Clinical and immunological features of severe and moderate coronavirus disease 2019
Clinical and immunological features of severe and moderate coronavirus disease 2019
复制标题
DOI：
10.1172/jci137244
复制
发表时间：
2020-05-01
影响因子：
15.9
通讯作者：
Ning, Qin
中科院分区：
文献类型：
--
作者：
Chen, Guang;Wu, Di;Ning, Qin
背景自2019年12月以来，由严重急性呼吸道综合征冠状病毒2型（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）在武汉爆发，目前正在成为全球威胁。我们旨在描述和比较重度和中度COVID-19的免疫学特征。在这项回顾性研究中，分析了21例COVID-19患者（17例男性和4例女性）的临床和免疫学特征。根据中国国家卫生委员会发布的指南，这些患者被分类为重度（11例）和中度（10例）。重度和中度病例的中位年龄分别为61.0岁和52.0岁。常见临床表现为发热、咳嗽、乏力。与中度病例相比，重度病例更常见呼吸困难、淋巴细胞减少和低白蛋白血症，丙氨酸氨基转移酶、乳酸脱氢酶、C反应蛋白、铁蛋白和D-二聚体水平较高，IL-2 R、IL-6、IL-10和TNF-α水平显著较高。几乎所有患者的T淋巴细胞、CD 4（+）T细胞和CD 8（+）T细胞绝对数均降低，重度病例（分别为294.0、177.5和89.0 x 10（6）/L）明显低于中度病例（分别为640.5、381.5和254.0 x 10（6）/L）。重症患者CD 4（+）T细胞IFN-γ表达率（14.1%）低于中度患者（22.8%）。SARS-CoV-2感染可能主要影响T淋巴细胞，特别是CD 4（+）和CD 8（+）T细胞，导致数量减少以及CD 4（+）T细胞产生IFN-γ。这些潜在的免疫学标志物可能很重要，因为它们与COVID-19的疾病严重程度相关。
BACKGROUND. Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, and is now becoming a global threat. We aimed to delineate and compare the immunological features of severe and moderate COVID-19.METHODS. In this retrospective study, the clinical and immunological characteristics of 21 patients (17 male and 4 female) with COVID-19 were analyzed. These patients were classified as severe (11 cases) and moderate (10 cases) according to the guidelines released by the National Health Commission of China.RESULTS. The median age of severe and moderate cases was 61.0 and 52.0 years, respectively. Common clinical manifestations included fever, cough, and fatigue. Compared with moderate cases, severe cases more frequently had dyspnea, lymphopenia, and hypoalbuminemia, with higher levels of alanine aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin, and D-dimer as well as markedly higher levels of IL-2R, IL-6, IL-10, and TNF-alpha. Absolute numbers of T lymphocytes, CD4(+) T cells, and CD8(+) T cells decreased in nearly all the patients, and were markedly lower in severe cases (294.0, 177.5, and 89.0 x 10(6)/L, respectively) than moderate cases (640.5, 381.5, and 254.0 x 10(6)/L, respectively). The expression of IFN-gamma by CD4(+) T cells tended to be lower in severe cases (14.1%) than in moderate cases (22.8%).CONCLUSION. The SARS-CoV-2 infection may affect primarily T lymphocytes, particularly CD4(+) and CD8(+) T cells, resulting in a decrease in numbers as well as IFN-gamma production by CD4(+) T cells. These potential immunological markers may be of importance because of their correlation with disease severity in COVID-19.