tests over a span of 38.5 days, showing negative results after an average of 28.0 days. The median number of days required to achieve the first negative result was 27.5 days for the consistently negative group and 37.0 days for the negative- positive-negative (re-positive) group. The ΔCt values for the E and RdRp genes increased continuously from their initial values on the day of hospitalization, peaked at 25.0 days post-hospitalization, and then decreased thereafter. Conclusions: In contrast to the patients in the consistently negative group, those in the re-positive group took an additional 10.0 days to achieve SARS-CoV-2 negativity in the rRT-PCR test. Therefore, repeated rRT-PCR tests after 4 weeks may not accurately reflect the actual viral load of clinically stable patients.
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