摘要
目的探讨新型冠状病毒感染(COVID-19)型急性呼吸窘迫综合征(ARDS)与非COVID-19型ARDS患者炎症反应和细胞免疫的差异性。方法选取2022年1月至2023年12月郑州市第一人民医院收治的COVID-19型ARDS患者120例纳入观察组(中度89例,重度31例),根据1∶1配对原则,另选取同期其他肺部致病菌导致ARDS患者120例纳入对照组,同期健康体检者120例纳入健康组。比较三组受检者及不同病情程度COVID-19型ARDS患者血清炎性相关因子[白介素-6(IL-6)、白介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]及细胞免疫相关因子[T细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))、自然杀伤细胞(NK细胞)]水平,采用Spearman分析炎性及细胞免疫相关因子与COVID-19感染及COVID-19型ARDS患者病情严重程度的相关性,采用偏回归分析COVID-19型患者ARDS发生的影响因素。结果观察组患者血清IL-6、IL-4、TNF-α、CRP水平[(47.52±6.25)ng/L、(21.53±3.59)ng/L、(1.55±0.36)ng/L、(20.69±3.81)mg/L]明显高于对照组[(15.83±2.67)ng/L、(13.68±2.46)ng/L、(1.27±0.30)ng/L、(12.35±2.67)mg/L],且对照组明显高于健康组[(3.12±0.79)ng/L、(2.76±0.54)ng/L、(0.88±0.25)ng/L、(3.98±1.12)mg/L],差异均有统计学意义(P<0.05);观察组患者的CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平[(59.03±3.03)%、(19.56±1.04)%、(27.81±3.97)%、(22.59±3.40)%]明显低于对照组[(64.42±3.26)%、(28.10±1.91)%、(40.11±4.05)%、(35.31±3.97)%],且对照组明显低于健康组[(70.35±4.18)%、(43.38±3.06)%、(50.88±4.67)%、(40.64±4.06)%],差异均有统计学意义(P<0.05);COVID-19型ARDS重度患者的血清IL-6、IL-4、TNF-α、CRP水平[(66.58±6.10)ng/L、(30.66±5.47)ng/L、(1.92±0.45)ng/L、(28.96±3.70)mg/L]明显高于中度患者[(40.88±4.62)ng/L、(18.35±3.07)ng/L、(1.42±0.33)ng/L、(17.81±2.93)mg/L],而CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平[(52.54±4.07)%、(15.20±1.09)%、(22.13±1.81)%、(18.03±1.46)%]明显低于中度患者[(61.29±3.62)%、(21.08±1.35)%、(29.79±2.02)%、(24.18±2.25)%],差异均有统计学意义(P<0.05);Spearman分析结果显示,IL-6(r=0.675、0.609)、IL-4(r=0.632、0.614)、TNF-α(r=0.585、0.566)、CRP(r=0.619、0.587)水平与COVID-19感染及COVID-19型ARDS患者病情严重程度均呈正相关(P<0.05),CD3^(+)(r=-0.539、-0.505)、CD4^(+)(r=-0.592、-0.554)、CD8^(+)(r=-0.588、-0.570)、NK细胞(r=-0.601、-0.592)水平与COVID-19感染及COVID-19型ARDS患者病情严重程度均呈负相关(P<0.05);偏回归分析结果显示,血清IL-6、IL-4、TNF-α、CRP、CD3^(+)、CD4^(+)、CD8^(+)、NK细胞水平均是COVID-19型患者发生ARDS的危险因素(P<0.05)。结论炎症及细胞免疫相关因子表达在COVID-19型及非COVID-19型ARDS患者中存在差异性,且与COVID-19感染及COVID-19型ARDS病情严重程度均具有一定相关性,可辅助临床识别COVID-19感染,评估病情严重程度。
Objective To investigate the differences in inflammatory response and cellular immunity between patients with corona virus disease-2019(COVID-19)-induced acute respiratory distress syndrome(ARDS)and the non-COVID-19 ARDS patients.Methods A total of 120 patients with COVID-19-induced ARDS admitted to Zheng-zhou First People's Hospital from January 2022 to December 2023 were selected as the observation group(89 moderate cases and 31 severe cases)according to the 1:1 matching principle.Another 120 patients with ARDS caused by other pul-monary pathogens were selected as the control group,and 120 healthy individuals were selected as the healthy group.The serum inflammatory-related factors[interleukin-6(IL-6),interleukin-4(IL-4),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)]and cellular immune-related factors[T cell subsets(CD3^(+),CD4^(+),CD8^(+)),natural killer cells(NK cells)]levels were compared among the three groups of subjects and between patients with different disease severi-ty.Spearman analysis was used to analyze the correlation of inflammatory response cellular immune-related factors CO-VID-19 infection and the severity of COVID-19-induced ARDS patients.Partial regression analysis was used to ana-lyze the influencing factors of ARDS occurrence in COVID-19 patients.Results The levels of IL-6,IL-4,TNF-α,and CRP in the observation group were(47.52±6.25)ng/L,(21.53±3.59)ng/L,(1.55±0.36)ng/L,(20.69±3.81)mg/L,sig-nificantly higher than(15.83±2.67)ng/L,(13.68±2.46)ng/L,(1.27±0.30)ng/L,(12.35±2.67)mg/L in the control group;and the levels in the control group were significantly higher than(3.12±0.79)ng/L,(2.76±0.54)ng/L,(0.88±0.25)ng/L,(3.98±1.12)mg/L in the healthy group;the differences were statistically significant(P<0.05).The levels of CD3^(+),CD4^(+),CD8^(+),and NK cells in the observation group[(59.03±3.03)%,(19.56±1.04)%,(27.81±3.97)%,(22.59±3.40)%]were sig-nificantly lower than those in the control group[(64.42±3.26)%,(28.10±1.91)%,(40.11±4.05)%,(35.31±3.97)%],and the levels in the control group were significantly lower than those in the healthy group[(70.35±4.18)%,(43.38±3.06)%,(50.88±4.67)%,(40.64±4.06)%],with statistically significant differences(P<0.05).The levels of serum IL-6,IL-4,TNF-α,and CRP in severe COVID-19 ARDS patients[(66.58±6.10)ng/L,(30.66±5.47)ng/L,(1.92±0.45)ng/L,(28.96±3.70)mg/L]were significantly higher than those in moderate patients[(40.88±4.62)ng/L,(18.35±3.07)ng/L,(1.42±0.33)ng/L,(17.81±2.93)mg/L],while the levels of CD3^(+),CD4^(+),CD8^(+),and NK cells[(52.54±4.07)%,(15.20±1.09)%,(22.13±1.81)%,(18.03±1.46)%]were significantly lower than those in moderate patients[(61.29±3.62)%,(21.08±1.35)%,(29.79±2.02)%,(24.18±2.25)%],with statistically significant differences(P<0.05).Spearman analysis showed that the levels of IL-6(r=0.675,0.609),IL-4(r=0.632,0.614),TNF-α(r=0.585,0.566),and CRP(r=0.619,0.587)were positively correlated with the severity of COVID-19 infection and the severity of COVID-19 ARDS patients(P<0.05),while the levels of CD3^(+)(r=-0.539,-0.505),CD4^(+)(r=-0.592,-0.554),CD8^(+)(r=-0.588,-0.570),and NK cells(r=-0.601,-0.592)were negatively correlated with COVID-19 infection and the severity of COVID-19 ARDS patients(P<0.05).The partial regression analysis results showed that the levels of serum IL-6,IL-4,TNF-α,CRP,CD3^(+),CD4^(+),CD8^(+),and NK cells were risk factors for the occurrence of ARDS in COVID-19 patients(P<0.05).Conclusion There are differences in the expression of inflammatory and cellular immune-related factors in COVID-19 and non-COV-ID-19 ARDS patients,and they are correlated with both COVID-19 infection and the severity of COVID-19 ARDS,which can assist clinical identification of COVID-19 infection and evaluation of the severity of the disease.
作者
乐婷
刘超
邢孟宣
娄萍
LE Ting;LIU Chao;XING Meng-xuan;LOU Ping(EICU,Zhengzhou First People's Hospital,Zhengzhou 450000,Henan,CHINA;ICU,Zhengzhou First People's Hospital,Zhengzhou 450000,Henan,CHINA)
出处
《海南医学》
CAS
2024年第15期2156-2161,共6页
Hainan Medical Journal
基金
2022年河南省医学科技攻关联合共建项目(编号:LHGJ20220029)。
关键词
新型冠状病毒感染
急性呼吸窘迫综合征
炎症反应
细胞免疫
差异性
相关性
Corona virus disease-2019(COVID-19)
Acute respiratory distress syndrome
Inflammatory re-sponse
Cellular immunity
Difference
Correlation