2019新型冠状病毒感染检测(英语:COVID-19 testing)是通过核酸、抗体或抗原等分子检测手段[1][2][3][4]及胸腔CT断层成像等临床辅助手段,对人体是否感染2019冠状病毒(SARS-CoV-2)或患有2019新型冠状病毒感染(COVID-19)予以诊断。
2019新型冠状病毒感染检测在2019新型冠状病毒感染疫情中,对于及时诊断、救治患者[1][2][5][6][7],疫情监视与控制、恢复经济与正常生活[3][8][9][10][11][12][13][14],起着非常关键的作用,被认为是发现、切断传染链的决定性工具。[15][16]韩国[17][18]与德国[19]在疫情早期开始的广泛而卓有组织的检测、隔离和接触者追踪措施,被认为是其得以较为成功控制冠状病毒疫情的背后原因。 由于病毒携带者可能的无症状感染以及目前尚未开发出可普遍应用的有效疫苗或治疗方法,充分的COVID-19检测、及时获得检测结果,以及接触者追踪、疫情监视、感染者隔离、控制传染源等公共卫生防护措施并配合保持社交距离与佩戴口罩等个人行为方式的改变,是尽早解脱目前普遍的居家隔离与出行限制、从经济衰退状态下安全重启经济的不可或缺的步骤。
COVID-19分子与血清检测
COVID-19分子与血清检测的三类方法
- 核酸检测:核酸检测目前以PCR相关技术为主,过程比较容易开发,是被广泛用于检测患者呼吸道病毒和COVID-19确诊的黄金方法,但其缺点是一般对实验室及医疗防护等技术条件要求高、依现有操作获得结果大多比较费时;[1][7][21]恒温核酸扩增技术的实施可望极大加快核酸检测获得结果的速度[22][23],而有报道称目前雅培病毒快速检测设备的结果准确度不尽令人满意[24][25][26][27][28]。近来发展的CRISPR病毒检测技术具有较高的敏感度和特异性,可望较大幅度降低新冠病毒快速检测技术的误差和不确定性。[4]2019冠状病毒感染者能由核酸检测出阳性的时间可能长达六周,但一般在康复十天后病毒自身复制活性接近为零。[29]
- 快速抗原检测:抗原检测应用于检测COVID-19病毒带来的特有的蛋白分子,有速度快的优点,采检后约 10-30 分钟就可完成[10][11][30][31][32], 但也有灵敏度方面的不足:假阴性检测结果的比例较高。[21][31]快速检测结果为阴性的样品可经由上面提到的PCR核酸检测进一步确认。因抗原检测适合于检测载量大、感染力强的病毒携带者,灵敏度与精确度欠佳[33][34]、但效率高、价钱便宜适合大量筛检,快速找出病毒是否已在族群存在[30],近来在控制疫情过程中获得更为广泛的应用。[15][16][35]
- 抗体检测:基于血清抗体的免疫测定法通过人体对病毒入侵导致的免疫反应间接检测COVID-19病史。因为产生抗体相对病毒感染有一段时间滞后,抗体检测对人体感染初期(一周内)不敏感,准确度的一致性比较差;[36][37]由于其他类型冠状病毒引发的抗体与新冠病毒存在交叉反应[37][38],现有各种抗体检测产品假阳性结果经常出现;此类测试是否适用于检测亚临床或轻微感染导致的较低水平抗体,也有待进一步研究。[36]相对优点是检测操作便捷、采样感染风险低,往往可以在一小时内获得结果,并比较适合于对群体疫情进行监测评估及接触者追踪等相关流行病学分析。[1][3][21][39][40]但疫情初期公众对抗体检测的效用期望可能过高。[4]
SARS-CoV-2核酸及抗原检测的采样方法
核酸检测及抗原检测的灵敏度和特异度很大程度上取决于呼吸道样品正确的采集方法和时机。采样类型包括:上呼吸道标本、下呼吸道标本(痰液、气道抽取物、肺泡灌洗液)、血液、粪便、尿液和结膜分泌物等。[41]对门诊患者或初期病毒检测,应优先采集上呼吸道样本(鼻腔、喉咙等处取样)[42][43];对较严重的呼吸道疾病患者优先采集下呼吸道样本(气管内抽吸或支气管肺泡灌洗)[43]。
上呼吸道 采集样本方法包括:
其中较新的唾液采样方法可由被检测者自己完成,更为快捷、安全。[44]
COVID-19确诊方法
分子检测确诊方法
影像学检测
相关数据
各国检测相关数据
应用抗体检测与核酸检测对美国COVID-19患者数目的估计
美国疾病控制与预防中心官员依据抗体检测数据估计,截至2020年6月美国正在或曾经罹患COVID-19患者可能达到两千万人,约十倍于经由核酸检测确诊的官方数字(230万至240万之间)[50]。 但新冠病毒抗体检测的阳性也有一定可能是由普通感冒病毒与新冠抗体的交叉反应引起[37]。
各国次级行政区检测数据
次级行政区 | 检测数 | 时间 |
---|---|---|
广东省 | 24930000 | 累计截至8月5日[51] |
湖北省 | 6393436 | 累计截至5月17日[52] |
武汉市 | 9899828 | 5月14日至6月1日[53] |
北京市 | 11880000 | 6月11日至7月14日[54] |
相关条目
延伸阅读
- Habibzadeh, Parham; Mofatteh, Mohammad; Silawi, Mohammad; Ghavami, Saeid; Faghihi, Mohammad Ali. Molecular diagnostic assays for COVID-19: an overview. Critical Reviews in Clinical Laboratory Sciences. 2021-08-18, 58 (6): 385–398. ISSN 1040-8363. PMC 7898297 . PMID 33595397. doi:10.1080/10408363.2021.1884640 (英语).
参考资料
- ↑ 1.0 1.1 1.2 1.3 Sheridan, Cormac. Fast, portable tests come online to curb coronavirus pandemic. Nature Biotechnology. 2020-03-23 [2020-03-25]. doi:10.1038/d41587-020-00010-2.
- ↑ 2.0 2.1 Coronavirus disease (COVID-19) technical guidance: Laboratory testing for 2019-nCoV in humans. www.who.int. [2020-03-06].
- ↑ 3.0 3.1 3.2 Breaking Down the Two Tests That Could Help Contain the COVID-19 Pandemic: One detects an active infection; another signals that the virus has already left the body. Both are critical for tracking the spread of disease. Smithsonian Magazine. 2020-04-07 [2020-04-08].
- ↑ 4.0 4.1 4.2 Sheridan, Cormac. Coronavirus testing finally gathers speed. Nature Biotechnology. 2020-11-05. doi:10.1038/d41587-020-00021-z (英语).
- ↑ Cohen, Jon; Kupferschmidt, Kai. Countries test tactics in 'war' against COVID-19. Science. 2020-03-20, 367 (6484): 1287–1288 [2020-03-20]. PMID 32193299. doi:10.1126/science.367.6484.1287.
- ↑ 全球遭遇新冠检测难题,多国专家联合支招. [2020-03-18].
- ↑ 7.0 7.1 Everything You Need to Know About Coronavirus Testing: How it works, why we need it, and why it's taking so damn long for the US to get people diagnosed. www.wired.com. [2020-03-26].
- ↑ The lost month: How a failure to test blinded the U.S. to COVID-19. The Seattle Times. 2020-03-28.
- ↑ To End The Coronavirus Crisis We Need Widespread Testing, Experts Say. NPR. 2020-03-24 [2020-04-07].
- ↑ 10.0 10.1 Fast COVID-19 test by San Diego's Quidel comes up big in saving Pac-12 football. [2020-09-27].
- ↑ 11.0 11.1 Covid-19 tests that give results in minutes to be rolled out across world. the Guardian. 2020-09-28 [2021-10-20] (英语).
- ↑ The case for airport coronavirus testing, and why it matters. [2020-09-28].
- ↑ Testing in a Pandemic — Improving Access, Coordination, and Prioritization
- ↑ Here Is Why Diagnostic Tests Are As Important As Vaccines When It Comes To Stopping Covid In The U.S.
- ↑ 15.0 15.1 Pancevski, Bojan. As Covid-19 Cases Surge, Europe Turns to New Testing Methods. Wall Street Journal. 2020-10-09 [2021-10-20]. ISSN 0099-9660 (美国英语).
- ↑ 16.0 16.1 16.2 The day we let Covid-19 spin out of control. [2021-01-24].
- ↑ Coronavirus cases have dropped sharply in South Korea. What's the secret to its success?. Science. 2020-03-17 [2020-04-11].
- ↑ Experts Credit South Korea's Extensive Testing For Curbing Coronavirus Spread. NPR.org. [2020-05-23].
- ↑ Pass the salt: The minute details that helped Germany build virus defences. Reuters. 2020-04-09 [2021-10-20] (英语).
- ↑ Siouxsie Wiles & Toby Morris: What we don't know about Covid-19. The Spinoff. 2020-05-06 [2020-05-06].
- ↑ 21.0 21.1 21.2 What to know about the three main types of coronavirus tests. CNN. 2020-04-29 [2020-04-30].
- ↑ Abbott Launches 5-Minute COVID-19 Isothermal Point-of-Care Test. [2021-10-20] (美国英语).
- ↑ 5分钟!FDA紧急使用授权批准雅培COVID-19即时检测!-MedSci.cn. www.medsci.cn. [2021-10-20].
- ↑ Coronavirus Testing Hampered by Disarray, Shortages, Backlogs. Wall Street Journal. 2020-04-19 [2020-04-19].
- ↑ 5分钟出新冠检测结果…美国这个“黑科技”靠谱吗?. 新浪网. 2020-04-24.
- ↑ Performance of the rapid Nucleic Acid Amplification by Abbott ID NOW COVID-19 in nasopharyngeal swabs transported in viral media and dry nasal swabs, in a New York City academic institution. [2020-05-13].
- ↑ False Negatives Raise More Questions About Virus Test Accuracy. Bloomberg.com. 2020-05-13 [2021-10-20] (英语).
- ↑ FDA Cautions About Accuracy Of Widely Used Abbott Coronavirus Test. [2020-05-16].
- ↑ Symptom-Based Strategy to Discontinue Isolation for Persons with COVID-19 (2020) referenced Xiao, Ai Tang; Tong, Yi Xin; Zhang, Sheng. Profile of RT-PCR for SARS-CoV-2: A Preliminary Study From 56 COVID-19 Patients. Clinical Infectious Diseases. 2020-11-19, 71 (16): 2249–2251. ISSN 1058-4838. PMC 7188124 . PMID 32306036. doi:10.1093/cid/ciaa460 (英语).
- ↑ 30.0 30.1 Delta 變種病毒來勢洶洶!臺灣準備好了嗎?. GeneOnline News. 2021-08-26 [2021-10-20] (繁体中文(中国台湾)).
- ↑ 31.0 31.1 FDA authorizes rapid COVID 19 antigen test: The test is quicker than PCR tests but has a high rate of false negatives. [2020-05-10].
- ↑ Abbott wins U.S. authorization for $5 rapid COVID-19 antigen test. Reuters. 2020-08-26 [2021-10-20] (英语).
- ↑ Accuracy Concerns Continue to Surround Rapid Antigen Tests for COVID-19. [2020-11-14].
- ↑ Covid-19: Innova lateral flow test is not fit for “test and release” strategy, say experts. [2020-11-30].
- ↑ Public Health Officials Pursue Covid-19 Tests That Trade Precision for Speed. [2020-09-09].
- ↑ 36.0 36.1 Deeks, Jonathan J.; Dinnes, Jacqueline; Takwoingi, Yemisi; Davenport, Clare; Spijker, René; Taylor-Phillips, Sian; Adriano, Ada; Beese, Sophie; Dretzke, Janine; Ferrante di Ruffano, Lavinia; Harris, Isobel M. Antibody tests for identification of current and past infection with SARS-CoV-2. The Cochrane Database of Systematic Reviews. 2020-06-25, 6: CD013652. ISSN 1469-493X. PMID 32584464. doi:10.1002/14651858.CD013652.
- ↑ 37.0 37.1 37.2 IDSA COVID-19 Antibody Testing Primer Updated: May 4 (PDF). [2020-11-27].
- ↑ Prepandemic coronavirus antibodies may react to COVID-19. [2021-01-30].
- ↑ Researchers Push for Mass Blood Tests as a Covid-19 Strategy. www.wired.com. [2020-03-27].
- ↑ The next frontier in coronavirus testing: Identifying the full scope of the pandemic, not just individual infections. STAT. 2020-03-27 [2020-04-30].
- ↑ 新冠肺炎防治手册:病原学与炎症指标检查 (PDF). [2020-10-01].
- ↑ CDC: Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19. [2020-06-25].
- ↑ 43.0 43.1 WHO: 利用全球流感监测和应对系统监测COVID-19的操作注意事项 (PDF). [2020-06-25].
- ↑ 44.0 44.1 Coronavirus (COVID-19) Update: FDA Issues Emergency Use Authorization to Yale School of Public Health for SalivaDirect, Which Uses a New Method of Saliva Sample Processing. [2020-08-16].
- ↑ 【健康码】粤港澳互认健康码将公布 惟三地核酸检测收费相差近5至7倍 . HKET. 2020-06-12
- ↑ 新型冠状病毒测试服务 . 香港中文大学医务中心
- ↑ COVID-19 Diagnostics: Performing a Nasopharyngeal and Oropharyngeal Swab (简体中文(中国大陆))
- ↑ 为啥核酸采样要增加肛拭子网友表示:羞涩了……_媒体_澎湃新闻-The Paper. 澎湃新闻. [2021-01-24].
- ↑ 听说要查“肛拭子”,网友表示:还是不回家过年了!_腾讯新闻. new.qq.com. [2021-01-24].
- ↑ Reuters: Coronavirus may have infected 10 times more Americans than reported, CDC says. [2020-06-26].
- ↑ 广州排查高风险国家在穗4355人,均已做核酸检测纳入管理. 澎湃新闻. [2020-04-19].
- ↑ 湖北省累计核酸检测超639万人次 无症状感染者检出率持续降低. 中国政府网. [2020-10-11].
- ↑ 武汉核酸检测近990万人 检出300名无症状感染者. 新华网. [2020-10-11].
- ↑ 北京:全市累计核酸检测已达1188万人. 新华网. [2020-10-11].
- ↑ Resnick, Brian. "It’s like we’re flying blind": The US has a Covid-19 data problem. Vox. 2020-08-05 [2021-10-20] (英语).
- ↑ FDA Authorizes Quest Diagnostics COVID-19 Diagnostic Testing for Specimen Pooling for Emergency Use. Quest Diagnostics Newsroom. [2021-10-20] (美国英语).
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