托珠单抗对重症 COVID-19 患者炎症标志物和氧合状态的影响：一项单中心回顾性研究。

Impact of Tocilizumab on Inflammatory Markers and Oxygen Status in Severe COVID-19 Patients: A Single Centre Retrospective Study.

机构信息

Department of General Medicine, National Institute of Medical Sciences and Research Hospital, Nims University Rajasthan, Jaipur, India.

Department of Pharmacy Practice, Institute of Pharmacy, Nims University Rajasthan, Jaipur India.

出版信息

Infect Disord Drug Targets. 2022;22(5):e210222201328. doi: 10.2174/1871526522666220221143920.

DOI:10.2174/1871526522666220221143920

PMID:35189802

Abstract

OBJECTIVE

This retrospective study aims to investigate the impact of tocilizumab on inflammatory markers in patients with severe COVID-19. The effect on oxygenation was also assessed.

METHODS

This study is a single-centre, retrospective cohort study conducted at NIMS hospital. Data of the eligible patients with severe COVID-19 pneumonia who received injection tocilizumab (max 800 mg) were charted and analysed. Oxygenation and inflammatory markers were compared before and after (day 3 and day 7) tocilizumab injection. Effect of dysglycemia on the efficacy of tocilizumab was assessed. Outcomes were analysed in the form of discharge without oxygen, discharge with oxygen, and death. Data were analysed by SPSS v22.

RESULTS

The mean age of the subjects was 57.8 ± 12.2 years, and 78.57% were male. Forty-four percent of the patient had type 2 diabetes. Tocilizumab treatment was associated with reduction in the oxygen requirement [median:10 L/min (IQR6- 14)] v/s 4 L/min (IQR 3-7, p-0.005]. Peripheral oxygen saturation also improved after tocilizumab [92 % (IQR 90-96)] v/s [95 % (IQR 94-96), p-0.01)], respectively. Serum CRP level decreased significantly when evaluated after three days (44±5 v/s 20 ±3 mg/dl, p=< 0.001). Out of the 42, 12 (29%) patients died due to severe COVID-19 or its complications. When compared with the patients who survived, patients who died had a higher level of D-dimer (1.2 ± 0.51 v/s 3.1 ±1.2 ng/dl, p-value- 0.04), and LDH: (845 ±55 v/s 1364 ±198 U/L, p - 0.01). At day seven of the tocilizumab injection, diabetic patients (n-13) had higher IL-6 serum level than nondiabetic patients (n-16) [(median- 311(IQR-1245.5) v/s (209 (IQR-546.2), p-value- 0.048].

CONCLUSION

In this retrospective pre-post analysis, tocilizumab injection was associated with reduced inflammation and improved oxygenation in severe COVID-19. Despite high IL-6 levels, diabetes had no impact on the efficacy of the tocilizumab.

摘要

目的

本回顾性研究旨在探讨托珠单抗对重症 COVID-19 患者炎症标志物的影响。同时评估了其对氧合的影响。

方法

本研究为单中心回顾性队列研究，在 NIMS 医院进行。纳入了接受托珠单抗（最大 800mg）治疗的重症 COVID-19 肺炎患者，记录并分析其数据。比较托珠单抗注射前后（第 3 天和第 7 天）的氧合和炎症标志物。评估血糖异常对托珠单抗疗效的影响。结果以无吸氧出院、吸氧出院和死亡的形式进行分析。使用 SPSS v22 进行数据分析。

结果

研究对象的平均年龄为 57.8±12.2 岁，78.57%为男性。44%的患者患有 2 型糖尿病。托珠单抗治疗与降低氧需求相关[中位数：10L/min（IQR6-14）]与 4L/min（IQR3-7，p-0.005）]。托珠单抗治疗后外周血氧饱和度也有所改善[92%（IQR90-96）]与[95%（IQR94-96）]，p-0.01）]。第 3 天评估时，血清 CRP 水平显著下降[44±5 与 20±3mg/dl，p<0.001）]。42 例患者中，12 例（29%）因重症 COVID-19 或其并发症死亡。与存活患者相比，死亡患者的 D-二聚体水平更高[1.2±0.51 与 3.1±1.2ng/dl，p 值-0.04）]，乳酸脱氢酶水平更高[845±55 与 1364±198U/L，p-0.01）]。托珠单抗注射第 7 天，糖尿病患者（n=13）血清 IL-6 水平高于非糖尿病患者（n=16）[中位数：311（IQR1245.5）与 209（IQR546.2），p 值-0.048]。