Suryawanshi Shekhar Yashwant, Priya Shrishtee, Sinha Sandarbh Saumya, Soni Srinath, Haidry Naqoosh, Verma Shilpi, Singh Supriya
Department of Oral and Maxillofacial Surgery, ACPM Dental College, Dhule, Maharashtra, India.
Department of Conservative Dentistry and Endodontics, Hazaribag College of Dental Sciences, Hazaribagh, Demotand, Jharkhand, India.
J Family Med Prim Care. 2021 Jul;10(7):2518-2523. doi: 10.4103/jfmpc.jfmpc_2400_20. Epub 2021 Jul 30.
Ever since the World Health Organization (WHO) announced the SARS-CoV-2 or nCOVID-19 infection (a pandemic), continuous spread of the virus has been observed which has continuously seen to affect and kill multitudes of individuals all over the world. An understanding of the pathophysiology of this disease is necessary for an effective treatment. Laboratory investigations play an important role in the diagnosis as well as treatment of this infectious disease. Hematological parameters demonstrate alterations during the progression of nCOVID-19 infection. Of these, many are indicative of extremely poor clinical outcome. Hematological findings like leukopenia, lymphopenia, thrombocytopenia and coagulation-related abnormalities are the most common manifestations. The aim of this study was to assess the dynamic profile and clinical implications of hematological and immunological parameters among nCOVID-19 infections.
This retrospective study was designed after categorizing patients suffering from COVID-19 into three groups: (a) Group I; (b) Group II and (c) Group III or severe critical patients. Hematological and immunological parameters of neutrophilic and white blood cell counts, d-dimer levels, hemoglobin levels, immunoglobulin G (IgG) and M (IgM) levels and interleukin-6 (IL-6) levels were assessed. Statistical analysis using Kruskal-Wallis test was used.
Normal white blood cell and neutrophil count among COVID-19 patients was seen. However, median values in Group II ( < 0.01) and Group III ( < 0.0001) were found to show significantly higher values when compared to Group I. A significant ( < 0.01) decrease in lymphocytic counts was found among severe and critical patients. Hemoglobin level was found to demonstrate higher decrease ( < 0.01) among severe and critical patients. Platelet count was found in normal range in all COVID-19 patients. Routine coagulation tests revealed increased fibrinogen ( < 0.01) and d-dimer levels ( < 0.0001) in severe and critical patients. Normal proportions of total CD3+ and CD4 + T lymphocytes were observed in COVID-19. However, CD8 + T lymphocytes proportion was found to be decreased (-value < 0.05). Immunoglobulin G levels among Groups II and III patients were found to be lower when compared with Group I ( < 0.001). No statistical significance was observed between the groups in IgM levels. Plasma IL-6 levels were found to show progressive rise among Groups II and III patients ( < 0.05).
Analysis of hematological and immunological parameters profiles in COVID-19 patients may help in deciphering the clinical progression of patients suffering from COVID-19 disease. Thus, regular monitoring of the hospitalized patients may help in planning the management of these cases.
自世界卫生组织（WHO）宣布新型冠状病毒肺炎（SARS-CoV-2 或 nCOVID-19）感染为大流行疾病以来，该病毒持续传播，不断影响并导致全球众多人死亡。了解这种疾病的病理生理学对于有效治疗至关重要。实验室检查在这种传染病的诊断和治疗中发挥着重要作用。在 nCOVID-19 感染进展过程中，血液学参数会发生改变。其中，许多参数表明临床结局极差。白细胞减少、淋巴细胞减少、血小板减少和凝血相关异常等血液学表现是最常见的症状。本研究的目的是评估 nCOVID-19 感染患者血液学和免疫学参数的动态变化及其临床意义。
本回顾性研究将 COVID-19 患者分为三组：（a）第一组；（b）第二组；（c）第三组或重症患者组。评估中性粒细胞和白细胞计数、D-二聚体水平、血红蛋白水平、免疫球蛋白 G（IgG）和 M（IgM）水平以及白细胞介素-6（IL-6）水平等血液学和免疫学参数。采用 Kruskal-Wallis 检验进行统计分析。
COVID-19 患者的白细胞和中性粒细胞计数正常。然而，与第一组相比，第二组（<0.01）和第三组（<0.0001）的中位数显著更高。重症和危重症患者的淋巴细胞计数显著降低（<0.01）。重症和危重症患者的血红蛋白水平下降更为明显（<0.01）。所有 COVID-19 患者的血小板计数均在正常范围内。常规凝血检查显示，重症和危重症患者的纤维蛋白原（<0.01）和 D-二聚体水平升高（<0.0001）。COVID-19 患者的总 CD3 + 和 CD4 + T 淋巴细胞比例正常。然而，CD8 + T 淋巴细胞比例降低（P 值<0.05）。与第一组相比，第二组和第三组患者的免疫球蛋白 G 水平较低（<0.001）。各组 IgM 水平之间未观察到统计学差异。第二组和第三组患者的血浆 IL-6 水平呈逐渐上升趋势（<0.05）。
分析 COVID-19 患者的血液学和免疫学参数变化可能有助于解读 COVID-19 疾病患者的临床进展。因此，定期监测住院患者可能有助于规划这些病例的管理。
