新型冠状病毒(2019-nCoV)感染患者肺损伤相关的临床及生化指标研究  

Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury

作　　者：刘映霞 杨扬 张聪 黄凤鸣[3] 王福祥 袁静 王召钦 李金秀 李建明 冯程 张政 王力非 彭凌 陈莉 秦宇豪 赵丹丹 谭曙光[4] 尹路 徐军[5] 周丛照[2] 蒋澄宇[3] 刘磊 LIU YingXia;YANG Yang;ZHANG Cong;HUANG FengMing;WANG FuXiang;YUAN Jing;WANG ZhaoQin;LI JinXiu;LI JianMing;FENG Cheng;ZHANG Zheng;WANG LiFei;PENG Ling;CHEN Li;QIN YuHao;ZHAO DanDan;TAN ShuGuang;YIN Lu;XU Jun;ZHOU CongZhao;JIANG ChengYu;LIU Lei(Shenzhen Key Laboratory of Pathogen and Immunity,National Clinical Research Center for Infectious Disease,State Key Discipline of Infectious Disease,Shenzhen Third People′s Hospital,Second Hospital Affiliated to Southern University of Science and Technology,Shenzhen 518112,China;Hefei National Laboratory for Physical Sciences at the Microscale and School of Life Sciences,University of Science and Technology of China,Hefei 230027,China;State Key Laboratory of Medical Molecular Biology,Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences,Department of Biochemistry,Peking Union Medical College,Beijing 100005,China;Institute of Microbiology,Chinese Academy of Sciences,Beijing 100101,China;Emergence Department Peking Union Medical College Hospital,Beijing,100731,China)

机构地区：[1]南方科技大学附属第二医院,深圳市第三人民医院,国家感染性疾病临床医学研究中心,深圳市病原微生物与免疫重点实验室,感染病国家重点学科,深圳518112 [2]中国科学技术大学,合肥微尺度物质科学国家实验室,生命科学学院,合肥230027 [3]中国医学科学院基础医学研究所,北京协和医学院生物化学与分子生物学系,医学分子生物学国家重点实验室,北京100005 [4]中国科学院微生物研究所,北京100101 [5]北京协和医院急诊科,北京100731

出　　处：《中国科学：生命科学》2020年第3期258-269,共12页Scientia Sinica(Vitae)

基　　金：国家重大科技专项(批准号:2017ZX10103011,2017ZX10204401);中国医学科学院医学创新基金(批准号:2017-I2M-1-009);深圳市科技研发项目(批准号:JCYJ20180504165549581,JCYJ20170413141236906903);中国博士后科学基金(批准号:2019T120147)资助。

摘　　要：Ⅱ新型冠状病毒(2019-n Co V)2019年12月在湖北省武汉市暴发,并迅速传播到中国多地及其他国家.在本研究中,我们报告了来自中国深圳早期的2019-n Co V感染患者的流行病学、临床指标、生化指标和影像学特征,以及可用于预测疾病严重程度的潜在生物标记物.所有12例2019-n Co V感染患者均发展为肺炎,其中一半患者进一步发展为急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS).最常见的生化指标异常是低白蛋白(albumin, ALB)血症、淋巴细胞(lymphocytes, LYM)计数减少、淋巴细胞百分比和中性粒细胞(neutrophils, NEU)百分比降低、C反应蛋白(C-reactive protein, CRP)和乳酸脱氢酶(lactate dehydrogenase, LDH)水平升高,以及CD8细胞计数降低.从患者呼吸道特别是下呼吸道检测到的2019-n Co V病毒滴度与肺部疾病的严重程度正相关. ALB,LYM, LYM(%), LDH, NEU(%)和CRP的水平与急性肺损伤程度高度相关.年龄、病毒滴度、肺损伤评分和血液生化指标(ALB, CRP, LDH, LYM(%), LYM及NEU(%))可能是疾病严重程度的预测指标.此外, 2019-n Co V感染患者的血浆血管紧张素Ⅱ水平显著升高,并且与病毒滴度和肺损伤程度线性相关.该研究结果提供了多种潜在的可用于诊断的生物标志物,并提出了血管紧张素Ⅱ受体阻滞剂(angiotensin Ⅱ receptor blocker, ARB)药物或可作为治疗2019-n Co V感染的潜在药物进行深入研究.The outbreak of the 2019-nCoV infection began in December 2019 in Wuhan, Hubei province, and rapidly spread to many provinces in China as well as other countries. Here we report the epidemiological, clinical, laboratory, and radiological characteristics, as well as potential biomarkers for predicting disease severity in 2019-nCoV-infected patients in Shenzhen, China. All 12 cases of the 2019-nCoV-infected patients developed pneumonia and half of them developed acute respiratory distress syndrome(ARDS). The most common laboratory abnormalities were hypoalbuminemia, lymphopenia, decreased percentage of lymphocytes(LYM) and neutrophils(NEU), elevated C-reactive protein(CRP) and lactate dehydrogenase(LDH), and decreased CD8 count. The viral load of2019-nCoV detected from patient respiratory tracts was positively linked to lung disease severity. albumin(ALB) LYM, LYM(%),LDH, NEU(%) and CRP were highly correlated to the acute lung injury. Age, viral load, lung injury score, and blood biochemistry indexes, ALB, CRP, LDH, LYM(%), LYM, and NEU(%), may be predictors of disease severity. Moreover, the Angiotensin Ⅱ level in the plasma sample from 2019-nCoV infected patients was markedly elevated and linearly associated to viral load and lung injury. Our results suggest a number of potential diagnosis biomarkers and angiotensin receptor blocker(ARB) drugs for potential repurposing treatment of 2019-nCoV infection.

关 键 词：2019-nCoV 血管紧张素Ⅱ 急性呼吸窘迫综合征 

分 类 号：R563.1[医药卫生—呼吸系统]