武汉地区重型及危重型2019新型冠状病毒肺炎(COVID-19)患者D-二聚体、炎症指标、细胞因子与疾病严重程度的关系  

Association of D-dimer,inflammatory markers,cytokines abnormality,and disease severity in COVID-19 severe/critical patients in Wuhan

作　　者：张婕[1,2] 高晓玲[3] 李登举[4] 蒋毅[5] 刘燕[6] 庞玲[7] 许东 杨林花 Zhang Jie;Gao Xiaoling;Li Dengju;Jiang Yi;Liu Yan;Pang Ling;Xu Dong;Yang Linhua(Shanxi Medical University,Taiyuan 030001,China;Department of Gastroenterology,The First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Respiratory and Critical Care Medicine,The Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Hematology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei 430030,China;Department of Respiratory and Critical Care Medicine,The First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Critical Care Medicine,The First Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Infectious Disease,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei 430030,China;Department of Hematology,The Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第一医院消化内科,太原030001 [3]山西医科大学第二医院呼吸与危重症医学科,太原030001 [4]华中科技大学同济医学院附属同济医院血液科,武汉430030 [5]山西医科大学第一医院呼吸与危重症医学科,太原030001 [6]山西医科大学第一医院重症医学科,太原030001 [7]华中科技大学同济医学院附属同济医院感染科,武汉430030 [8]山西医科大学第二医院血液科,太原030001

出　　处：《中华血液学杂志》2020年第11期927-931,共5页Chinese Journal of Hematology

基　　金：山西省卫生健康委员会新冠肺炎科研专项(05)。

摘　　要：目的分析2019新型冠状病毒肺炎(COVID-19)重型及危重型患者D-二聚体、炎症指标、细胞因子水平与疾病严重程度的关系。方法收集华中科技大学同济医院中法新城院区山西援鄂国家医疗一队2020年2月8日至3月25日收治的41例COVID-19患者病例资料,重型28例,危重型13例,比较不同临床分型COVID-19患者的基本临床特征,入院时D-二聚体、炎症指标[WBC、ANC、降钙素原(PCT)、超敏C-反应蛋白(hsCRP)]、细胞因子(IL-2R、IL-6、IL-8、TNF-α)水平;比较有无D-二聚体异常患者的细胞因子(IL-2R、IL-6、IL-8、TNF-α)水平;并比较抗凝治疗前后患者D-二聚体、细胞因子指标(IL-2R、IL-6、IL-8、TNF-α)水平变化。结果 41例患者中,男23例(56.1%),女18例(43.9%),平均年龄(55.4±11.9)岁。危重型患者平均年龄[(61.1±10.4)岁]高于重型患者[(52.8±11.7)岁],差异有统计学意义(t=2.264,P=0.032)。危重型患者合并高血压(χ^2=10.420,P=0.001)、心血管疾病(χ^2=6.972,P=0.008)、脑血管疾病(χ^2=6.972,P=0.008)比例高于重型患者。危重型患者出现呼吸困难、盗汗及乏力症状比例均高于重型患者,差异均有统计学意义(χ^2分别为14.898、6.972、7.823,P值分别为<0.001、0.008、0.005)。危重型患者D-二聚体、WBC、ANC、PCT、hsCRP、IL-8水平均高于重型患者,差异均有统计学意义(P值均<0.05)。D-二聚体异常患者IL-2R、IL-8、TNF-α水平均较D-二聚体正常者增高,差异均有统计学意义(P值均<0.05)。8例预防性抗凝治疗患者D-二聚体、IL-2R、IL-6、IL-8抗凝治疗后比治疗前水平降低。结论 COVID-19危重型患者存在更严重的凝血-免疫功能紊乱,动态监测D-二聚体、细胞因子水平有助于早期识别COVID-19危重型患者,抗凝治疗可能通过纠正凝血-免疫功能紊乱促进疾病好转。Objective To analyze the association of D-dimer levels,inflammatory indicators,cytokine abnormality,and disease severity in COVID-19 severe/critical type patients.Methods The medical records of 41 patients were collected from a single center in Wuhan from February 8,2020 to March 25,2020.The patients were divided into severe type group(28 patients)and critical type group(13 patients).The levels of D-dimer,WBC,ANC,PCT,hsCRP,IL-2R,IL-6,IL-8,and TNF-α were compared among patients with different clinical types of COVID-19 infection.Moreover,the changes in the cytokines were analyzed in patients with different D-dimer levels.And,the levels of D-dimer,IL-2R,IL-6,IL-8,and TNF-αbefore and after anticoagulant therapy were assessed.Statistical analyses were performed using Student t test,Mann-Whitney U test,and Chi-square test.Results Among the 41 patients,23 were men(56.1%)and 18 were women(43.9%);the median patient age was 57 y.The age of the critical type patients[(61.1±10.4)y]was higher than that of severe type patients[(52.8±11.7)y];the difference was significant(t=-2.264,P=0.032).The proportion of critical type patients with chronic diseases,especially hypertension,cardiovascular disease,and cerebrovascular disease,was higher as compared to that in those with severe type patients;the differences were significant(all P<0.05).The prevalence of dyspnea,sweats,and fatigue symptoms in the critical type patients was higher than that in those with severe type disease;the differences were significant(χ^2=14.898,6.972,7.823;P<0.001,0.008,0.005).The levels of D-dimer,WBC,ANC,PCT,hsCRP,and IL-8 in critical type patients were higher than those in severe type patients;the differences were significant(all P<0.05).The levels of IL-2R,IL-8,and TNF-αin patients with abnormal D-dimer were higher as compared to those in patients with normal D-dimer levels;the differences were significant(all P<0.05).Eight patients were treated with prophylactic anticoagulation;the levels of D-dimer,IL-2R,IL-6 and IL-8 after anticoagulant therapy

关 键 词：新型冠状病毒肺炎 凝血功能 D-二聚体 细胞因子 

分 类 号：R563.1[医药卫生—呼吸系统]