Wang Tao, Lin Qiuhai, Xie Yun, Yang Luyu, Cao Song, Dong Hui, Du Jiang, Wang Ruilan
Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named "Shanghai First People's Hospital"), Shanghai 201620, China.
Department of Critical Care Medicine, Wuhan Third Hospital, Wuhan 430074, Hubei, China. Corresponding author: Wang Ruilan, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2022 May;34(5):497-501. doi: 10.3760/cma.j.cn121430-20211013-01478.
To evaluate the effect of thymosin alpha 1 on the prognosis of patients with coronavirus disease 2019 (COVID-19).
A retrospective cohort study was performed to collect clinical data of 95 patients treated by Shanghai Aid Medical Team in Wuhan Third Hospital during January 31, 2020 and March 4, 2020, who were confirmed COVID-19. They were divided into two groups according to whether they were treated with thymosin alpha 1 after admission. The 28-day mortality (primary outcome), and 28-ventilator-free-day, lymphocyte count (LYM) level, C-reactive protein (CRP) level (secondary outcomes) were compared between two groups. Survival analysis was performed using the Kaplan-Meier curve. The effect of thymosin alpha 1 on 28-day survival was evaluated with Cox regression model.
Among the 95 patients, there were 31 cases in thymosin group and 64 cases in non-thymosin group; 29 patients died 28 days after admission, including 11 cases (35.5%) in thymosin group and 18 cases (28.1%) in non-thymosin group. Kaplan-Meier survival curve showed that thymosin alpha 1 could improve the 28-day survival of patients with COVID-19, but the univariate Cox model analysis showed that the difference was not statistically significant [hazard ratio (HR) = 0.48, 95% confidence interval (95%CI) was 0.20-1.14, P = 0.098]; multivariate Cox model analysis showed that thymosin alpha 1 was the factor to improve the 28-day mortality (HR = 0.15, 95%CI was 0.04-0.55, P = 0.004), old age (HR = 1.10, 95%CI was 1.05-1.15, P < 0.001), accompanied by chronic renal dysfunction (HR = 42.35, 95%CI was 2.77-648.64, P = 0.007), decrease of LYM at admission (HR = 0.15, 95%CI was 0.04-0.60, P = 0.007) and the use of methylprednisolone (HR = 4.59, 95%CI was 1.26-16.67, P = 0.021) were also risk factors for the increase of 28-day mortality. The use of immunoglobulin and antiviral drugs abidol and ganciclovir did not affect the 28-day mortality. After adjustment for age, gender, LYM and other factors, weighted multivariate Cox analysis model showed thymosin alpha 1 could significantly improve the 28-day survival of COVID-19 patients (HR = 0.45, 95%CI was 0.25-0.84, P = 0.012). In terms of secondary outcomes, no statistical difference (all P > 0.05) was found between two groups in days without ventilator at 28 days after admission (days: 17.97±13.56 vs. 20.09±12.67) and the increase of LYM at 7 days after admission [×10/L: -0.07 (-0.23, 0.43) vs. 0.12 (-0.54, 0.41)]. But the decrease of CRP at 7 days after admission in thymosin alpha group was significantly greater than that in non-thymosin group [mg/L: 39.99 (8.44, 82.22) vs. 0.53 (-7.78, 22.93), P < 0.05].
Thymosin alpha 1 may improve 28-day mortality and inflammation state in COVID-19 patients.
评估胸腺肽α1对2019冠状病毒病（COVID-19）患者预后的影响。
进行一项回顾性队列研究，收集2020年1月31日至2020年3月4日期间在武汉市第三医院接受上海援鄂医疗队治疗的95例确诊COVID-19患者的临床资料。根据入院后是否接受胸腺肽α1治疗将患者分为两组。比较两组的28天死亡率（主要结局）以及28天无呼吸机天数、淋巴细胞计数（LYM）水平、C反应蛋白（CRP）水平（次要结局）。采用Kaplan-Meier曲线进行生存分析。用Cox回归模型评估胸腺肽α1对28天生存的影响。
95例患者中，胸腺肽组31例，非胸腺肽组64例；29例患者在入院28天后死亡，其中胸腺肽组11例（35.5%），非胸腺肽组18例（28.1%）。Kaplan-Meier生存曲线显示，胸腺肽α1可改善COVID-19患者的28天生存，但单因素Cox模型分析显示差异无统计学意义[风险比（HR）=0.48，95%置信区间（95%CI）为0.20 - 1.14，P = 0.098]；多因素Cox模型分析显示，胸腺肽α1是改善28天死亡率的因素（HR = 0.15，95%CI为0.04 - 0.55，P = 0.004），高龄（HR = 1.10，95%CI为1.05 - 1.15，P <
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