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不确定的 QuantiFERON Gold Plus 检测结果揭示了重症 COVID-19 患者干扰素γ反应不足。

Indeterminate QuantiFERON Gold Plus Results Reveal Deficient Interferon Gamma Responses in Severely Ill COVID-19 Patients.

机构信息

Department of Pathology & Laboratory Medicine, UNC School of Medicine, Chapel Hill, North Carolina, USA.

Immunology, Histocompatibility and Immunogenetics Laboratories/McLendon Clinical Laboratories UNC Hospitals, Chapel Hill, North Carolina, USA.

出版信息

J Clin Microbiol. 2021 Sep 20;59(10):e0081121. doi: 10.1128/JCM.00811-21. Epub 2021 Jul 7.

Abstract

SARS-CoV-2 is a novel positive-sense single-stranded RNA virus that has caused a recent pandemic. Most patients have a mild disease course, while approximately 20% have moderate to severe disease, often requiring hospitalization and, in some cases, care in the intensive care unit. By investigating a perceived increased rate of indeterminate QuantiFERON-TB Gold Plus results in hospitalized COVID patients, we demonstrate that severely ill COVID-19 patients have at least a 6-fold reduction of interferon gamma (IFN-γ) levels compared to control patients. What is more, over 60% of these severely ill COVID-19 patients' peripheral T cells were found to be unable to produce measurable IFN-γ when stimulated with phytohemagglutinin (PHA), a potent IFN-γ mitogen, reflected by an indeterminate QuantiFERON-TB Gold Plus result. This defect of IFN-γ production was independent of absolute lymphocyte counts and immunosuppressive therapy. It was associated with increased levels of interleukin-6 (IL-6), which was a predictor of patient outcomes for our cohort when measured early in the course of disease. Finally, in a subset of COVID-19 patients, we found elevated IL-10 levels in addition to IL-6 elevation. In addition to finding a significant limitation of interferon-gamma release assay (IGRA) testing in severely ill COVID-19 patients, these data provide evidence that many of these patients demonstrate a focused Th2 immune response with inhibition of IFN-γ signaling and, in many cases, significant elevations of IL-6.

摘要

SARS-CoV-2 是一种新型的正链单链 RNA 病毒,导致了最近的一次大流行。大多数患者疾病进程较轻,而约 20%的患者为中度至重度疾病,常需要住院治疗,在某些情况下需要入住重症监护病房。通过调查住院 COVID 患者中 QuantiFERON-TB Gold Plus 检测结果不确定率的升高,我们发现重症 COVID-19 患者的干扰素 γ(IFN-γ)水平较对照组至少降低了 6 倍。更重要的是,超过 60%的重症 COVID-19 患者的外周 T 细胞在受到植物血凝素(PHA)刺激时无法产生可测量的 IFN-γ,导致 QuantiFERON-TB Gold Plus 检测结果不确定。这种 IFN-γ产生缺陷与绝对淋巴细胞计数和免疫抑制治疗无关。它与白细胞介素 6(IL-6)水平升高有关,在我们的队列中,当疾病早期测量时,IL-6 水平是患者预后的一个预测因素。最后,在一部分 COVID-19 患者中,我们发现除了 IL-6 升高外,IL-10 水平也升高了。除了发现严重 COVID-19 患者的干扰素释放试验(IGRA)检测存在显著局限性外,这些数据还提供了证据,表明许多患者表现出 Th2 免疫反应为主,抑制 IFN-γ信号转导,在许多情况下,IL-6 水平显著升高。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3123/8451425/1e0ad69a294a/jcm.00811-21-f001.jpg

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