National Engineering Research Center for Non-Food Biorefinery, State Key Laboratory of Non-Food Biomass and Enzyme Technology, Guangxi Biomass Engineering Technology Research Center, Guangxi Key Laboratory of Biorefinery, Guangxi Academy of Sciences, Nanning, Guangxi, China.
FASEB J. 2021 Feb;35(2):e21245. doi: 10.1096/fj.202002512.
Lymphopenia is commonly observed in SARS and COVID-19 patients although the lymphocyte count is not always below 0.8 × 10 /L in all the patients. It is suggested that lymphopenia serves as a useful predictor for prognosis in the patients. It is also hypothesized that lymphopenia is related to glucocorticoids and apoptosis. However, the ordering between lymphopenia and apoptosis appears different between SARS and COVID-19 patients, ie, lymphopenia is prior to apoptosis in SARS patients whereas apoptosis is prior to lymphopenia in COVID-19 patients. This paper attempts to figure out this contradiction through three players, lymphopenia, glucocorticoids, and apoptosis. Although the literature does not provide a solid explanation, the level of glucocorticoids could determine the ordering between lymphopenia and apoptosis because the administration of high doses of glucocorticoids could lead to lymphopenia whereas low doses of glucocorticoids could benefit patients. In the meantime, this paper raises several questions, which need to be answered in order to better understand the whole course of COVID-19.
淋巴细胞减少在 SARS 和 COVID-19 患者中很常见，尽管并非所有患者的淋巴细胞计数都始终低于 0.8×10 /L。有人提出，淋巴细胞减少可作为预测患者预后的有用指标。还有人假设淋巴细胞减少与糖皮质激素和细胞凋亡有关。但是，SARS 和 COVID-19 患者之间的淋巴细胞减少和细胞凋亡之间的顺序似乎不同，即 SARS 患者中淋巴细胞减少先于细胞凋亡，而 COVID-19 患者中细胞凋亡先于淋巴细胞减少。本文试图通过淋巴细胞减少、糖皮质激素和细胞凋亡这三个参与者来解决这个矛盾。尽管文献没有提供确凿的解释，但糖皮质激素的水平可以决定淋巴细胞减少和细胞凋亡之间的顺序，因为大剂量的糖皮质激素可导致淋巴细胞减少，而小剂量的糖皮质激素则对患者有益。同时，本文提出了几个需要回答的问题，以更好地了解 COVID-19 的整个过程。
