细胞因子在评估新型冠状病毒肺炎患者疾病严重程度及预后中的价值

Values of cytokines in evaluating the severity and prognosis of patients with coronavirus disease 2019

目的研究细胞因子在评估新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者疾病严重程度及预后中的价值。方法回顾性分析武汉市雷神山医院205例COVID-19患者资料,根据疾病严重程度分为普通型组(n=117)、重型组(n=69)和危重型组(n=19)。收集患者的基本情况和细胞因子相关参数,比较3组间差异并分析其在评估COVID-19患者疾病严重程度及预后中的价值。结果3组患者的年龄、新型冠状病毒核酸检测结果、白细胞介素(interleukin,IL)-6、IL-10、IL-2受体、IL-8、肿瘤坏死因子-α差异有统计学意义(P<0.05)。相关性分析显示,年龄、新型冠状病毒核酸检测结果持续20 d阳性、IL-6水平、IL-10水平、IL-2受体水平、IL-8水平、肿瘤坏死因子-α水平与COVID-19分型具有相关性(相关系数r s分别为0.354、0.187、0.366、0.327、0.329、0.273、0.157,P<0.05)。死亡COVID-19患者的IL-6、IL-10、IL-2受体、IL-8、肿瘤坏死因子-α水平高于存活患者(P<0.05)。多因素分析显示,年龄[比值比(odds ratio,OR)=1.034,95%置信区间(confidence interval,CI)(1.006,1.063),P=0.016]、IL-6水平[OR=1.030,95%CI(1.006,1.055),P=0.015]、IL-10水平[OR=1.088,95%CI(1.003,1.179),P=0.042]和IL-2受体水平[OR=1.003,95%CI(1.001,1.005),P=0.001]是普通型COVID-19患者转成重型/危重型的独立风险因素。结论COVID-19患者体内的细胞因子水平与疾病的严重程度及预后密切相关。

Objective To investigate the values of cytokines in evaluating the severity and prognosis of patients with coronavirus disease 2019(COVID-19). Methods A total of 205 COVID-19 patients in Wuhan Leishenshan Hospital were retrospectively analyzed. According to the severity of the disease, patients were divided into common group(n=117), severe group(n=69) and critical group(n=19). The patients’ basic condition and cytokine related parameters were collected, the differences between the three groups were compared and their values in assessing the severity and prognosis of COVID-19 patients were analyzed. Results There were statistically significant differences in the age,severe acute respiratory syndrome coronavirus 2 nucleic acid test results, interleukin(IL)-6, IL-10, IL-2 receptor, IL-8, and tumor necrosis factor-α among the three groups of patients(P<0.05). Correlation analysis showed that the age, severe acute respiratory syndrome coronavirus 2 nucleic acid test continued to be positive for 20 days, IL-6 level, IL-10 level, IL-2 receptors level, IL-8 level and tumor necrosis factor-α level were related to the classification of COVID-19. The correlation coefficient r s was 0.354, 0.187, 0.366, 0.327, 0.329, 0.273 and 0.157, respectively(P<0.05). The levels of IL-6, IL-10, IL-2 receptor, IL-8, and tumor necrosis factor-α in dead patients with COVID-19 were higher than those in surviving patients(P<0.05). Multivariate analysis showed that age [odds ratio(OR)=1.034, 95% confidence interval(CI)(1.006,1.063), P=0.016], IL-6 level [OR=1.030, 95%CI(1.006, 1.055), P=0.015], IL-10 level [OR=1.088, 95%CI(1.003, 1.179),P=0.042] and IL-2 receptor level [OR=1.003, 95%CI(1.001, 1.005), P=0.001] were independent risk factors for common COVID-19 to become severe or critical. Conclusion The levels of cytokines in COVID-19 patients are closely related to the severity and prognosis of the disease.