Characterization of the inflammatory response to COVID-19 illness in pregnancy.
Characterization of the inflammatory response to COVID-19 illness in pregnancy.
复制标题
妊娠期 COVID-19 疾病炎症反应的特征。
DOI：
10.1016/j.cyto.2023.156319
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发表时间：
2023
期刊：
影响因子：
3.8
通讯作者：
Dude,CarolynnM
中科院分区：
文献类型：
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作者：
Forrest,AlexandraD;Poliektov,NatalieE;Easley,KirkA;Michopoulos,Vasiliki;Ravi,Meghna;Cheedarla,Narayanaiah;Neish,AndrewS;Cheedarla,Suneetha;Roback,JohnD;Dunlop,AnneL;Badell,MartinaL;Dude,CarolynnM
怀孕患者面临的COVID-19相关疾病的发病率和死亡率高于非怀孕患者。先前在非妊娠患者中的研究确定，入住ICU的SARS-CoV-2阳性患者的不良临床结局与促炎标志物白细胞介素（IL）-1β、IL-6、IL-8和IL-10的显著增加相关。重要的是，高水平的这些炎症标志物也与不良妊娠结局相关，包括自发性早产、先兆子痫和严重呼吸道疾病。研究设计这是一项回顾性队列研究，比较了急性/急性后SARS-CoV-2感染的妊娠患者与既往暴露的患者的血清炎症细胞因子谱。两个队列中的所有受试者的SARS-CoV-2抗体检测均为阳性;然而，急性/急性后感染队列中的受试者在血清样本采集后30天内记录了SARS-CoV-2逆转录聚合酶链反应（RT-PCR）阳性结果。在妊娠13至39周的产前静脉穿刺期间获取血清样本，并按胎龄匹配队列。炎性细胞因子干扰素（IFN）-γ、IL-10、IL-1β、IL-4、IL-6、IL-8、和肿瘤坏死因子（TNF）-α从母体血清使用标准ELISA测定和中位数细胞因子浓度进行比较使用Mann-Whitney检验。19名在格鲁吉亚亚特兰大市格雷迪纪念医院接受产前护理的感染者。急性/急性后感染患者（n = 22）的SARS-CoV-2抗体、IL-10、IL-1β和IL-8浓度显著较高，而既往暴露患者（n = 28）的IL-4浓度显著较高。医学合并症无显著组间差异。急性/急性后SARS-CoV-2感染的孕妇血清促炎细胞因子浓度显著高于既往暴露的孕妇，这表明与非妊娠人群一样，SARS-CoV-2感染改变了妊娠期间循环促炎标志物的水平。细胞因子水平的增加可能导致COVID-19疾病中观察到的不良产科结局。
ObjectivePregnant patients face greater morbidity and mortality from COVID-19 related illness than their non-pregnant peers. Previous research in non-pregnant patients established that poor clinical outcomes in SARS-CoV-2 positive patients admitted to the ICU were correlated with a significant increase in the proinflammatory markers interleukin (IL)-1β, IL-6, IL-8, and IL-10. Importantly, high levels of these inflammatory markers have also been associated with adverse pregnancy outcomes, including spontaneous preterm birth, preeclampsia, and severe respiratory disease.Study DesignThis was a retrospective cohort study that compared the serum inflammatory cytokine profiles of pregnant patients with acute/post-acute SARS-CoV-2 infection to those with previous exposure. All subjects in both cohorts tested positive for SARS-CoV-2 antibodies; however, those in the acute/post-acute infection cohort had a documented positive SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) result within 30 days of serum sample collection. Serum samples were obtained during prenatal venipuncture from 13 to 39 weeks’ gestation and the cohorts were matched by gestational age. The inflammatory cytokines interferon (IFN)-γ, IL-10, IL-1β, IL-4, IL-6, IL-8, and tumor necrosis factor (TNF)-α were assayed from maternal serum using a standard ELISA assay and median cytokine concentrations were compared using the Mann-Whitney test.Results and DiscussionWe enrolled 50 non-Hispanic Black patients with confirmed COVID-19 infection who received prenatal care at Grady Memorial Hospital in Atlanta, Georgia. Those with acute/post-acute infection (n = 22) had significantly higher concentrations of SARS-CoV-2 antibody, IL-10, IL-1β, and IL-8, while patients with previous exposure (n = 28) had significantly higher concentrations of IL-4. There were no significant inter-group differences in medical comorbidities. Pregnant patients with acute/post-acute SARS-CoV-2 infection had significantly higher serum concentrations of pro-inflammatory cytokines as compared to those with previous exposure, suggesting that, like in the non-pregnant population, SARS-CoV-2 infection alters the levels of circulating proinflammatory markers during pregnancy. The increased levels of cytokines may contribute to the adverse obstetric outcomes observed with COVID-19 illness.