COVID-19合并肝功能不全患者输注SARS-CoV-2抗体阳性血浆诱导抗体依赖性增强效应的效果分析

Effect analysis of antibody dependent enhancement effect induced by anti-SARS-CoV-2 antibody positive plasma infusion in patients with COVID-19 complicating liver dysfunction

目的 探讨合并肝功能不全的COVID-19患者输注SARS-CoV-2抗体阳性库存血浆是否诱导抗体依赖性增强(ADE)效应。方法 回顾性分析该院2022年12月15日至2023年1月20日收治的26例输注含SARS-CoV-2多克隆抗体库存血浆的COVID-19合并肝功能不全患者的临床资料,比较分析患者输注血浆前后外周血单核细胞(MONO)计数、白细胞介素(IL)-2、IL-4、IL-6、IL-10、肿瘤坏死因子(TNF)-α、γ-干扰素(IFN-γ)等细胞因子水平变化。以同期37例未输注血浆的患者为对照组,比较两组患者治疗第5天外周血MONO计数、细胞因子水平、咽拭子SARS-CoV-2核酸检测、肺部感染病灶吸收等情况。结果 观察组与对照组治疗第5天外周血MONO计数升高者比例(69.23%vs. 59.56%)、细胞因子升高者比例(IL-2:66.67%vs. 76.92%、IL-4:22.22%vs. 46.15%、IL-6:33.33%vs. 38.46%、IL-10:33.33%vs. 30.27%、TNF-α:33.33%vs. 46.15%、IFN-γ:44.44%vs. 61.54%)、咽拭子SARS-CoV-2核酸检测阴性者比例(46.67%vs. 59.09%)、病灶开始吸收者比例(87.50%vs. 84.85%)比较,差异均无统计学意义(P>0.05)。结论 COVID-19合并肝功能不全患者输注含SARS-CoV-2多克隆抗体的库存血浆未诱导明显的ADE效应。

Objective To investigate whether or not the infusion of anti-SARS-CoV-2 antibody-positive stock plasma inducing the antibody-dependent enhancement(ADE)effect in the patients with COVID-19 complicating liver dysfunction.Methods The clinical data of 26 patients with COVID-19 complicating liver dysfunction infused with SARS-CoV-2 antibody-positive stock plasma in this hospital from December 15,2022 to January 20,2023 were analyzed retrospectively.The changes of peripheral blood mononuclear cells(MONO)count and cytokines IL-2,IL-4,IL-6,IL-10,TNF-αand IFN-γlevels were compared and analyzed before and after plasma infusion.Thirty-seven patients with COVID-19 without plasma infusion during the same period served as the control group.The situation such as peripheral blood MONO count,cytokines levels,throat swab SARS-CoV-2 nucleic acid test,pulmonary infection lesion absorption on 5 d of treatment were compared between the two groups.Results The proportions of peripheral blood MONO count increase in the observation group and control group were 69.23%and 59.56%respectively,the proportions of cytokines increase were 66.67%vs.76.92%for IL-2,22.22%vs.46.15%for IL-4,33.33%vs.38.46%for IL-6,33.33%vs.30.27%for IL-10,33.33%vs.46.15%for TNF-αand 44.44%vs.61.54%for IFN-γ,the throat swab SARS-CoV-2 nucleic acid detection negative ratio was 46.67%vs.59.09%.The proportion of the patients with lesion absorption beginning was 87.50%vs.84.85%,and the differences were not statistically significant(P>0.05).Conclusion Infusion of stock plasma containing anti-SARS-CoV-2 polyclonal antibodies in the patients with COVID-19 complicating liver dysfunction does not induce significant ADE.