摘要
目的评估人工肝血液净化系统(以下简称人工肝)治疗重型及危重型新型冠状病毒肺炎患者的疗效,观察治疗前后患者淋巴细胞亚群和细胞因子的变化。方法纳入2020年1月31日至2月18日河南省人民医院公共卫生中心病房收治的6例新型冠状病毒肺炎患者,其中重型3例,危重型3例。根据患者病情制订人工肝治疗方案,回顾性分析患者流行病学史、临床特征、实验室检查和患者人工肝治疗前后淋巴细胞亚群和细胞因子变化。结果截至2020年2月24日,2例重型患者治愈出院,1例好转出院,平均住院时间为19 d;2例危重型患者仍在院治疗中,1例死亡。3例重型患者均采用血液滤过治疗;2例危重型采用血浆置换+血液滤过治疗模式,1例采用持续床旁血液滤过治疗。治疗前6例患者中性粒细胞与淋巴细胞比值分别为6.42、2.63、15.00、15.09、12.04和30.41,治疗后分别为4.77、6.05、4.86、5.43、32.77和23.46,变化无规律。6例患者淋巴细胞绝对数在治疗前偏低,中位数为382/μL,人工肝治疗后淋巴细胞绝对数上升,中位数为476/μL。检测3例危重型患者治疗前后细胞因子水平,2例在治疗后白细胞介素6(interleukin-6,IL-6)水平分别从26042.00 ng/L和282.03 ng/L下降至226.85 ng/L和26.15 ng/L,1例患者IL-6水平持续升高,从30.14 ng/L上升至709.25 ng/L,该例患者最终死亡。结论人工肝治疗可改善重型及危重型新型冠状病毒肺炎患者的炎症反应,提升其淋巴细胞和各淋巴细胞亚群绝对数;IL-6水平与疾病进展有关,或能作为早期鉴别重型及危重型新型冠状病毒肺炎的预后因素。
Objective To evaluate the efficacy of artificial liver blood purification system in the treatment of severe and critical patients with corona virus disease 2019(COVID-19),and to observe the dynamic changes of lymphocyte subsets and cytokines after treatment.Methods A total of six patients with COVID-19 admitted to the ward of public health center of Henan Provincial People′s Hospital from January 31 to February 18,2020 were enrolled,including three severe cases and three critical cases.The protocals of artificial liver treatment were developed according to the patients′conditions,and the patients′epidemiological history,clinical characteristics,and laboratory examination data were retrospectively analyzed.At the same time,dynamic changes of lymphocyte subsets and cytokines were detected before and after artificial liver treatment.Results By February 24,2020,two severe patients were discharged after cured,and one case was discharged after improved,with an average stay of 19 days.Two critical patients were still hospitalized and one died.Three severe patients were all treated with hemofiltration,while two critical patients were treated with hemofiltration plus plasma exchange,and one was treated with continuous bedside hemofiltration.Among six patients,the ratio of neutrophils to lymphocytes before treatment were 6.42,2.63,15.00,15.09,12.04 and 30.41,respectively.After treatment,the ratio of neutrophils to lymphocytes became 4.77,6.05,4.86,5.43,32.77 and 23.46,respectively.The absolute numbers of lymphocytes in six patients before treatment were low,with a median of 382/μL.After treatment of artificial liver,the absolute numbers of lymphocytes increased,with a median of 476/μL.Cytokines were detected in three critical patients,and the interleukin 6(IL-6)levels in two cases were 26042.00 ng/L and 282.03 ng/L,respectively before treatment.After treatment,the levels decreased to 226.85 ng/L and 26.15 ng/L,respectively.IL-6 continued increasing from 30.14 ng/L to 709.25 ng/L in one another critical patient,who
作者
彭真
宁会彬
李宽
靳慧鸣
牛垚飞
李静
尚佳
Peng Zhen;Ning Huibin;Li Kuan;Jin Huiming;Niu Yaofei;Li Jing;Shang Jia(Department of Infectious Disease,Henan Provincial People′s Hospital,Zhengzhou 450003,China)
出处
《中华传染病杂志》
CAS
CSCD
2020年第6期329-332,共4页
Chinese Journal of Infectious Diseases
