多种炎症指标联合淋巴细胞亚群在COVID-19不同临床分型的临床诊断价值分析

Value of various inflammatory markers combined with lymphocyte subsets on clinical diagnosis of different clinical types of COVID-19

摘要:

目的：探讨不同临床分型的新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）患者多种炎症指标水平变化规律及临床意义。方法：收集2020年1月28日至3月3日在湖北省中西结合医院住院110例COVID-19确诊患者作为研究对象，并将其按《新型冠状病毒感染的肺炎诊疗方案（试行第7版）》诊断标准分为普通型、重型、危重型3组，回顾性分析和比较各组患者的一般资料、血清白蛋白（albumin，ALB）、C反应蛋白（C-reactive protein，CRP）、降钙素原（procalcitonin，PCT）及细胞因子白介素-1β（interleukin-1β，IL-1β）、白介素-6（interleukin-6，IL-6）、白介素-8（interleukin-8，IL-8）、白介素-10（interleukin-10，IL-10），以及全血CD4+ T淋巴细胞计数（CD4+ T lymphocyte，CD4+ T）、CD8+ T淋巴细胞计数（CD8+ T lymphocyte，CD8+ T）各指标水平；各组炎症指标表达的数据不符合正态分布以中位数（四分位间距）表示，普通组、重型组、危重型组肺炎组间数据差异采用Kruskal-Wallis秩和检验，组间两两比较采用Mann-Whitney U检验；对具有统计学意义的炎症指标鉴别诊断价值采用受试工作者特征曲线（receiver operator characteristic curve，ROC曲线），并根据ROC曲线下面积（area under the curve，AUC）选取最佳诊断炎症指标。结果：对于血清IL-6、IL-10、CRP、PCT水平，危重型组＞重型组＞普通型组，ALB、CD4+ T、CD8+ T水平，普通型组＞重型组＞危重型组，差异均有统计学意义（P＜0.001）。血清IL-1β、IL-8水平在各临床分组中变化不明显，P值分别为0.388和0.128，无统计学意义（P>0.05）。IL-6与CRP/ALB 2个指标联合后AUC为0.931，敏感度为0.885，特异性为0.825。结论：血清多种炎症指标联合T淋巴细胞亚群实时检测有助于判断 COVID-19患者的临床病情评价，作为治疗效果评估、危重程度及预后等的重要参考，联合监测血清IL-6与CRP/ALB将大大提高预测COVID-19危重程度的准确率。

Abstract:

Objective：To investigate the change law and the clinical significance of various inflammatory markers in COIVD-19 pa－tients with different clinical types. Methods：A total of 110 patients diagnosed with COVID-19 who were hospitalized in the Hubei Provincial Hospital of Integrated Chinese and Western Medicine from January 28 to March 3，2020 were collected as study objects and were divided into three groups of the ordinary group，the severe group and the critically ill group according to the diagnostic criteria from Diagnostic and Therapeutic Protocols for COVID-19（The trial 7）. General data，serum albumin（ALB），C-reactive protein （CRP），procalcitonin（PCT） and cytokines interleukin-1β（IL-1β），interleukin-6（IL-6），interleukin-8（IL-8），interleukin-10（IL-10），CD4+ T lymphocyte count（CD4+ T） and CD8+ T lymphocyte count（CD8+ T） in each group were retrospectively analyzed and com－pared. The expression data of inflammatory indicators in each group was not consistent with the normal distribution as the median（quartile）. Kruskal-wallis rank sum test was used for detecting data differences among three groups，and Mann-Whitney U test was used for the pairwise comparison between the groups. The re－ceiver operator characteristic curve（ROC curve） was used for the diagnostic value of inflammatory indicators with statistical significance，and the best diagnostic inflammatory index was se－lected according to the area under the curve（AUC）. Results：Levels of serum IL-6，IL-10，CRP and PCT were the highest in the critically ill group，following the severe group and the ordi－nary group；levels of ALB，CD4+ T，CD8+ T were the highest in the ordinary group，following the severe group and the critically ill group，with statistically significant differences（P<0.001）. Levels of serum IL-1β and IL-8 did not change significantly in each clini－cal group and P values were 0.388 and 0.128，without statistical significance（P>0.05）. AUC of serum IL-6 and CRP/ALB was 0.931，the sensitivity was 0.885，and the specificity was 0.825. Conclusion：Real-time detection of various serum inflammatory markers combined with T lymphocyte subsets can contribute to judging the prognosis of patients with COVID-19，which can be regarded as a vital reference to evaluate effectiveness，e severity and prognosis. The combined detection of serum IL-6 and CRP/ALB will greatly improve the accuracy of predicting the severity of COVID-19.