阿那白滞素与托珠单抗在抗细胞因子疗法治疗2019冠状病毒病中的比较
Comparison of Anakinra and Tocilizumab in Anticytokine Therapy in the Treatment of Coronavirus Disease-2019.
作者信息
Ozkan Feyza, Sari Süleyman
机构信息
Department of Anesthesiology and Reanimation, Yozgat City Hospital, Yozgat, Turkey.
出版信息
Indian J Crit Care Med. 2022 Oct;26(10):1091-1098. doi: 10.5005/jp-journals-10071-24320.
BACKGROUND
It is known that coronavirus disease-2019 (COVID-19) pneumonia causes cytokine storm, and treatment modalities are being developed on inhibition of proinflammatory cytokines. We aimed to investigate the effects of anticytokine therapy on clinical improvement and the differences between anticytokine treatments.
MATERIALS AND METHODS
A total of 90 patients with positive COVID-19 polymerase chain reaction (PCR) test were divided into three groups, group I ( = 30) was given anakinra, group II ( = 30) was given tocilizumab, and group III ( = 30) was given standard treatment. Group I was treated with anakinra for 10 days; tocilizumab, intravenously, was given in group II. Group III patients were selected from those who did not receive any anticytokine treatment other than the standard treatment. Laboratory values, Glasgow coma scale (GCS), and PaO/FiO values were analyzed on days 1, 7, and 14.
RESULTS
The seventh-day mortality rates were 6.7% in group II, 23.3% in group I, and 16.7% in group III. In group II, the ferritin levels on the 7th and 14th days were significantly lower ( = 0.004), and the lymphocyte levels on the seventh day were significantly higher ( = 0.018). Examining the changes between the first intubation days, in the early period (seventh day), group I was found to be 21.7%, group II was 26.9%, and group III was 47.6%.
CONCLUSION
We observed the positive effects of the use of tocilizumab on clinical improvement in the early period; mechanical ventilation requirement was delayed and at a lower rate. Anakinra treatment did not change mortality and PaO/FiO rates. Mechanical ventilation requirements occurred earlier in the patients who were not receiving any anticytokine therapy. Studies with larger patient populations are needed to demonstrate the potential efficacy of anticytokine therapy.
HOW TO CITE THIS ARTICLE
Ozkan F, Sari S. Comparison of Anakinra and Tocilizumab in Anticytokine Therapy in the Treatment of Coronavirus Disease-2019. Indian J Crit Care Med 2022;26(10):1091-1098.
背景
已知2019冠状病毒病（COVID-19）肺炎会引发细胞因子风暴，目前正在研发针对抑制促炎细胞因子的治疗方法。我们旨在研究抗细胞因子疗法对临床改善的影响以及不同抗细胞因子治疗之间的差异。
材料与方法
总共90例COVID-19聚合酶链反应（PCR）检测呈阳性的患者被分为三组，第一组（n = 30）给予阿那白滞素，第二组（n = 30）给予托珠单抗，第三组（n = 30）给予标准治疗。第一组用阿那白滞素治疗10天；第二组静脉注射托珠单抗。第三组患者选自那些除标准治疗外未接受任何抗细胞因子治疗的患者。在第1天、第7天和第14天分析实验室值、格拉斯哥昏迷量表（GCS）和动脉血氧分压/吸入氧分数（PaO₂/FiO₂）值。
结果
第二组第7天的死亡率为6.7%，第一组为23.3%，第三组为16.7%。在第二组中，第7天和第14天的铁蛋白水平显著更低（P = 0.004），第7天的淋巴细胞水平显著更高（P = 0.018）。在早期（第7天），检查首次插管日之间的变化，发现第一组为21.7%，第二组为26.9%，第三组为47.6%。
结论
我们观察到使用托珠单抗在早期对临床改善有积极作用；机械通气需求延迟且发生率较低。阿那白滞素治疗未改变死亡率和PaO₂/FiO₂比率。未接受任何抗细胞因子治疗的患者更早出现机械通气需求。需要更大规模的患者群体研究来证明抗细胞因子疗法的潜在疗效。
如何引用本文
Ozkan F, Sari S. Comparison of Anakinra and Tocilizumab in Anticytokine Therapy in the Treatment of Coronavirus Disease-2019. Indian J Crit Care Med 2022;26(10):1091-1098.
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