Immunology, Hospital General Universitario de Ciudad Real, Spain; Immunology, Facultad de Medicina de Ciudad Real, Spain.
Immunology, Hospital General Universitario de Ciudad Real, Spain; Immunology, Facultad de Medicina de Ciudad Real, Spain.
Clin Immunol. 2020 Aug;217:108486. doi: 10.1016/j.clim.2020.108486. Epub 2020 May 29.
The lymphopenia exhibited in patients with COVID-19 has been associated with a worse prognosis in the development of the disease. To understand the factors associated with a worse evolution of COVID-19, we analyzed comorbidities, indicators of inflammation such as CRP and the ratio of neutrophils/lymphocytes, as well as the count of blood cells with T-lymphocyte subtypes in 172 hospitalized patients with COVID-19 pneumonia. Patients were grouped according to their needs for mechanical ventilation (ICU care) or not. Within the comorbidities studied, obesity was the only associated with greater severity and ICU admission. Both the percentage and the absolute number of neutrophils were higher in patients needing ICU care than non-ICU patients, whereas absolute lymphocyte count, and especially the percentage of lymphocytes, presented a deep decline in critical patients. There was no difference between the two groups of patients for CD4 T-lymphocytes, neither in percentage of lymphocyte nor in absolute number, however for CD8 T-cells the differences were significant for both parameters which were in decline in ICU patients. There was a firm correlation between the highest values of inflammation indicators with the decrease in percentage of CD8 T-lymphocytes. This effect was not seen with CD4 cells. Obesity together with lymphopenia, especially whether preferentially affects to CD8 T- lymphocytes, are factors that can predict a poor prognosis in patients with COVID-19.
在 COVID-19 患者中表现出的淋巴细胞减少与疾病发展的预后不良有关。为了了解与 COVID-19 恶化相关的因素，我们分析了合并症、炎症指标如 CRP 和中性粒细胞/淋巴细胞比值，以及 172 例住院 COVID-19 肺炎患者的 T 淋巴细胞亚群的血细胞计数。患者根据是否需要机械通气（重症监护）进行分组。在研究的合并症中，肥胖是唯一与严重程度和 ICU 入院相关的因素。需要 ICU 护理的患者中性粒细胞的百分比和绝对值均高于非 ICU 患者，而淋巴细胞绝对值，尤其是淋巴细胞百分比，在危重症患者中明显下降。两组患者的 CD4 T 淋巴细胞，无论是淋巴细胞的百分比还是绝对数量均无差异，但对于 CD8 T 细胞，两个参数的差异均有统计学意义，均在 ICU 患者中下降。炎症指标的最高值与 CD8 T 淋巴细胞百分比的下降之间存在密切相关性。这一效应在 CD4 细胞中并未出现。淋巴细胞减少，尤其是是否优先影响 CD8 T 淋巴细胞，肥胖与 COVID-19 患者的不良预后相关。
