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长期新冠与生物标志物失调——是否正转向免疫耗竭?

Long COVID and Biomarker Dysregulation-A Shift Toward Immune Exhaustion?

作者信息

Kallaste Anne, Kisand Kalle, Aart Agnes, Salumets Ahto, Kisand Kai, Peterson Pärt, Lember Margus

机构信息

Department of Internal Medicine, Tartu University Hospital, L. Puusepa 8, 51014 Tartu, Estonia.

Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014 Tartu, Estonia.

出版信息

Medicina (Kaunas). 2025 May 28;61(6):996. doi: 10.3390/medicina61060996.


DOI:10.3390/medicina61060996
PMID:40572685
Abstract

SARS-CoV-2 infection can lead to persistent or newly emerging symptoms lasting for months, a condition known as long COVID (LC). The pathophysiology of LC remains poorly understood, with cytokine dysregulation proposed as a key mechanism, although findings across the studies have been inconsistent. We conducted a longitudinal study using the Olink Target 96 Inflammation Panel to assess cytokines in COVID-19 (COV) patients at three months and six months post-infection. These profiles were compared with those of individuals recovering from other upper respiratory tract infections (non-COV). Additionally, we analyzed differences between individuals with LC and those who recovered from COVID-19. Predictive models for LC at three months and sixth months post-infection were developed using inflammatory markers and relevant clinical cofactors, including gender, age, BMI, hemogram, Β2-microglobulin, D-dimers, LDH, AST, ALT, Ferritin, vitamin D, CRP, and the severity of acute COVID-19 infection as classified by WHO criteria. We observed a general decline in inflammatory biomarkers in post-COVID-19 patients over time, with only a few cytokines elevated (CCL4 at month 3 and CST5 at month 6) compared to non-COV controls. In LC patients, an early phase of low-grade inflammation transitioned into significant reduction in proinflammatory biomarkers compared to recovered individuals. Rather than indicating immune normalization, this pattern suggests a possible suppression or exhaustion of the immune response in the months following acute infection. Importantly, our predictive modeling demonstrated that this specific cytokine signature, in combination with acute disease severity and clinical cofactors, described well the presence of LC. Our findings suggest that inflammation-related biomarker dysregulation following acute SARS-CoV-2 infection evolves dynamically over a six-month period. By the sixth month, compared to the third month, the presence of LC is more accurately predicted by a combination of persistent biomarker alteration and the severity of the initial infection, as defined by WHO criteria. This represents a novel insight, as previous studies have primarily associated LC with elevated proinflammatory markers, whereas our results suggest that immune suppression or exhaustion may play a more prominent role in the later stages.

摘要

严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染可导致持续数月或新出现的症状,即所谓的“长新冠”(LC)。尽管各项研究结果并不一致,但长新冠的病理生理学仍知之甚少,细胞因子失调被认为是关键机制。我们开展了一项纵向研究,使用Olink Target 96炎症检测板评估新冠病毒病(COV)患者在感染后三个月和六个月时的细胞因子水平。将这些数据与从其他上呼吸道感染中康复的个体(非COV)的数据进行比较。此外,我们分析了长新冠患者与新冠病毒病康复者之间的差异。利用炎症标志物和相关临床辅助因素(包括性别、年龄、体重指数、血常规、β2微球蛋白、D-二聚体、乳酸脱氢酶、谷草转氨酶、谷丙转氨酶、铁蛋白、维生素D、C反应蛋白以及根据世界卫生组织标准分类的急性新冠病毒病感染严重程度),建立了感染后三个月和六个月时长新冠的预测模型。我们观察到,新冠病毒病康复患者的炎症生物标志物随时间总体呈下降趋势,与非COV对照组相比,只有少数细胞因子升高(第3个月的CCL4和第6个月的CST5)。与康复个体相比,长新冠患者早期的低度炎症转变为促炎生物标志物的显著减少。这种模式并非表明免疫功能正常化,而是提示在急性感染后的数月内,免疫反应可能受到抑制或耗竭。重要的是,我们的预测模型表明,这种特定的细胞因子特征,结合急性疾病严重程度和临床辅助因素,能够很好地描述长新冠的存在。我们的研究结果表明,急性SARS-CoV-2感染后与炎症相关的生物标志物失调在六个月内会动态演变。到第六个月时,与第三个月相比,结合持续的生物标志物改变和初始感染的严重程度(根据世界卫生组织标准定义),能更准确地预测长新冠的存在。这代表了一种新的见解,因为先前的研究主要将长新冠与促炎标志物升高联系起来,而我们的结果表明,免疫抑制或耗竭可能在后期发挥更突出的作用。

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本文引用的文献

[1]
Diverse immunological dysregulation, chronic inflammation, and impaired erythropoiesis in long COVID patients with chronic fatigue syndrome.

J Autoimmun. 2024-7

[2]
Muscle abnormalities worsen after post-exertional malaise in long COVID.

Nat Commun. 2024-1-4

[3]
Enduring echoes: Post-infectious long-term changes in innate immunity.

Eur J Intern Med. 2024-5

[4]
Long-term outcomes following hospital admission for COVID-19 versus seasonal influenza: a cohort study.

Lancet Infect Dis. 2024-3

[5]
The Long-COVID autonomic syndrome in hospitalized patients: A one-year prospective cohort study.

Eur J Intern Med. 2024-2

[6]
Epidemiology, clinical presentation, pathophysiology, and management of long COVID: an update.

Mol Psychiatry. 2023-10

[7]
Laboratory Findings and Biomarkers in Long COVID: What Do We Know So Far? Insights into Epidemiology, Pathogenesis, Therapeutic Perspectives and Challenges.

Int J Mol Sci. 2023-6-21

[8]
A systematic review and meta-analysis of long COVID symptoms.

Syst Rev. 2023-5-27

[9]
Long COVID: a review and proposed visualization of the complexity of long COVID.

Front Immunol. 2023

[10]
CCL13 and human diseases.

Front Immunol. 2023

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