新加坡国家传染病中心Barnaby Edward Young联合Yee-Sin Leo研究组近日取得新进展。他们分析了新加坡SARS-CoV-2感染患者的流行病学特征和临床病程。这一研究成果发表在《美国医学会杂志》上。

为了报告新加坡在这次疫情中流行病学调查、临床特征和管理方面的的初步经验，2020年1月23日至2月3日，研究组对新加坡4所医院中首批确诊为SARS-CoV-2感染的18例患者进行了描述性分析。

这18例SARS-CoV-2感染住院患者的中位年龄为47岁，50％为女性，临床表现为上呼吸道感染的有12例（67％），15例（83％）患者的鼻咽拭子中检出病毒的时间持续7天甚至更久。6例（33％）患者需要补充氧气，其中2例需要重症监护，没有患者死亡。

通过PCR在50%的粪便样本和8%的血液样本中检测到了病毒，但在尿液中未检测到。5名需要补充氧气的患者接受了洛匹那韦-利托那韦治疗。5例患者中有3例在3天内退烧，吸氧需求减少，2例因进行性呼吸衰竭而恶化。使用洛匹那韦-利托那韦治疗的5例患者中有4例出现恶心、呕吐和/或腹泻，而3例出现肝功能异常。

总之，在新加坡首批被诊断为SARS-CoV-2感染的18例患者中，临床表现通常是轻度呼吸道感染。一些患者需要补充氧气，并在接受抗逆转录病毒药物治疗后有不同的临床结局。

附：英文原文

Title: Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore

Author: Barnaby Edward Young, Sean Wei Xiang Ong, Shirin Kalimuddin, Jenny G. Low, Seow Yen Tan, Jiashen Loh, Oon-Tek Ng, Kalisvar Marimuthu, Li Wei Ang, Tze Minn Mak, Sok Kiang Lau, Danielle E. Anderson, Kian Sing Chan, Thean Yen Tan, Tong Yong Ng, Lin Cui, Zubaidah Said, Lalitha Kurupatham, Mark I-Cheng Chen, Monica Chan, Shawn Vasoo, Lin-Fa Wang, Boon Huan Tan, Raymond Tzer Pin Lin, Vernon Jian Ming Lee, Yee-Sin Leo, David Chien Lye

Issue&Volume: 2020-03-03

Abstract: AbstractImportance  Objective  To report the initial experience in Singapore with the epidemiologic investigation of this outbreak, clinical features, and management.Design, Setting, and Participants  Descriptive case series of the first 18 patients diagnosed with polymerase chain reaction (PCR)–confirmed SARS-CoV-2 infection at 4 hospitals in Singapore from January 23 to February 3, 2020; final follow-up date was February 25, 2020.Exposures  Confirmed SARS-CoV-2 infection.Main Outcomes and Measures  Clinical, laboratory, and radiologic data were collected, including PCR cycle threshold values from nasopharyngeal swabs and viral shedding in blood, urine, and stool. Clinical course was summarized, including requirement for supplemental oxygen and intensive care and use of empirical treatment with lopinavir-ritonavir.Results  Among the 18 hospitalized patients with PCR-confirmed SARS-CoV-2 infection (median age, 47 years; 9 [50%] women), clinical presentation was an upper respiratory tract infection in 12 (67%), and viral shedding from the nasopharynx was prolonged for 7 days or longer among 15 (83%). Six individuals (33%) required supplemental oxygen; of these, 2 required intensive care. There were no deaths. Virus was detectable in the stool (4/8 [50%]) and blood (1/12 [8%]) by PCR but not in urine. Five individuals requiring supplemental oxygen were treated with lopinavir-ritonavir. For 3 of the 5 patients, fever resolved and supplemental oxygen requirement was reduced within 3 days, whereas 2 deteriorated with progressive respiratory failure. Four of the 5 patients treated with lopinavir-ritonavir developed nausea, vomiting, and/or diarrhea, and 3 developed abnormal liver function test results.Conclusions and Relevance  Among the first 18 patients diagnosed with SARS-CoV-2 infection in Singapore, clinical presentation was frequently a mild respiratory tract infection. Some patients required supplemental oxygen and had variable clinical outcomes following treatment with an antiretroviral agent.

DOI: 10.1001/jama.2020.3204

Source: https://jamanetwork.com/journals/jama/fullarticle/2762688