Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Key Laboratory of Respiratory Diseases, National Health Commission of People's Republic of China, Wuhan, China.
Postgrad Med J. 2022 Dec 1;98(1166):906-913. doi: 10.1136/postgradmedj-2021-139704.
Several predictors of COVID-19 severity have been reported. However, chronic airway inflammation characterised by accumulated lymphocytes or eosinophils may affect the pathogenesis of COVID-19.
In this retrospective cohort study, we reviewed the medical records of all patients with laboratory-confirmed COVID-19 with chronic bronchitis, chronic obstructive pulmonary disease (COPD) and asthma admitted to the Sino-French New City Branch of Tongji Hospital, a large regional hospital in Wuhan, China, from 26 January to 3 April. The Tongji Hospital Ethics Committee approved this study.
There were 59 patients with chronic bronchitis, COPD and asthma. When compared with non-severe patients, severe patients were more likely to have decreased lymphocyte counts (0.6×10⁹/L vs 1.1×10⁹/L, p<0.001), eosinopaenia (<0.02×10⁹/L; 73% vs 24%, p<0.001), increased lactate dehydrogenase (LDH) (471.0 U/L vs 230.0 U/L, p<0.001) and elevated interleukin 6 level (47.4 pg/mL vs 5.7 pg/mL, p=0.002) on admission. Eosinopaenia and elevated LDH were significantly associated with disease severity in both univariate and multivariate regression models including the above variables. Moreover, eosinophil count and LDH level tended to return to normal range over time in both groups after treatment and severe patients recovered slower than non-severe patients, especially in eosinophil count.
Eosinopaenia and elevated LDH are potential predictors of disease severity in patients with COVID-19 with underlying chronic airway diseases. In addition, they could indicate disease progression and treatment effectiveness.
已有多项关于 COVID-19 严重程度的预测因素的报道。然而，以淋巴细胞或嗜酸性粒细胞积累为特征的慢性气道炎症可能会影响 COVID-19 的发病机制。
在这项回顾性队列研究中，我们回顾了 2020 年 1 月 26 日至 4 月 3 日期间，中国武汉大型区域医院同济医院中法新城院区收治的所有经实验室确诊的、患有慢性支气管炎、慢性阻塞性肺疾病（COPD）和哮喘的 COVID-19 患者的病历。同济医院伦理委员会批准了这项研究。
共有 59 例慢性支气管炎、COPD 和哮喘患者。与非重症患者相比，重症患者的淋巴细胞计数较低（0.6×10⁹/L 比 1.1×10⁹/L，p<0.001）、嗜酸性粒细胞减少症（<0.02×10⁹/L；73%比 24%，p<0.001）、乳酸脱氢酶（LDH）升高（471.0 U/L 比 230.0 U/L，p<0.001）和白细胞介素 6 水平升高（47.4 pg/mL 比 5.7 pg/mL，p=0.002）。在包括上述变量的单因素和多因素回归模型中，嗜酸性粒细胞减少症和 LDH 升高均与疾病严重程度显著相关。此外，两组患者在治疗后，嗜酸性粒细胞计数和 LDH 水平均趋于恢复正常范围，且重症患者的恢复速度慢于非重症患者，尤其是在嗜酸性粒细胞计数方面。
嗜酸性粒细胞减少症和 LDH 升高是 COVID-19 合并慢性气道疾病患者疾病严重程度的潜在预测因素。此外，它们可以指示疾病进展和治疗效果。
