6例接受血浆置换或托珠单抗治疗的重症新型冠状病毒肺炎患者的临床观察
[Clinical observation of 6 severe COVID-19 patients treated with plasma exchange or tocilizumab].
作者信息
Luo Song, Yang Lijuan, Wang Chun, Liu Chuanmiao, Li Dianming
机构信息
Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China.
Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China.
出版信息
Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020 May 25;49(2):227-231. doi: 10.3785/j.issn.1008-9292.2020.03.06.
Abstract
OBJECTIVE
To observe the clinical effect of plasma exchange and tocilizumab in treatment of patients with severe coronavirus disease 2019 (COVID-19).
METHODS
Six patients with severe COVID-19 admitted in First Affiliated Hospital of Bengbu Medical College from January 25 to February 25, 2020. Three patients were treated with plasma exchange and three patients were treated with tocilizumab. The effect on excessive inflammatory reaction of plasma exchange and tocilizumab was observed.
RESULTS
The C-reactive protein (CRP) and IL-6 levels were significantly decreased and the lymphocyte and prothrombin time were improved in 3 patients after treatment with plasma exchange; while inflammation level was not significantly decreased, and lymphocyte and prothrombin time did not improve in 3 patients treated with tocilizumab.
CONCLUSIONS
For severe COVID-19 patients with strong inflammatory reaction, plasma exchange may be preferred.
摘要
目的
观察血浆置换及托珠单抗治疗新型冠状病毒肺炎（COVID-19）重型患者的临床效果。
方法
选取2020年1月25日至2月25日蚌埠医学院第一附属医院收治的6例COVID-19重型患者，其中3例采用血浆置换治疗，3例采用托珠单抗治疗，观察血浆置换和托珠单抗对过度炎症反应的影响。
结果
血浆置换治疗的3例患者治疗后C反应蛋白（CRP）及白细胞介素-6（IL-6）水平显著降低，淋巴细胞及凝血酶原时间改善；而托珠单抗治疗的3例患者炎症水平未显著降低，淋巴细胞及凝血酶原时间未改善。
结论
对于炎症反应强烈的COVID-19重型患者，血浆置换可能为首选治疗方法。
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本文引用的文献
1
Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study.中国武汉 99 例 2019 年新型冠状病毒肺炎患者的流行病学和临床特征：描述性研究。
Lancet. 2020 Feb 15;395(10223):507-513. doi: 10.1016/S0140-6736(20)30211-7. Epub 2020 Jan 30.
2
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.中国武汉地区 2019 年新型冠状病毒感染患者的临床特征。
Lancet. 2020 Feb 15;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5. Epub 2020 Jan 24.
3
Pre-treatment interleukin-6 levels strongly affect bone erosion progression and repair detected by magnetic resonance imaging in rheumatoid arthritis patients.治疗前白细胞介素-6 水平强烈影响类风湿关节炎患者的磁共振成像检测到的骨侵蚀进展和修复。
Rheumatology (Oxford). 2017 Jul 1;56(7):1089-1094. doi: 10.1093/rheumatology/kex046.
4
Efficacy of biological disease-modifying antirheumatic drugs: a systematic literature review informing the 2016 update of the EULAR recommendations for the management of rheumatoid arthritis.生物制剂改善病情抗风湿药的疗效：系统文献回顾为 2016 年更新 EULAR 类风湿关节炎管理建议提供依据。
Ann Rheum Dis. 2017 Jun;76(6):1113-1136. doi: 10.1136/annrheumdis-2016-210713. Epub 2017 Mar 10.
5
Endotoxin adsorbents in extracorporeal blood purification: do they fulfill expectations?体外血液净化中的内毒素吸附剂：它们是否符合预期？
Int J Artif Organs. 2014 Mar;37(3):222-32. doi: 10.5301/ijao.5000304. Epub 2014 Apr 4.
6
A retrospective survey of the quality of reports and their correlates among randomized controlled trials of immunotherapy for Guillain-Barré syndrome.对免疫治疗格林-巴利综合征的随机对照试验报告质量及其相关性的回顾性调查。
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7
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PLoS One. 2013 Jul 3;8(7):e67868. doi: 10.1371/journal.pone.0067868. Print 2013.
8
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Clin Vaccine Immunol. 2013 Mar;20(3):319-27. doi: 10.1128/CVI.00636-12. Epub 2013 Jan 2.
9
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Microbiol Mol Biol Rev. 2012 Mar;76(1):16-32. doi: 10.1128/MMBR.05015-11.
10
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Nefrologia. 2011;31(4):415-34. doi: 10.3265/Nefrologia.pre2011.Apr.10640.
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