Distinct effects of asthma and COPD comorbidity on disease expression and outcome in patients with COVID-19
Distinct effects of asthma and COPD comorbidity on disease expression and outcome in patients with COVID-19
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哮喘和慢性阻塞性肺病合并症对 COVID-19 患者疾病表达和结果的独特影响
DOI：
10.1111/all.14517
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发表时间：
2020-08-11
期刊：
影响因子：
12.4
通讯作者：
Liu, Zheng
中科院分区：
文献类型：
--
作者：
Song, Jia;Zeng, Ming;Liu, Zheng
背景慢性呼吸道疾病对冠状病毒病2019年(新冠肺炎)的影响尚不清楚。目的探讨哮喘合并慢性阻塞性肺疾病(COPD)对新冠肺炎患者疾病表现和预后的影响及其可能的机制。方法对961例临床转归明确(死亡或出院)的新冠肺炎患者进行回顾性研究。从病历中提取人口统计学和临床信息。应用免疫组织化学方法检测肺癌患者肺组织中血管紧张素转换酶II(ACE2)的表达。用多种细胞因子刺激BEAS-2B细胞。结果在该队列中，21例(2.2%)患有COPD，22例(2.3%)患有哮喘。调整混杂因素后，慢性阻塞性肺病患者发生严重疾病(OR：23.433；95%CI 1.525~360.135；P<；267.369)和急性呼吸窘迫综合征(OR：19.762；95%CI 1.461~267.369；P=0.025)的风险高于哮喘患者。与哮喘组比较，慢性阻塞性肺疾病患者，尤其是重症新冠肺炎患者外周血中CD_4~+、CD_8~(+)T细胞和B细胞计数明显降低，而肿瘤坏死因子-α、IL-2受体、IL-10、IL-8和IL-6水平显著升高。与无哮喘和COPD的对照组相比，COPD患者下呼吸道ACE2蛋白表达增加，而哮喘组下呼吸道ACE2蛋白表达减少。IL-4和IL-13下调BEAS-2B细胞中ACE2的表达，而TNF-α、IL-12和IL-17A上调ACE2的表达。结论哮喘和慢性阻塞性肺疾病患者发生严重新冠肺炎的危险性不同，可能与血管紧张素转换酶2表达不同有关。
Background The impacts of chronic airway diseases on coronavirus disease 2019 (COVID-19) are far from understood. Objective To explore the influence of asthma and chronic obstructive pulmonary disease (COPD) comorbidity on disease expression and outcomes, and the potential underlying mechanisms in COVID-19 patients. Methods A total of 961 hospitalized COVID-19 patients with a definite clinical outcome (death or discharge) were retrospectively enrolled. Demographic and clinical information were extracted from the medical records. Lung tissue sections from patients suffering from lung cancer were used for immunohistochemistry study of angiotensin-converting enzyme II (ACE2) expression. BEAS-2B cell line was stimulated with various cytokines. Results In this cohort, 21 subjects (2.2%) had COPD and 22 (2.3%) had asthma. After adjusting for confounding factors, COPD patients had higher risk of developing severe illness (OR: 23.433; 95% CI 1.525-360.135;P < .01) and acute respiratory distress syndrome (OR: 19.762; 95% CI 1.461-267.369;P = .025) than asthmatics. COPD patients, particularly those with severe COVID-19, had lower counts of CD4(+)T and CD8(+)T cells and B cells and higher levels of TNF-alpha, IL-2 receptor, IL-10, IL-8, and IL-6 than asthmatics. COPD patients had increased, whereas asthmatics had decreased ACE2 protein expression in lower airways, compared with that in control subjects without asthma and COPD. IL-4 and IL-13 downregulated, but TNF-alpha, IL-12, and IL-17A upregulated ACE2 expression in BEAS-2B cells. Conclusion Patients with asthma and COPD likely have different risk of severe COVID-19, which may be associated with different ACE2 expression.