托珠单抗治疗轻度肥胖的2019冠状病毒病患者的疗效：病例系列
Effect of tocilizumab treatment in mildly-obese patients with coronavirus disease 2019: a case series.
作者信息
Abe Takashi, Yamaguchi Fumihiro, Sakakura Shunsuke, Yamazaki Yohei, Shikama Yusuke
机构信息
Department of Respiratory Medicine, Showa University Fujigaoka Hospital, Fujigaoka, Yokohama, Japan.
出版信息
Ann Transl Med. 2022 Dec;10(23):1263. doi: 10.21037/atm-2022-49.
BACKGROUND
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an increasingly widespread international medical problem. Several randomized trials and observational studies in patients with COVID-19 have been performed. However, the standard treatment strategy has not yet been established. The purpose of this study is to report effect of tocilizumab treatment combined with remdesivir, dexamethasone, and heparin on obese Japanese patients with COVID-19. Tocilizumab is a monoclonal antibody against the interleukin-6 (IL-6) receptor. Obesity, characterized by systemic enlarged adipocytes, promotes proinflammatory cytokine expression in adipose tissue. More specifically, obesity induces detrimental adipocytokine production including tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and IL-6. In addition, its production in the adipose tissue is associated with body mass index (BMI) and adipocyte size. IL-6 can promote inflammation not only in the adipose tissues but also in endothelial cells and triggers systemic inflammation.
METHODS
A cross-sectional observational study was conducted. The study sample consisted of 96 patients between August 2020 and January 2021 at Showa University Fujigaoka Hospital.
RESULTS
Overall, 56.3% (54 of 96) were administered with remdesivir, 54.2% (52 of 96) with dexamethasone, 19.8% (19 of 96) with anticoagulant therapy with heparin. Of the patients, nine were administered tocilizumab with remdesivir, dexamethasone, and heparin. The current study indicated that single-dose treatment of tocilizumab in combination with remdesivir, dexamethasone, and heparin is beneficial for obese Japanese patients with COVID-19.
CONCLUSIONS
We believe that the severity of obesity is related to the anti-IL-6 treatment sensitivity in patients with COVID-19.
背景
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）是一个日益广泛传播的国际医学问题。已经对COVID-19患者进行了多项随机试验和观察性研究。然而，标准治疗策略尚未确立。本研究的目的是报告托珠单抗联合瑞德西韦、地塞米松和肝素治疗肥胖日本COVID-19患者的效果。托珠单抗是一种抗白细胞介素-6（IL-6）受体的单克隆抗体。以全身脂肪细胞增大为特征的肥胖会促进脂肪组织中促炎细胞因子的表达。更具体地说，肥胖会诱导产生有害的脂肪细胞因子，包括肿瘤坏死因子-α（TNF-α）、单核细胞趋化蛋白-1（MCP-1）和IL-6。此外，其在脂肪组织中的产生与体重指数（BMI）和脂肪细胞大小有关。IL-6不仅可以促进脂肪组织中的炎症，还可以促进内皮细胞中的炎症，并引发全身炎症。
方法
进行了一项横断面观察性研究。研究样本包括2020年8月至2021年1月在昭和大学藤冈医院的96例患者。
结果
总体而言，56.3%（96例中的54例）接受了瑞德西韦治疗，54.2%（96例中的52例）接受了地塞米松治疗，19.8%（96例中的19例）接受了肝素抗凝治疗。在这些患者中，9例接受了托珠单抗联合瑞德西韦、地塞米松和肝素治疗。当前研究表明，托珠单抗单剂量联合瑞德西韦、地塞米松和肝素治疗对肥胖日本COVID-19患者有益。
结论
我们认为肥胖的严重程度与COVID-19患者的抗IL-6治疗敏感性有关。
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