新型冠状病毒肺炎重症患者的细胞免疫功能特征及其预后评估价值的队列研究

Clinical and prognostic value of cellular immune function in severe patients with coronavirus disease 2019(COVID-19):A cohort study

目的探讨细胞免疫功能对新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症确诊患者的临床及预后评估价值。方法采用队列研究的方法,收集武汉大学人民医院东院收治的119例重症患者的临床资料,其中男60例(50.4%)、女59例(49.6%),平均年龄(60.9±14.2)岁。以在院死亡为随访的主要终点,入院后30 d内疾病转归评估分型为随访的次要终点,分析细胞免疫功能与COVID-19临床及预后的相关性。结果22例患者死亡,47例随访期内评估为重/危重型。生存组与死亡组主要终点事件中CD3^+、CD4^+、CD8^+、CD19^+计数的差异有统计学意义(均P<0.05),普通组和重/危重症组次要终点事件中CD3^+、CD4^+、CD8^+、CD19^+计数的差异有统计学意义(均P<0.05)。受试者工作特征(ROC)曲线结果显示,死亡患者和重/危重症患者细胞免疫功能ROC曲线下面积均有良好的预测价值(均P<0.05)。结论细胞免疫功能对COVID-19具有良好的临床及预后评估价值。

Objective To investigate the characteristics and prognostic value of cellular immune function in severe patients with coronavirus disease 2019(COVID-19).Methods A cohort study was conducted to collect the clinical data of 119 severe patients admitted to the Renmin Hospital of Wuhan University(Eastern District)including 60 males(50.4%)and 59 females(49.6%),with an average age of 60.9±14.2 years.The primary endpoint of follow-up was death in the hospital,and the disease outcome classification was the secondary endpoint of follow-up within 30 days after admission.We analyzed the correlation between cellular immune function and COVID-19 prognosis.Results A total of22 patients died during this process,and 47 patients were severe/critical during the follow-up period.The counts of CD3^+,CD4^+,CD8^+,and CD19^+in the primary endpoint events were significantly different between the survival group and the death group(all P<0.05).The counts of CD3^+,CD4^+,CD8^+,CD19^+in the secondary endpoint events were significantly different between the normal group and the severe/critical group(all P<0.05).The results of the receiver operating characteristic(ROC)curve showed that the area under the cellular immune function curve of dead patients and severe/critical patients had good predictive value(all P<0.05).Conclusion Cell immune function has good clinical and prognostic value for COVID-19.