血浆置换和托珠单抗治疗六例2019冠状病毒病(COVID-19)重型患者临床分析  

Clinical observation of 6 severe COVID-19 patients treated with plasma exchange or tocilizumab

作　　者：骆嵩[1] 杨丽娟[2] 王春[1] 刘传苗[3] 李殿明[4] LUO Song;YANG Lijuan;WANG Chun;LIU Chuanmiao;LI Dianming(Department of Neurology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui Province,China;Department of Pediatrics,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui Province,China;Department of Infectious Diseases,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui Province,China;Department of Respiratory Medicine,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui Province,China)

机构地区：[1]蚌埠医学院第一附属医院神经内科,安徽蚌埠233004 [2]蚌埠医学院第一附属医院儿科,安徽蚌埠233004 [3]蚌埠医学院第一附属医院感染科,安徽蚌埠233004 [4]蚌埠医学院第一附属医院呼吸科,安徽蚌埠233004

出　　处：《浙江大学学报（医学版）》2020年第2期227-231,共5页Journal of Zhejiang University(Medical Sciences)

基　　金：蚌埠医学院第一附属医院领先新技术项目(2019091);蚌埠医学院自然科学基金(BYKY1673,1790);安徽省高校自然科学研究重点项目(KJ2019A0364);中匈科学合作基金-青年学者计划(2019)。

摘　　要：目的:分析血浆置换和托珠单抗治疗2019冠状病毒病(COVID-19)重型患者的疗效。方法:回顾性分析2020年1月25日至2月25日在蚌埠医学院第一附属医院感染应急病区接受治疗的6例COVID-19重型患者的临床资料(3例采用血浆置换治疗,3例采用托珠单抗治疗)。观察血浆置换和托珠单抗治疗对患者体内过度炎症反应的抑制作用。结果:血浆置换治疗后,3例患者C反应蛋白和IL-6水平下降明显,淋巴细胞和凝血酶原时间均有改善;托珠单抗治疗后,3例患者炎症水平未见明显下降,淋巴细胞计数和凝血酶原时间也无明显改善。结论:COVID-19重型患者采用血浆置换治疗后炎症因子水平明显降低或恢复正常,而托珠单抗治疗患者炎症因子下降不明显。因此对于炎症反应强烈的COVID-19重型患者,血浆置换可能是首选。Objective:To observe the clinical effect of plasma exchange and tocilizumab in treatment of patients with severe coronavirus disease 2019(COVID-19).Methods:Six patients with severe COVID-19 admitted in First Affiliated Hospital of Bengbu Medical College from January 25 to February 25,2020.Three patients were treated with plasma exchange and three patients were treated with tocilizumab.The effect on excessive inflammatory reaction of plasma exchange and tocilizumab was observed.Results:The C-reactive protein(CRP)and IL-6 levels were significantly decreased and the lymphocyte and prothrombin time were improved in 3 patients after treatment with plasma exchange;while inflammation level was not significantly decreased,and lymphocyte and prothrombin time did not improve in 3 patients treated with tocilizumab.Conclusion:For severe COVID-19 patients with strong inflammatory reaction,plasma exchange may be preferred.

关 键 词：2019冠状病毒病 严重急性呼吸综合征冠状病毒2 新型冠状病毒肺炎 危重病 血浆置换 托珠单抗 

分 类 号：R512.99[医药卫生—内科学]