Jurado Aurora, Martín María C, Abad-Molina Cristina, Orduña Antonio, Martínez Alba, Ocaña Esther, Yarce Oscar, Navas Ana M, Trujillo Antonio, Fernández Luis, Vergara Esther, Rodríguez Beatriz, Quirant Bibiana, Martínez-Cáceres Eva, Hernández Manuel, Perurena-Prieto Janire, Gil Juana, Cantenys Sergi, González-Martínez Gema, Martínez-Saavedra María T, Rojo Ricardo, Marco Francisco M, Mora Sergio, Ontañón Jesús, López-Hoyos Marcos, Ocejo-Vinyals Gonzalo, Melero Josefa, Aguilar Marta, Almeida Delia, Medina Silvia, Vegas María C, Jiménez Yesenia, Prada Álvaro, Monzón David, Boix Francisco, Cunill Vanesa, Molina Juan
Department of Immunology and Allergology, Hospital Universitario Reina Sofía-Instituto de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.
Centro de Hemoterapia y Hemodonación de Castilla y León, Paseo de Filipinos s/n, 47007 Valladolid, Spain.
Immun Ageing. 2020 Aug 14;17:22. doi: 10.1186/s12979-020-00194-w. eCollection 2020.
The SARS-CoV-2 infection has widely spread to become the greatest public health challenge to date, the COVID-19 pandemic. Different fatality rates among countries are probably due to non-standardized records being carried out by local health authorities. The Spanish case-fatality rate is 11.22%, far higher than those reported in Asia or by other European countries. A multicentre retrospective study of demographic, clinical, laboratory and immunological features of 584 Spanish COVID-19 hospitalized patients and their outcomes was performed. The use of renin-angiotensin system blockers was also analysed as a risk factor.
In this study, 27.4% of cases presented a mild course, 42.1% a moderate one and for 30.5% of cases, the course was severe. Ages ranged from 18 to 98 (average 63). Almost 60 % (59.8%) of patients were male. Interleukin 6 was higher as severity increased. On the other hand, CD8 lymphocyte count was significantly lower as severity grew and subpopulations CD4, CD8, CD19, and NK showed concordant lowering trends. Severity-related natural killer percent descents were evidenced just within aged cases. A significant severity-related decrease of CD4 lymphocytes was found in males. The use of angiotensin-converting enzyme inhibitors was associated with a better prognosis. The angiotensin II receptor blocker use was associated with a more severe course.
Age and age-related comorbidities, such as dyslipidaemia, hypertension or diabetes, determined more frequent severe forms of the disease in this study than in previous literature cohorts. Our cases are older than those so far reported and the clinical course of the disease is found to be impaired by age. Immunosenescence might be therefore a suitable explanation for the hampering of immune system effectors. The adaptive immunity would become exhausted and a strong but ineffective and almost deleterious innate response would account for COVID-19 severity. Angiotensin-converting enzyme inhibitors used by hypertensive patients have a protective effect in regards to COVID-19 severity in our series. Conversely, patients on angiotensin II receptor blockers showed a severer disease.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染已广泛传播，成为迄今为止最大的公共卫生挑战——新型冠状病毒肺炎（COVID-19）大流行。各国不同的病死率可能是由于当地卫生当局进行的记录不规范。西班牙的病死率为11.22%，远高于亚洲或其他欧洲国家报告的病死率。对584例西班牙COVID-19住院患者的人口统计学、临床、实验室和免疫学特征及其结局进行了一项多中心回顾性研究。还分析了使用肾素-血管紧张素系统阻滞剂作为危险因素的情况。
在本研究中，27.4%的病例病程为轻度，42.1%为中度，30.5%为重度。年龄范围为18至98岁（平均63岁）。近60%（59.8%）的患者为男性。随着病情严重程度增加，白细胞介素6升高。另一方面，随着病情加重，CD8淋巴细胞计数显著降低，CD4、CD8、CD19和自然杀伤细胞（NK）亚群呈一致的降低趋势。仅在老年病例中发现与病情严重程度相关的自然杀伤细胞百分比下降。在男性中发现与病情严重程度相关的CD4淋巴细胞显著减少。使用血管紧张素转换酶抑制剂与较好的预后相关。使用血管紧张素II受体阻滞剂与更严重的病程相关。
在本研究中，年龄以及与年龄相关的合并症，如血脂异常、高血压或糖尿病，比以往文献队列中更频繁地导致疾病出现严重形式。我们研究中的病例比迄今为止报告的病例年龄更大，并且发现年龄会损害疾病的临床病程。因此，免疫衰老可能是免疫系统效应器受到阻碍的一个合适解释。适应性免疫将耗尽，而强烈但无效且几乎有害的先天反应将导致COVID-19病情严重。在我们的系列研究中，高血压患者使用血管紧张素转换酶抑制剂对COVID-19病情严重程度具有保护作用。相反，使用血管紧张素II受体阻滞剂的患者病情更严重。
