Yuan Shuang, Meng FuLei, Zhou Shuai, Liu XiaoYing, Liu XiaoMing, Zhang LiHong, Wang Tao
Graduate School of Hebei Medical University, Shijiazhuang, China.
Department of Nephrology, The First Hospital of Hebei Medical University, Shijiazhuang, China.
Front Med (Lausanne). 2024 Oct 30;11:1444719. doi: 10.3389/fmed.2024.1444719. eCollection 2024.
Patients on maintenance hemodialysis (MHD) were more vulnerable to and had a higher mortality during the COVID-19 pandemic. As angiotensin converting enzyme 2 (ACE2) and transmembrane protease serine S1 member 2 (TMPRSS2) played crucial roles in viral entry into the human host cells, we therefore investigated in the MHD patients whether their plasma levels were associated with susceptibility to the COVID-19.
Blood samples were collected from the patients in our then COVID-19 free center immediately upon lifting of the stringent quarantine measures in early December of 2022 and infection situation was observed within the following 2 weeks. Plasma levels of the soluble ACE2 (sACE2), ACE (sACE) and TMPRSS2 (sTMPRSS2) were measured with ELISA method. Data were stepwisely tested for independent effect, relevant role and synergistic action on the susceptibility by multiple logistic regression, receiver operating characteristic curve and multiple dimensionality reduction (MDR) method, respectively.
Among the 174 eligible patients, 95 (54.6%) turned COVID-19 positive with a male to female ratio of 1.57 during the observation period. Comparing with the uninfected, the infected had significantly higher sACE2 and lower sTMPRSS2 levels upon comparable sACE concentration. Besides the sACE2, factors associated with susceptibility were vintage and individual session time of the hemodialysis, smoking and comorbidity of hepatitis, whereas lymphocyte counts showed a tendency ( = 0.052). Patients simultaneously manifesting higher sACE2 level and lower lymphocyte counts had an increased infection risk as confirmed by the MDR method.
By sorting out the susceptible ones expeditiously, this algorithmic approach may help the otherwise vulnerable MHD patients weather over future wave of COVID-19 variants or outbreak of other viral diseases.
维持性血液透析（MHD）患者在新冠疫情期间更易感染且死亡率更高。由于血管紧张素转换酶2（ACE2）和跨膜丝氨酸蛋白酶2（TMPRSS2）在病毒进入人体宿主细胞过程中起关键作用，因此我们调查了MHD患者的血浆水平是否与新冠易感性相关。
2022年12月初严格隔离措施解除后，立即从当时我们中心未感染新冠的患者中采集血样，并在接下来的2周内观察感染情况。采用酶联免疫吸附测定法检测可溶性ACE2（sACE2）、血管紧张素转换酶（sACE）和TMPRSS2（sTMPRSS2）的血浆水平。分别采用多因素logistic回归、受试者工作特征曲线和多因素降维（MDR）方法逐步检验数据对易感性的独立作用、相关作用和协同作用。
在174例符合条件的患者中，95例（54.6%）在观察期内新冠检测呈阳性，男女比例为1.57。与未感染者相比，在sACE浓度相当的情况下，感染者的sACE2水平显著更高，sTMPRSS2水平更低。除sACE2外，与易感性相关的因素包括血液透析的透析龄和单次透析时间、吸烟以及合并肝炎，而淋巴细胞计数呈一种趋势（P = 0.052）。MDR方法证实，同时表现出较高sACE2水平和较低淋巴细胞计数的患者感染风险增加。
通过快速筛选出易感患者，这种算法方法可能有助于原本易感染的MHD患者抵御未来新冠病毒变种浪潮或其他病毒性疾病的爆发。
