摘要
目的评价血必净联合人免疫球蛋白在重型及危重型新型冠状病毒肺炎(新冠肺炎)中的临床疗效。方法采用回顾性研究方法,分析重庆医科大学附属第二医院和重庆市中医院医疗团队2020年1月至3月在支援重庆市公共卫生医疗救治中心及重庆三峡中心医院抗击新冠肺炎期间收治的65例重型、危重型新冠肺炎患者的临床资料。根据不同治疗方案将患者分为常规治疗组(常规抗病毒、抗感染及对症支持治疗)、血必净组(炎性细胞因子升高者加用血必净注射液)和联合组(血必净联合人免疫球蛋白,淋巴细胞及其亚群监测结果提示免疫力低下者加用人免疫球蛋白)。观察3组患者治疗前后血常规、血气分析、心肌酶谱、肝肾功能、淋巴细胞及其亚群、细胞因子等相关指标和危重程度评分改善情况;采用Kaplan-Meier法绘制各组患者28 d生存曲线,比较各组累积生存率。结果65例重型及危重型新冠肺炎患者中,仅接受常规治疗20例,加用血必净治疗22例,加用血必净联合人免疫球蛋白治疗23例。治疗前,联合组CD4^(+)T细胞计数明显低于其他两组,白细胞介素-6(IL-6)明显高于其他两组,而3组间其余指标差异均无统计学意义,提示3组患者治疗前基线较为均衡。常规治疗组治疗后患者病情有所减轻,表现为急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和乳酸脱氢酶(LDH)较治疗前明显降低〔APACHEⅡ评分(分):5.20±2.74比6.20±1.93,LDH(μmol·s^(-1)·L^(-1)):4.1±1.0比4.7±0.9,均P<0.01〕,但仍存在肝脏损伤,表现为天冬氨酸转氨酶(AST)较治疗前明显升高〔U/L:30.5(23.8,41.5)比21.0(17.0,34.0),P<0.05〕。血必净组治疗后患者呼吸功能改善,免疫力有所增强,CD4^(+)T细胞比例改善程度较常规治疗组更加显著(4.86±6.31比-0.95±12.38,P<0.05),但仍存在"炎症风暴"且合并肝损伤,表现为IL-4较治疗前明显升高(ng/L:2.57±1.15比1.92±1.04,P<0.05),白蛋
Objective To evaluate the clinical efficacy of Xuebijing combined with human immunoglobulin for the treatment of severe and critically ill patients with coronavirus disease 2019(COVID-19).Methods A retrospective study was conducted.The clinical data of 65 patients with severe and critical COVID-19 admitted to Chongqing Public Health Medical Center and Chongqing Three Gorges Central Hospital from January 2020 to March 2020 during the period of supporting to combat COVID-19 by the medical team of the Second Affiliated Hospital of Chongqing Medical University and Chongqing Hospital of Traditional Chinese Medicine were analyzed.According to different treatment regimens,patients were divided into conventional treatment group(conventional antivirus,anti-infection and symptomatic support treatments),Xuebijing group(Xuebijing was applied to patients with elevated inflammatory cytokines)and combination group(Xuebijing combined with human immunoglobulin,human immunoglobulin was applied to patients with low immunity indicated by monitoring results of lymphocytes and their subsets).The improvement of blood routine examination,blood gas analysis,myocardial enzyme spectrum,liver and kidney function,lymphocytes and their subsets and cytokines as well as severity score in three groups before and after treatment were observed.Kaplan-Meier method was used to draw the 28-day survival curve of each group,and the cumulative survival rate among the groups was compared.Results Among the 65 severe and critically ill COVID-19 patients,only 20 patients received conventional treatment,22 patients were treated with Xuebijing based on conventional treatment,and 23 patients were treated with Xuebijing combined with human immunoglobulin based on conventional treatment.Before treatment,CD4^(+)T cell count in combination group was higher than other two groups,and interleukin-6(IL-6)was lower than other two groups,while other indicators showed no statistically significant differences among the three groups,suggesting that the baseline of the thre
作者
陈丽
张安
李群堂
崔勇袁
国丹
Chen Li;Zhang An;Li Quntang;Cui Yong;Yuan Guodan(Department of Critical Care Medicine,the Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Preventive Medicine,Chongqing Traditional Chinese Medicine Hospital,Chongqing 400021,China;Department of Critical Care Medicine,Chongqing Three Gorges Central Hospital,Chongqing 404000,China;Department of Critical Care Medicine,Geleshan Hospital District,Chongqing Public Health Medical Center,Chongqing 400036,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2021年第4期399-404,共6页
Chinese Critical Care Medicine
基金
重庆市科学技术局新型冠状病毒肺炎疫情应急科技攻关专项(cstc2020jscx-fyzxX0012)
重庆市卫生健康委员会新冠肺炎防控应急科研专项(2020NCPZX04)。
关键词
新型冠状病毒
重症肺炎
血必净
人免疫球蛋白
2019 Novel coronavirus
Severe pneumonia
Xuebijing
Human immunoglobulin
