托珠单抗治疗对重症 COVID-19 患者铁稳态的影响。

Tocilizumab Treatment Effect on Iron Homeostasis in Severe COVID-19 Patients.

机构信息

Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Department of Neurology, Meir Medical Center, Kfar Saba, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Acta Haematol. 2022;145(4):440-447. doi: 10.1159/000522307. Epub 2022 Jan 31.

DOI:10.1159/000522307

PMID:35100583

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9059034/

Abstract

BACKGROUND

Tocilizumab has been proposed as an effective treatment for severe COVID-19. We aimed to investigate whether tocilizumab administration is associated with increased availability of serum iron which may possibly be associated with adverse effects on clinical outcomes.

METHODS

We performed an observational, retrospective cohort study. We included adults, who were hospitalized in ICU with the diagnosis of severe COVID-19 infection eligible for tocilizumab treatment. Laboratory data including serum iron, ferritin, transferrin saturation, hemoglobin, and C-reactive protein levels of all patients were collected shortly before and 24 h, 48 h, and 72 h after tocilizumab administration.

RESULTS

During the study period, 15 patients fulfilled the inclusion criteria and were eligible to receive tocilizumab treatment. Tocilizumab therapy was associated with a prominent increase in serum iron and transferrin saturation levels (26 ± 13 μg/dL and 15 ± 8% before treatment and 79 ± 32 μg/dL and 41 ± 15% 72 h after treatment, respectively, p < 0.001) and decrease in serum ferritin levels (1,921 ± 2,071 ng/mL before and 1,258 ± 1,140 ng/mL 72 h after treatment, p = 0.027).

CONCLUSION

Treatment of severe COVID-19 patients with tocilizumab is associated with a profound increase in serum iron and ferritin saturation levels along with a decrease in ferritin levels. This may represent an undesirable side effect that may potentiate viral replication.

摘要

背景

托珠单抗被提议作为治疗严重 COVID-19 的有效方法。我们旨在研究托珠单抗的使用是否与血清铁含量的增加有关，而血清铁含量的增加可能与对临床结局的不良影响有关。

方法

我们进行了一项观察性、回顾性队列研究。我们纳入了在 ICU 住院的、符合使用托珠单抗治疗条件的严重 COVID-19 感染的成年患者。收集所有患者在使用托珠单抗前及使用后 24 小时、48 小时和 72 小时的血清铁、铁蛋白、转铁蛋白饱和度、血红蛋白和 C-反应蛋白水平等实验室数据。

结果

在研究期间，15 名患者符合纳入标准并符合接受托珠单抗治疗的条件。托珠单抗治疗与血清铁和转铁蛋白饱和度水平的显著升高相关（分别为 26 ± 13 μg/dL 和 15 ± 8%，治疗前和治疗后 72 小时为 79 ± 32 μg/dL 和 41 ± 15%，p < 0.001），以及血清铁蛋白水平的降低（治疗前为 1,921 ± 2,071 ng/mL，治疗后 72 小时为 1,258 ± 1,140 ng/mL，p = 0.027）。