[新型冠状病毒肺炎中的继发性噬血细胞性淋巴组织细胞增生症和细胞因子释放综合征，是同一实体还是不同实体？]

[Secondary hemophagocytic lymphohistiocytosis and cytokine release syndrome in COVID-19, the same or different entities?].

作者信息

Alfaro-Murillo Alberto, Lazo-Paéz Gustavo

机构信息

Medicina Interna e Inmunología Clínica, Caja Costarricense del Seguro Social, San José, Costa Rica.

Servicio de Inmunología y Reumatología Pediátrica, Hospital Nacional de Niños "Dr. Carlos Sáenz-Herrera", San José, Costa Rica.

出版信息

Rev Chilena Infectol. 2021 Apr;38(2):271-278. doi: 10.4067/S0716-10182021000200271.

DOI:10.4067/S0716-10182021000200271

PMID:34184718

Abstract

BACKGROUND

Excessive release of cytokines in severe COVID-19 resembles secondary hemophagocytic lymphohistiocytosis (sHLH).

AIM

To compare the clinical and laboratory characteristics between sHLH and cytokine release syndrome (CRS) in COVID-19.

METHODS

A review of articles in the PubMed database was performed, using the following keywords "HLH and COVID", "HScore in COVID". Articles available until July 16, 2020 were included.

RESULTS

A comparative table was prepared based on the diagnostic criteria of the HLH 2004 protocol, HScore and characteristics of the CRS-COVID-19. Eighteen variables are used for comparison.

DISCUSSION

The CRS in COVID-19 presented similarity with the CRS of sHLH; however, it cannot be stated that they are the same entity. Case reports of sHLH in COVID-19 are small. HScore is a tool that could guide the diagnosis of sHLH in the context of CRS-COVID-19, in a more practical way than the classic criteria described in HLH-2004; however, its application in COVID-19 is limited due to the absence of key features of the hyperinflammatory state of COVID-19 that are included in HLH.

CONCLUSIONS

CRS-COVID-19 is not synonymous with sHLH. Although this last entity may or may not be present in the severe COVID-19.

摘要

背景

重症新型冠状病毒肺炎（COVID-19）中细胞因子的过度释放类似于继发性噬血细胞性淋巴组织细胞增生症（sHLH）。

目的

比较COVID-19中sHLH与细胞因子释放综合征（CRS）的临床和实验室特征。

方法

在PubMed数据库中检索文章，使用以下关键词“HLH与COVID”“COVID中的HScore”。纳入截至2020年7月16日可获取的文章。

结果

根据HLH 2004方案的诊断标准、HScore以及CRS-COVID-19的特征编制了一个比较表。使用18个变量进行比较。

讨论

COVID-19中的CRS与sHLH的CRS有相似之处；然而，不能说它们是同一实体。COVID-19中sHLH的病例报告数量较少。HScore是一种工具，在CRS-COVID-19的背景下，它可以比HLH-2004中描述的经典标准更实际地指导sHLH的诊断；然而，由于HLH中包含的COVID-19高炎症状态的关键特征缺失，其在COVID-19中的应用受到限制。