恢复期血浆治疗可降低严重大流行流感 A（H1N1）2009 病毒感染患者的死亡率。
Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection.
机构信息
Infectious Disease Division, Queen Mary Hospital, State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong.
出版信息
Clin Infect Dis. 2011 Feb 15;52(4):447-56. doi: 10.1093/cid/ciq106. Epub 2011 Jan 19.
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 α (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.
背景
治疗西班牙流感和甲型 H5N1 流感患者的经验表明，恢复期血浆疗法可能有益。然而，其在 2009 年甲型 H1N1 大流行流感病毒（H1N1 2009）感染的重症患者中的疗效尚不清楚。
方法
在 2009 年 9 月 1 日至 2010 年 6 月 30 日期间，我们通过招募需要重症监护的重症 H1N1 2009 感染的年龄≥18 岁的患者进行了一项前瞻性队列研究。为患者提供了从 H1N1 2009 感染中康复的患者通过单采术采集的中和抗体滴度≥1：160 的恢复期血浆治疗。将临床结局与拒绝血浆治疗的未治疗对照组进行比较。
结果
共招募了 93 例需要重症监护的重症 H1N1 2009 感染患者。20 例（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。治疗组的死亡率明显低于未治疗组（20.0%比 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 例连续呼吸道病毒载量和细胞因子水平的亚组分析表明，与对照组相比，血浆治疗组在第 3、5 和 7 天的病毒载量明显降低（P<0.05）。治疗组相应的白细胞介素 6、白细胞介素 10 和肿瘤坏死因子-α 的时间水平也较低（P<0.05）。
结论
恢复期血浆治疗重症 H1N1 2009 感染可降低呼吸道病毒载量、血清细胞因子反应和死亡率。
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