静注人免疫球蛋白治疗新型冠状病毒肺炎危重症的回顾性分析

The effect of intravenous immunoglobulin on prognosis of critically ill patients with Coronavirus Disease 2019:a retrospective study

目的:探究静脉注射人免疫球蛋白(IVIG)治疗新型冠状病毒肺炎(COVID-19)危重症的疗效。方法:对2020年2月4日至2020年3月17日收住同济医院ICU护理单元并行无创呼吸机(Bipap呼吸机)治疗的COVID-19危重症患者进行回顾性分析。按实际治疗方案分为IVIG治疗组和对照组。使用Kaplan-Meier曲线和log-rank检验对IVIG治疗组和对照组的死亡风险进行评估。校正的风险比(HR)和95%置信区间(CI)则由多变量Cox比例风险回归模型确定,探究IVIG治疗对危重症新冠肺炎患者住院30 d和50 d预后的影响。结果:共纳入111例危重症COVID-19患者,其中IVIG治疗组45例,对照组66例。2组在年龄、性别、既往史、首发症状、肺CT征象以及实验室检查均无明显差异,具有较好的可比性。尽管IVIG治疗组的充血性心力衰竭的发生率高于对照组,但IVIG治疗组能显著改善危重症新冠患者30 d和50 d生存曲线(Log rank P分别为0.029和0.045),且IVIG对新冠危重症的保护效应是独立于其他治疗药物以外的,30 d和50 d住院死亡校正HR及95%CI分别为0.573(0.330-0.984)和0.573(0.334-0.983)。结论:IVIG治疗可明显改善COVID-19危重症的生存率。

OBJECTIVE To explore the effect of intravenous immunoglobulin(IVIG)on prognosis of critically ill-patients with Coronavirus disease 2019(COVID-19).METHODS A retrospective analysis was performed on COVID-19 critically ill patients admitted to the ICU of Tongji Hospital from February 4,2020 to March 17,2020 who were treated with Bipap ventilator.They were divided into IVIG treatment group and control group according to the actual treatment plan.Kaplan-Meier curves and log-rank tests were used to assess the risk of death in both IVIG treatment group and control group.Adjusted hazard ratios(HRs)and 95%confidence intervals(CIs)were determined by multivariable Cox proportional hazards regression models to examine the effect of IVIG treatment on 30-day and 50-day hospital outcomes in critically ill patients with COVID-19.RESULTS A total of 111 critically ill COVID-19 patients were recruitd,including 45 patients in the IVIG treatment group and 66 patients in the control group.There were no significant differences in age,sex,past history,first symptoms,lung CT signs and laboratory tests between the two groups,which means good comparability.Although the incidence of congestive heart failure was higher in the IVIG-treated group than in the control group,the IVIG-treated group significantly improved the 30-day and 50-day survival curves of critically ill patients with COV1 D-19(Log rank P=0.029 and 0.045,respectively),and the protective effect of IVIG on new coronary artery disease was independent of other therapeutic drugs,with adjusted HRs and 95%CIs of 0.573(0.330-0.984)and 0.573(0.334-0.983)for 30-day and 50-day in-hospital mortality,respectively.CONCLUSION IVIG treatment can significantly improve the survival rate of COVID-19 critical illness.