在评估新冠病毒疾病（COVID-19）预后中，人类白细胞抗原-DR（HLA-DR）单核细胞表达与T淋巴细胞频率的效用
Utility of Monocyte Expression of HLA-DR versus T Lymphocyte Frequency in the Assessment of COVID-19 Outcome.
作者信息
Hammad Reham, Kotb Hend G, Eldesoky Gehan Abdel-Rahman, Mosaad Alshaimaa Mohamed, El-Nasser Asmaa M, Abd El Hakam Fatma El-Zahraa, Eldesoky Noha Abdel-Rahman, Mashaal Alya, Farhoud Hesham
机构信息
Clinical Pathology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
Internal Medicine Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
出版信息
Int J Gen Med. 2022 May 19;15:5073-5087. doi: 10.2147/IJGM.S359690. eCollection 2022.
BACKGROUND
Dysregulated immunity is a hallmark of SARS-CoV-2 infection. Immune suppression is indicated by low monocyte expression of human leukocyte antigen D-related (mHLA-DR). T cells are important antiviral cells. We aimed to assess the role of mHLA-DR and T lymphocyte frequency in predicting COVID-19 severity.
PATIENTS AND METHODS
This cross-sectional study enrolled 97 SARS-CoV-2 positive patients, including mild to moderate (n = 49) and severe cases admitted to intensive care unit (ICU) (n = 48). These ICU cases were further subdivided into survivors (n = 35) and non-survivors (n = 13).
RESULTS
Severe cases had a significant decrease in the mHLA-DR mean fluorescence intensity (MFI) and T lymphocyte percentage compared to mild to moderate cases (<0.001). Non-survivors had a lower T lymphocyte percentage (=0.004) than survivors. The mHLA-DR MFI and T lymphocyte percentage correlated with oxygen saturation (r=0.632, <0.001) and (r=0.669, <0.001), respectively. According to the ROC curves, mHLA-DR MFI, at a cutoff of 143 and an AUC of 0.9, is a reliable biomarker for distinguishing severe COVID-19 cases, with 89.6% sensitivity and 81.6% specificity, while T lymphocyte frequency had 81.3% sensitivity and 81.6% specificity at a cutoff of 54.4% and an AUC of 0.9. The T lymphocyte percentage as a predictor of ICU survival at a cutoff of 38.995% exhibited 100% sensitivity and 57.1% specificity. According to multivariate regression analysis, reduced mHLA-DR MFI and T lymphocyte percentage are independent predictors of COVID-19 severity (OR = 0.976, 95% CI: 0.955-0.997, = 0.025) and (OR = 0.849, 95% CI: 0.741-0.972, = 0.018), respectively.
CONCLUSION
Reduced mHLA-DR expression and T-lymphocyte percentage are independent predictors of COVID-19 severity. Oxygen saturation percentage is correlated with mHLA-DR MFI and T lymphocyte frequency. The T lymphocyte frequency is a proposed predictor of COVID-19 survival in ICU admitted patients.
背景
免疫失调是新型冠状病毒2（SARS-CoV-2）感染的一个标志。免疫抑制表现为人白细胞抗原D相关分子（mHLA-DR）的单核细胞低表达。T细胞是重要的抗病毒细胞。我们旨在评估mHLA-DR和T淋巴细胞频率在预测新型冠状病毒肺炎（COVID-19）严重程度中的作用。
患者与方法
这项横断面研究纳入了97例SARS-CoV-2阳性患者，包括轻症至中症患者（n = 49）和入住重症监护病房（ICU）的重症患者（n = 48）。这些ICU病例进一步分为幸存者（n = 35）和非幸存者（n = 13）。
结果
与轻症至中症患者相比，重症患者的mHLA-DR平均荧光强度（MFI）和T淋巴细胞百分比显著降低（<0.001）。非幸存者的T淋巴细胞百分比低于幸存者（=0.004）。mHLA-DR MFI和T淋巴细胞百分比分别与血氧饱和度相关（r = 0.632，<0.001）和（r = 0.669，<0.001）。根据ROC曲线，mHLA-DR MFI在临界值为143且曲线下面积（AUC）为0.9时，是区分重症COVID-19病例的可靠生物标志物，敏感性为89.6%，特异性为81.6%，而T淋巴细胞频率在临界值为54.4%且AUC为0.9时，敏感性为81.3%，特异性为81.6%。T淋巴细胞百分比作为ICU生存预测指标，在临界值为38.995%时，敏感性为100%，特异性为57.1%。根据多因素回归分析，mHLA-DR MFI降低和T淋巴细胞百分比降低分别是COVID-19严重程度的独立预测因素（比值比[OR] = 0.976，95%置信区间[CI]：0.955 - 0.997，P = 0.025）和（OR = 0.849，95% CI：0. {741 - 0.972}，P = 0.018）。
结论
mHLA-DR表达降低和T淋巴细胞百分比降低是COVID-19严重程度的独立预测因素。血氧饱和度百分比与mHLA-DR MFI和T淋巴细胞频率相关。T淋巴细胞频率是入住ICU的COVID-19患者生存的一个预测指标。
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