Convalescent Plasma Treatment Reduced Mortality in Patients With Severe Pandemic Influenza A (H1N1) 2009 Virus Infection
Convalescent Plasma Treatment Reduced Mortality in Patients With Severe Pandemic Influenza A (H1N1) 2009 Virus Infection
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DOI：
10.1093/cid/ciq106
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发表时间：
2011-02-01
影响因子：
11.8
通讯作者：
Yuen, Kwok-Yung
中科院分区：
文献类型：
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作者：
Hung, Ivan F. N.;To, Kelvin K. W.;Yuen, Kwok-Yung
背景西班牙流感和甲型H5 N1流感患者的治疗经验表明，恢复期血浆治疗可能是有益的。然而，其在严重甲型H1N1流感病毒（H1N1 2009）感染患者中的疗效仍不清楚。在2009年9月1日至2010年6月30日期间，我们进行了一项前瞻性队列研究，招募了年龄≥ 18岁的2009年H1N1严重感染需要重症监护的患者。向患者提供中和抗体滴度>= 1：160的恢复期血浆治疗，该血浆通过单采术从2009年H1N1感染恢复的患者中获得。并与未接受血浆治疗的患者进行比较。招募了93名患有严重H1N1 2009感染并需要重症监护的患者。20例患者（21.5%）接受了血浆治疗。治疗组和对照组在年龄、性别和疾病严重程度评分方面相匹配。治疗组的死亡率显著低于非治疗组（20.0% vs 54.8%; P = 0.01）。多变量分析显示，血浆治疗降低了死亡率（比值比[OR]，0.20; 95%置信区间[CI]，0.06 - 0.69; P = 0.011），而急性肾衰竭并发症与死亡独立相关（OR，3.79; 95% CI，1.15-12.4; P = 0.028）。对44例具有连续呼吸道病毒载量和细胞因子水平的患者进行的亚组分析表明，与对照组相比，血浆治疗与显著降低的第3、5和7天病毒载量相关（P <0.05）。治疗组相应时间的白细胞介素6、白细胞介素10和肿瘤坏死因子α水平也较低（P <0.05）。用恢复期血浆治疗2009年严重H1N1感染可降低呼吸道病毒载量、血清细胞因子反应和死亡率。
Background. Experience from treating patients with Spanish influenza and influenza A(H5N1) suggested that convalescent plasma therapy might be beneficial. However, its efficacy in patients with severe pandemic influenza A(H1N1) 2009 virus (H1N1 2009) infection remained unknown.Methods. During the period from 1 September 2009 through 30 June 2010, we conducted a prospective cohort study by recruiting patients aged >= 18 years with severe H1N1 2009 infection requiring intensive care. Patients were offered treatment with convalescent plasma with a neutralizing antibody titer of >= 1:160, harvested by apheresis from patients recovering from H1N1 2009 infection. Clinical outcome was compared with that of patients who declined plasma treatment as the untreated controls.Results. Ninety-three patients with severe H1N1 2009 infection requiring intensive care were recruited. Twenty patients (21.5%) received plasma treatment. The treatment and control groups were matched by age, sex, and disease severity scores. Mortality in the treatment group was significantly lower than in the nontreatment group (20.0% vs 54.8%; P = .01). Multivariate analysis showed that plasma treatment reduced mortality (odds ratio [OR], .20; 95% confidence interval [CI], .06-.69; P = .011), whereas complication of acute renal failure was independently associated with death (OR, 3.79; 95% CI, 1.15-12.4; P = .028). Subgroup analysis of 44 patients with serial respiratory tract viral load and cytokine level demonstrated that plasma treatment was associated with significantly lower day 3, 5, and 7 viral load, compared with the control group (P < .05). The corresponding temporal levels of interleukin 6, interleukin 10, and tumor necrosis factor alpha (P < .05) were also lower in the treatment group.Conclusions. Treatment of severe H1N1 2009 infection with convalescent plasma reduced respiratory tract viral load, serum cytokine response, and mortality.