15例新型冠状病毒感染患者免疫状态分析及胸腺肽制剂的应用

Rational application of thymus peptide preparation based on immune state of patients with new coronavirus infection

目的探讨新型冠状病毒感染患者免疫状态,分析胸腺肽制剂使用人群及时机。方法对确诊为新冠肺炎的15例患者临床资料进行回顾性分析。结果15例新冠肺炎患者中有5例出现白细胞计数、淋巴细胞百分比和绝对计数降低,其中2例危重型和1例重型患者下降明显;有2例白细胞计数升高(考虑合并细菌感染);15例新冠肺炎患者中有10例患者总T淋巴细胞计数降低,有1例总淋巴细胞计数升高,4例为正常;15例新冠肺炎患者中有10例患者CD4+淋巴细胞计数降低,有1例患者CD4细胞计数升高,4例在正常范围内;有10例CD8+淋巴细胞计数正常范围内,有5例患者CD8+淋巴细胞计数降低;15例新冠肺炎患者中有5例患者CD4/CD8比值降低,有2例患者CD4/CD8比值升高;有2例患者NK淋巴细胞亚群比例下降,有2例患者B淋巴细胞亚群比例下降,变化与T淋巴细胞群一致。15例新冠患者中有8例患者使用了胸腺肽a1皮下注射,包括免疫激活状态者,其中1例出现皮疹、瘙痒后停用。结论不同患者免疫状态不一样,疾病不同的阶段免疫状态也不一样,应结合患者不同免疫状态和疾病不同阶段选择适宜人群和适宜的时机酌情使用免疫增强剂。

Objective To investigate the immune response of patients with new coronary viral infection and analyze the indications and population for the use of thymus peptide preparations.Methods A retrospective analysis was carried out on the clinical data of 15 patients diagnosed with new coronary pneumonia.Results Of the 15 patients,white blood cell count,lymphocyte percentage and absolute count were decreased in 5 cases.Of the 5 patients,the decrease was significant in 2 critical and 1 severe patients while there were 2 cases with high level of white blood cells(considering a combined bacterial infection).There were 10 patients with lower total lymphocyte count,1 case with higher total lymphocyte count and 4 cases with normal total lymphocyte count.There were 10 patients with lower CD4+lymphocyte count,1 case with higher CD4+cell count and 4 cases with normal range.There were 10 patients with normal CD8+lymphocyte count and 5 patients with reduced CD8-lymphocyte count.There were 5 patients with lower ratio of CD4/CD8 and 3 patients with higher ratio.There were 3 patients with lower ratio of NK lymphocyte subgroups and 1 case with lower proportion of B lymphocytes,which were consistent with the T lymphocyte population.Of the 15 patients,8 patients including immuno-activated patients were subcutaneously injected with thymosin a1,in whom 1 case was decommissioned after rash and itching.Conclusion The immune state of patients infected with the new coronavirus is different:immunosuppression and hyper-immune.Therefore,thymosin should be selected according to different immune status of patients.