Marc Felicia, Moldovan Corina Maria, Hoza Anica, Magheru Sorina, Ciavoi Gabriela, Farcas Dorina Maria, Sachelarie Liliana, Calin Gabriela, Romila Laura, Damir Daniela, Naum Alexandru Gratian
Clinical Departament, Faculty of Medicine and Pharmacy, Oradea University, University Street 1, 410087 Oradea, Romania.
Preclinical Department, Apollonia University, Păcurari Street 11, 700511 Iași, Romania.
J Clin Med. 2022 May 23;11(10):2945. doi: 10.3390/jcm11102945.
(1) Background: In patients hospitalized with COVID-19 pneumonia, especially moderate and severe forms, a cytokine storm may occur, characterized by the worsening of symptoms and the alteration of biological parameters on days 8-12 of the disease. The therapeutic options for cytokine storms are still controversial, requiring further clarification; (2) Methods: Our study included 344 patients with moderate and severe pneumonia admitted to the internal medicine department who developed a cytokine storm (diagnosed by clinical and biochemical criteria). In group A, 149 patients were treated with Remdesivir and Tocilizumab (together with other drugs, including corticosteroids, antibiotics and anticoagulants), and in group B, 195 patients received Remdesivir and Anakinra. Patients were monitored clinically and by laboratory tests, with the main biochemical parameters being CRP (C-reactive protein), LDH (lactic dehydrogenase) and ferritin; (3) Results: Patients were followed up from a clinical point of view and also by the measurement of CRP, LDH and ferritin at the beginning of therapy, on days three to four and on the tenth day. In both groups, we registered a clinical improvement and a decrease in the parameters of the cytokine storm. In group A, with the IL-6 antagonist Tocilizumab, the beneficial effect occurred faster; in group B, with the IL-1 antagonist Anakinra, the beneficial effect was slower. (4) Conclusions: The use of the immunomodulators, Tocilizumab and Anakinra, in the cytokine storm showed favorable effects, both clinical and biochemical.
(1) 背景：在因新型冠状病毒肺炎住院的患者中，尤其是中重症患者，可能会发生细胞因子风暴，其特征为疾病第8至12天症状恶化及生物学参数改变。细胞因子风暴的治疗选择仍存在争议，需要进一步阐明；(2) 方法：我们的研究纳入了344名因中重症肺炎入住内科且发生细胞因子风暴（通过临床和生化标准诊断）的患者。A组149名患者接受瑞德西韦和托珠单抗治疗（同时使用其他药物，包括皮质类固醇、抗生素和抗凝剂），B组195名患者接受瑞德西韦和阿那白滞素治疗。对患者进行临床和实验室监测，主要生化参数为CRP（C反应蛋白）、LDH（乳酸脱氢酶）和铁蛋白；(3) 结果：从临床角度以及在治疗开始时、第3至4天和第10天测量CRP、LDH和铁蛋白对患者进行随访。两组患者均出现临床改善且细胞因子风暴参数下降。A组使用IL-6拮抗剂托珠单抗，有益效果出现得更快；B组使用IL-1拮抗剂阿那白滞素，有益效果出现得较慢。(4) 结论：在细胞因子风暴中使用免疫调节剂托珠单抗和阿那白滞素显示出临床和生化方面的有利效果。
