Esposito Pasquale, Cipriani Leda, Verzola Daniela, Grignano Maria Antonietta, De Amici Mara, Testa Giorgia, Grosjean Fabrizio, Russo Elisa, Garibotto Giacomo, Rampino Teresa, Viazzi Francesca
Department of Internal Medicine, University of Genova, 16132 Genova, Italy.
IRCCS Ospedale Policlinico San Martino, Clinica Nefrologica, Dialisi, Trapianto, 16132 Genova, Italy.
J Clin Med. 2021 Mar 30;10(7):1383. doi: 10.3390/jcm10071383.
Uncontrolled inflammation plays a relevant role in the pathogenesis of coronavirus disease-19 (COVID-19). Here, we studied the time trend of inflammatory markers in a population of hemodialysis (HD) patients affected by COVID-19, undergoing two different dialysis approaches. In a prospective study, thirty-one maintenance HD patients with COVID-19 were randomized to expanded HD (HDx), performed using a medium cut-off membrane, or standard treatment using a protein-leaking dialyzer (PLD). Circulating levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), soluble TLR4 (sTLR4), and interferon-gamma (IFN-γ), were collected at diagnosis, and one and two weeks after. Compared with 14 non-infected HD patients, COVID-19 patients showed lymphopenia and higher ferritin and lactate dehydrogenase levels. Moreover, COVID-19 patients had higher levels of IL-10 (15.2 (12.5) vs. 1.2 (1.4) pg/mL, = 0.02). Twenty-nine patients were randomized to HDx (n = 15) or PLD (n = 14). After a single treatment, IL-8 showed a significant reduction in both groups, whereas IL-10 decreased only in HDx. All over the study, there were no significant modifications in circulating cytokine levels between the two groups, except for a parallel increase of IL-8 and IL-10 at one week control in the HDx group. No correlations were found between cytokine levels and clinical outcomes. In maintenance HD patients, COVID-19 is not related to a sustained inflammatory response. Therefore, modulation of inflammation seems not to be a suitable therapeutic target in this specific population.
不受控制的炎症在冠状病毒病-19（COVID-19）的发病机制中起重要作用。在此，我们研究了受COVID-19影响且采用两种不同透析方法的血液透析（HD）患者群体中炎症标志物的时间趋势。在一项前瞻性研究中，31例患有COVID-19的维持性HD患者被随机分为使用中截留膜进行的扩展HD（HDx）组或使用蛋白渗漏透析器（PLD）的标准治疗组。在诊断时以及诊断后1周和2周收集白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、白细胞介素-10（IL-10）、可溶性Toll样受体4（sTLR4）和干扰素-γ（IFN-γ）的循环水平。与14例未感染的HD患者相比，COVID-19患者表现出淋巴细胞减少以及更高的铁蛋白和乳酸脱氢酶水平。此外，COVID-19患者的IL-10水平更高（15.2（12.5）对1.2（1.4）pg/mL，P = 0.02）。29例患者被随机分为HDx组（n = 15）或PLD组（n = 14）。单次治疗后，两组的IL-8均显著降低，而IL-10仅在HDx组中降低。在整个研究过程中，除HDx组在1周对照时IL-8和IL-10平行升高外，两组循环细胞因子水平无显著变化。细胞因子水平与临床结局之间未发现相关性。在维持性HD患者中，COVID-19与持续的炎症反应无关。因此，在这一特定人群中，炎症调节似乎不是一个合适的治疗靶点。
