Zhagn Sheng, Li Danping, Chen Huazhong, Zheng Dan, Zhou Yiping, Chen Baoguo, Shi Weiwu, Lin Ronghai
Department of Critical Care Medicine, Taizhou Hospital of Zhejiang University, Taizhou 317000, Zhejiang Province, China.
Department of Science and Education, Taizhou Hospital of Zhejiang University, Taizhou 317000, Zhejiang Province, China.
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020 May 25;49(2):220-226. doi: 10.3785/j.issn.1008-9292.2020.03.10.
To investigate the effect of corticosteroids therapy on the inflammatory response in a critically ill coronavirus disease 2019 (COVID-19) patient.
A 55-year old female patient with critical ill COVID-19 was admitted in Taizhou Hospital on January 19, 2020. The patient was treated with methylprednisolone 80 mg on the 2nd day after admission. Thereafter, the dose was adjusted in a timely manner and the therapy lasted for 13 days. The peripheral lymphocyte subsets (CD3T, CD4 T, CD8 T, NK cells, B cells), as well as serum levels of lymphocyte factors (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ) were dynamically monitored.
On D1 of admission, the numbers of peripheral blood CD3 T, CD4 T, CD8 T, and NK cells were significantly lower than the normal range. With the improvement of the disease, the numbers of CD3 T, CD8 T and CD4 T cells gradually recovered and showed a linear growth trend (linear fitting equation: =18.59+109.4, <0.05). On D2 of admission, the patient's IL-6 and IL-10 levels were significantly higher than normal values, IFN-γ was at a normal high value, and then rapidly decreased; IL-2, IL-4, and TNF-α were all in the normal range. On the D6 and D7, the IL-6 and IL-10 decreased to the normal range for the first time. On the D18, the sputum virus nucleic acid test was negative for the first time, and the fecal virus nucleic acid test was still positive; on the D20 the sputum and fecal virus nucleic acid test were both negative. On D34, the patient recovered and was discharged. At the discharge the muscle strength score of the patient was 44 and the daily life ability evaluation was 90.
In the absence of effective antiviral drugs, early use of appropriate doses of corticosteroids in critically ill patient with COVID-19 can quickly alleviate inflammatory response and improve clinical symptoms, however, it may reduce the number of T cells, and to adjust the dose in time is necessary.
探讨皮质类固醇治疗对危重型新型冠状病毒肺炎（COVID-19）患者炎症反应的影响。
2020年1月19日，一名55岁的危重型COVID-19女性患者入住台州医院。患者入院后第2天接受80mg甲泼尼龙治疗。此后，剂量及时调整，治疗持续13天。动态监测外周血淋巴细胞亚群（CD3T、CD4 T、CD8 T、NK细胞、B细胞）以及淋巴细胞因子（IL-2、IL-4、IL-6、IL-10、TNF-α、IFN-γ）的血清水平。
入院第1天，外周血CD3 T、CD4 T、CD8 T和NK细胞数量显著低于正常范围。随着病情好转，CD3 T、CD8 T和CD4 T细胞数量逐渐恢复并呈线性增长趋势（线性拟合方程：=18.59+109.4，<0.05）。入院第2天，患者IL-6和IL-10水平显著高于正常值，IFN-γ处于正常高值，随后迅速下降；IL-2、IL-4和TNF-α均在正常范围内。在第6天和第7天，IL-6和IL-10首次降至正常范围。在第18天，痰病毒核酸检测首次转阴，粪便病毒核酸检测仍为阳性；在第20天，痰和粪便病毒核酸检测均为阴性。在第34天，患者康复出院。出院时患者肌力评分为44分，日常生活能力评分为90分。
在缺乏有效抗病毒药物的情况下，危重型COVID-19患者早期使用适当剂量的皮质类固醇可迅速减轻炎症反应并改善临床症状，然而，这可能会减少T细胞数量，因此及时调整剂量是必要的。
