Department of Infectious Disease, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang, China; Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Zhejiang University, Hangzhou, Zhejiang 310003, China.
Department of Infectious Disease, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang, China.
Int Immunopharmacol. 2021 Jan;90:107120. doi: 10.1016/j.intimp.2020.107120. Epub 2020 Oct 31.
To explore the application value of artificial liver support system in the clinical treatment of coronavirus disease 2019 (COVID-19) patients with cytokine storm.
Six cases of severe or critically severe COVID-19 patients treated in The First Affiliated Hospital, College of Medicine, Zhejiang University from January 22 to February 4, 2020 were recruited, and all of them received artificial liver support treatment. Statistical analysis was carried out on the change of cytokines (TNF-α, IL-10, IL-6, IFN-γ, IL-2, IL-4), inflammation-related indicators (white blood cell, neutrophil, lymphocyte, C-reactive protein and procalcitonin), immune-related indicators (B lymphocyte percentage, natural killer cell percentage, CD3CD4CD8 T cell percentage), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the 6 patients before and after treatment, and the proportions of patients with abnormal indicators were analyzed as well. In addition, computed tomography (CT) was used to observe the absorption of pulmonary lesions before and after the artificial liver support treatment.
The levels of cytokines (IL-6 and IL-10) were effectively reduced in the 6 patients after treatment with the artificial liver support system. Meanwhile, the proportions of patients with abnormal TNF-α, IL-10, IL-6 and IFN-γ were all decreased (p < 0.05). The levels of inflammation-related indicators including white blood cell, C-reactive protein and procalcitonin, and the proportions of patients with these abnormal indicators were both significantly reduced (p < 0.05). The level of neutrophil was not effectively reduced before and after the treatment, but the proportion was significantly reduced (p < 0.05). However, the abnormality of lymphocyte in the patients was not improved. There was no significant difference in immune-related indicators, AST and ALT before and after the treatment (p > 0.05). CT imaging showed that the artificial liver support treatment contributed to absorption of pulmonary lesions.
The artificial liver support system had a great clinical effect in the treatment of cytokine storm and inflammation in COVID-19 patients, and it could promote the absorption of infected lesions.
探讨人工肝支持系统在治疗新型冠状病毒病（COVID-19）并发细胞因子风暴患者中的应用价值。
纳入 2020 年 1 月 22 日至 2 月 4 日在浙江大学医学院附属第一医院收治的 6 例重型或危重型 COVID-19 患者，均接受人工肝支持治疗。对 6 例患者治疗前后细胞因子（TNF-α、IL-10、IL-6、IFN-γ、IL-2、IL-4）、炎症相关指标（白细胞、中性粒细胞、淋巴细胞、C 反应蛋白、降钙素原）、免疫相关指标（B 淋巴细胞百分比、自然杀伤细胞百分比、CD3+CD4+CD8+T 细胞百分比）、丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）的变化进行统计分析，并分析各指标异常患者的比例。此外，采用计算机断层扫描（CT）观察人工肝支持治疗前后肺部病变的吸收情况。
6 例患者经人工肝支持系统治疗后细胞因子（IL-6、IL-10）水平有效降低，同时 TNF-α、IL-10、IL-6、IFN-γ 异常患者比例均降低（p<0.05）。炎症相关指标白细胞、C 反应蛋白、降钙素原水平及异常患者比例均显著降低（p<0.05），中性粒细胞水平治疗前后未见有效降低，但比例显著降低（p<0.05），淋巴细胞异常无改善。免疫相关指标、AST、ALT 治疗前后差异均无统计学意义（p>0.05）。CT 影像学显示人工肝支持治疗有助于肺部病变的吸收。
人工肝支持系统在 COVID-19 患者细胞因子风暴及炎症的治疗中具有显著的临床疗效，能够促进感染病灶的吸收。
