Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China
Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China
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DOI：
10.1093/cid/ciaa248
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发表时间：
2020-08-01
影响因子：
11.8
通讯作者：
Tian, Dai-Shi
中科院分区：
文献类型：
--
作者：
Qin, Chuan;Zhou, Luoqi;Tian, Dai-Shi
背景资料。2019年12月，冠状病毒2019(新冠肺炎)在武汉出现，并在中国迅速传播。收集同济医院2020年1月10日至2月12日收治的所有新冠肺炎确诊病例的人口学和临床资料进行统计分析。对重症和非重症感染患者的外周血淋巴细胞亚群等实验室检查结果进行分析比较。在招募的452名新冠肺炎患者中，286人被诊断为严重感染。中位年龄为58岁，其中男性235人。最常见的症状是发热、呼吸急促、咳痰、乏力、干咳和肌肉痛。严重者往往淋巴细胞计数较低，白细胞计数和中性粒细胞/淋巴细胞比率(NLR)较高，单核细胞、嗜酸性粒细胞和嗜碱性粒细胞百分比较低。大多数重症患者感染相关生物标志物和炎性细胞因子水平升高。T细胞数量明显减少，且病情严重时受损程度更大。新冠肺炎患者辅助性T细胞(Th)和抑制性T细胞均低于正常水平，重症组Th细胞水平较低。重症组幼稚Th细胞百分率升高，记忆性Th细胞百分率下降。新冠肺炎患者外周血中调节性T细胞水平也较低，病情严重时下降更为明显。新型冠状病毒可能主要作用于淋巴细胞，尤其是T淋巴细胞。监测中性粒细胞受体和淋巴细胞亚群有助于新冠肺炎危重疾病的早期筛查、诊断和治疗。
Background. In December 2019, coronavirus 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China.Methods. Demographic and clinical data of all confirmed cases with COVID-19 on admission at Tongji Hospital from 10 January to 12 February 2020 were collected and analyzed. The data on laboratory examinations, including peripheral lymphocyte subsets, were analyzed and compared between patients with severe and nonsevere infection.Results. Of the 452 patients with COVID-19 recruited, 286 were diagnosed as having severe infection. The median age was 58 years and 235 were male. The most common symptoms were fever, shortness of breath, expectoration, fatigue, dry cough, and myalgia. Severe cases tend to have lower lymphocyte counts, higher leukocyte counts and neutrophil-lymphocyte ratio (NLR), as well as lower percentages of monocytes, eosinophils, and basophils. Most severe cases demonstrated elevated levels of infection-related biomarkers and inflammatory cytokines. The number of T cells significantly decreased, and were more impaired in severe cases. Both helper T (Th) cells and suppressor T cells in patients with COVID-19 were below normal levels, with lower levels of Th cells in the severe group. The percentage of naive Th cells increased and memory Th cells decreased in severe cases. Patients with COVID-19 also have lower levels of regulatory T cells, which are more obviously decreased in severe cases.Conclusions. The novel coronavirus might mainly act on lymphocytes, especially T lymphocytes. Surveillance of NLR and lymphocyte subsets is helpful in the early screening of critical illness, diagnosis, and treatment of COVID-19.