基于新冠肺炎救治探讨"四素一肽两移植"集束化治疗的应用规律及效果  

Analyze the application rules and effects of "Four Elements, One Peptide, and Two Transplantations" based on bundle treatment in coronavirus disease 2019

作　　者：阎岩 吕春燕  黄捷晖 Yan Yan;Lyu Chunyan;Davgadorj Chantsalmaa;Huang Jiehui(Clinical Laboratory Center,the Fifth People's Hospital of Wuxi,Wuxi Clinical College of Nantong University,Wuxi 214016,Jiangsu,China;Department of Respiratory and Critical Care Medicine,the Fifth People's Hospital of Wuxi,Wuxi 214016,Jiangsu,China)

机构地区：[1]无锡市第五人民医院临床检验中心,南通大学无锡临床学院,江苏无锡214016 [2]无锡市第五人民医院呼吸与危重症医学科,江苏无锡214016

出　　处：《中华危重病急救医学》2022年第9期909-914,共6页Chinese Critical Care Medicine

基　　金：无锡市"双百"中青年医疗卫生拔尖人才培养计划项目(BJ2020094);无锡市卫健委科研项目(J202110);中国公共卫生联盟项目(GWLM202005);无锡市科技发展计划项目(N2020X009)。

摘　　要：目的探讨"四素一肽两移植"集束化治疗新型冠状病毒肺炎(新冠肺炎)患者的应用规律及效果,为有效治疗及预防重症发生提供科学依据。方法采用回顾性比较研究方法,分析2020年1月至2022年3月无锡市第五人民医院收治的新冠肺炎患者的临床资料,包括人口学信息、基础疾病、临床分型、住院时间、治疗费用、临床症状、实验室检查等关键指标,评价"四素一肽两移植"集束化治疗新冠肺炎患者的应用规律及效果。结果2020年以L型新冠病毒株为主,2021年以德尔塔变异株为主,2022年以奥密克戎变异株为主;轻型病例比例也在2022年最高,>65岁年龄组患者发展为重型和危重型的比例最高。纳入的150例患者,"四素一肽两移植"集束化治疗方案中干扰素使用率最高(100.0%);2022年维生素C、干扰素和胸腺肽联合使用率最高;>65岁年龄组75.0%存在基础疾病,也是"四素一肽两移植"使用比例最高的年龄组。与轻型患者相比,随着严重程度增加新冠肺炎患者的年龄、住院时间及人均住院费用均显著增加。轻型、普通型、重型和危重型患者均出现了淋巴细胞计数降低,有40.0%的重型患者在入院3 d内出现淋巴细胞计数最低;危重型患者入院时淋巴细胞计数降低或持续降低,采用调节免疫的"四素一肽两移植"的方法可有效挽救危重型患者的生命。新冠病毒感染的所有病例中,51.3%为无症状感染者,其次以呼吸道症状(48.7%)和肺部病变(38.0%)为主。肾功能异常患者使用"四素一肽两移植"集束化治疗的比例最高,其次为凝血功能异常患者和肝功能异常患者。该集束化治疗促进各种临床分型患者CD4^(+)T淋巴细胞和B淋巴细胞明显增加;成人患者治疗后随着病毒转阴,M1型巨噬细胞比例升高,抑制免疫的调节性T细胞(Treg)和感染相关的CC趋化因子受体10^(+)(CCR10^(+))Treg细胞比例减少,轻型患者变化幅度更大、下降�Objective To explore the application rules and effects of"Four Elements,One Peptide,and Two Transplantations"in the bundle treatment of the patients with coronavirus disease 2019(COVID-19),so as to provide a scientific evidence for effective treatment and prevention of severe type.Methods A retrospective comparative study method was used to analyze the clinical data of COVID-19 patients admitted to Wuxi Fifth People's Hospital from January 2020 to March 2022,including demographic information,underlying diseases,clinical classification,length of hospital stay,treatment cost,clinical symptoms,laboratory tests and other key indicators,and evaluate the application rules and effect of"Four Elements,One Peptide,and Two Transplantations"in the bundle treatment of the patients with COVID-19.Results The L-type new coronavirus strain was predominant in 2020,the Delta variant in 2021,and the Omicron variant in 2022.The proportion of mild cases was highest in 2022,with the highest proportion of>65 years old patients developing severe and critical.Among the 150 patients,the proportion of interferon use(100.0%)was the highest in the bundle treatment regimen of"Four Elements,One Peptide,and Two Transplantation".The combined use of vitamin C,interferon and thymopeptide was highest in 2022.More than 75.0%of the age>65 years old group had underlying diseases,which was also the age group with the highest proportion of"Four Elements,One Peptide,and Two transplantations".Compared with mild cases,the age,length of hospital stay,and hospitalization cost of patients with COVID-19 increased significantly with severity.Mild,ordinary,severe,and critically ill patients all had low lymphocyte counts,with 40.0%of severe patients having the lowest lymphocyte counts within 3 days of admission.The lymphocyte count of critically ill patients was reduced or continuously reduced after admission,and the use of the"Four Elements,One Peptide,and Two transplantations"method to regulate immunity can effectively save the lives of critically ill patients.

关 键 词：新型冠状病毒肺炎 重症 肺移植 干细胞移植 集束化治疗 

分 类 号：R563.1[医药卫生—呼吸系统]