Department of Laboratory Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan
Huang Huayi, School of Laboratory Medicine, Youjiang National Medical University, Baise, Guangxi, 533000, Mindray North America, Mahwah, New Jersey, 07430, USA.
Department of Laboratory Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
Department of Laboratory Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan
Huang Huayi, School of Laboratory Medicine, Youjiang National Medical University, Baise, Guangxi, 533000, Mindray North America, Mahwah, New Jersey, 07430, USA.
Gwiritsani ntchito ulalo womwe uli pansipa kuti mugawane zolemba zonse za nkhaniyi ndi anzanu komanso anzanu.Dziwani zambiri.
Kuti timvetsetse bwino za kusintha kwa matenda a COVID-19, ndizothandiza pakuwongolera zachipatala komanso kukonzekera miliri yofananira mtsogolo.
Magawo a hematological a odwala 52 a COVID-19 omwe adagonekedwa m'zipatala zomwe adasankhidwa adawunikidwanso.Detayo idawunikidwa pogwiritsa ntchito pulogalamu yowerengera ya SPSS.
Asanayambe chithandizo, T cell subsets, ma lymphocytes okwana, maselo ofiira a magazi ofiira (RDW), eosinophils ndi basophils anali otsika kwambiri kuposa pambuyo pa chithandizo, pamene zizindikiro zotupa za neutrophils, neutrophils ndi lymphocytes The ratio (NLR) ndi C β-reactive protein ( CRP) komanso maselo ofiira a m'magazi (RBC) ndi hemoglobini anachepa kwambiri pambuyo pa chithandizo.Ma cell a T cell, ma lymphocyte okwana ndi ma basophils a odwala kwambiri komanso odwala kwambiri anali otsika kwambiri kuposa odwala omwe ali odziletsa.Ma Neutrophils, NLR, eosinophils, procalcitonin (PCT) ndi CRP ndi apamwamba kwambiri mwa odwala kwambiri komanso odwala kwambiri kusiyana ndi odwala omwe ali odziletsa.Ma CD3+, CD8+, ma lymphocyte okwana, mapulateleti, ndi ma basophils a odwala opitilira zaka 50 ndi otsika kuposa omwe ali ndi zaka zosakwana 50, pomwe neutrophils, NLR, CRP, RDW mwa odwala opitilira zaka 50 ndi apamwamba kuposa omwe ali ndi zaka zosakwana 50.Odwala kwambiri komanso odwala kwambiri, pali mgwirizano wabwino pakati pa nthawi ya prothrombin (PT), alanine aminotransferase (ALT) ndi aspartate aminotransferase (AST).
T cell subsets, lymphocyte count, RDW, neutrophils, eosinophils, NLR, CRP, PT, ALT ndi AST ndizizindikiro zofunika pakuwongolera, makamaka kwa odwala kwambiri komanso odwala kwambiri omwe ali ndi COVID-19.
Mliri wa 2019 Coronavirus (COVID-19) woyambitsidwa ndi mtundu watsopano wa coronavirus udayamba mu Disembala 2019 ndikufalikira mwachangu padziko lonse lapansi.1-3 Kumayambiriro kwa mliriwu, chisamaliro chachipatala chinali pa mawonetseredwe ndi miliri, kuphatikizapo computed tomography kuti chifaniziro cha odwala 4 ndi 5, ndiyeno anapezeka ndi zotsatira zabwino za nucleotide amplification.Komabe, kuvulala kosiyanasiyana kwa pathological kunapezeka pambuyo pake m'zigawo zosiyanasiyana.6-9 Umboni wochulukirachulukira ukuwonetsa kuti kusintha kwapathophysiological kwa COVID-19 ndizovuta kwambiri.Kuwukira kwa ma virus kumayambitsa kuwonongeka kwa ziwalo zingapo ndipo chitetezo chamthupi chimachulukana.Kuwonjezeka kwa seramu ndi alveolar cytokines ndi mapuloteni oyankha kutupa kwawonedwa7, 10-12, ndi lymphopenia ndi maselo a T cell osadziwika bwino apezeka mwa odwala kwambiri.13, 14 Zimanenedwa kuti chiŵerengero cha neutrophils ndi ma lymphocyte chakhala chizindikiro chothandiza kusiyanitsa zilonda za chithokomiro choopsa komanso chosaopsa pazachipatala.15 NLR ingathandizenso kusiyanitsa odwala omwe ali ndi zilonda zam'mimba ndi zowongolera zathanzi.16 Imagwiranso ntchito mu chithokomiro ndipo imalumikizidwa ndi matenda amtundu wa 2.17, 18 RDW ndi chizindikiro cha erythrocytosis.Kafukufuku wapeza kuti zimathandiza kusiyanitsa tinthu tating'onoting'ono ta chithokomiro, matenda a nyamakazi, matenda a lumbar disc, ndi chithokomiro.19-21 CRP ndizowonetseratu za kutupa ndipo zaphunziridwa nthawi zambiri.22 Posachedwapa zadziwika kuti NLR, RDW ndi CRP nawonso akutenga nawo gawo mu COVID-19 ndipo amatenga gawo lofunikira pakuzindikiritsa komanso kudziwa za matendawa.11, 14, 23-25 Chifukwa chake, zotsatira za mayeso a labotale ndizofunikira pakuwunika momwe wodwalayo alili ndikusankha chithandizo.Tidawunikiranso mozama magawo a labotale a odwala 52 a COVID-19 omwe adagonekedwa m'zipatala zodziwika ku South China malinga ndi chithandizo chawo chisanachitike komanso pambuyo pake, kuopsa kwawo, komanso zaka zawo, kuti timvetsetse kusintha kwa matendawa ndikuthandizira kasamalidwe kachipatala kamtsogolo. za COVID-19.
Kafukufukuyu adawunikiranso odwala 52 a COVID-19 omwe adagonekedwa kuchipatala chomwe chidasankhidwa cha Nanning Fourth Hospital kuyambira Januware 24, 2020 mpaka Marichi 2, 2020. Mwa iwo, 45 anali kudwala kwambiri ndipo 5 anali kudwala kwambiri.Mwachitsanzo, zaka zimachokera ku miyezi itatu mpaka zaka 85.Pankhani ya jenda, panali amuna 27 ndi akazi 25.Wodwala amakhala ndi zizindikiro monga kutentha thupi, chifuwa chowuma, kutopa, kupweteka mutu, kupuma movutikira, kutsekeka kwa mphuno, mphuno, zilonda zapakhosi, kupweteka kwa minofu, kutsekula m’mimba, ndi myalgia.Computed tomography inasonyeza kuti mapapo anali akhungu kapena galasi pansi, kusonyeza chibayo.Dziwani molingana ndi kope lachisanu ndi chiwiri la Chinese COVID-19 Diagnosis and Treatment Guidelines.Kutsimikiziridwa ndi nthawi yeniyeni qPCR kuzindikira kwa ma viral nucleotides.Malingana ndi njira zodziwira matenda, odwala adagawidwa m'magulu apakati, ovuta, komanso ovuta.Nthawi zolimbitsa thupi, wodwalayo amayamba kutentha thupi komanso kupuma, ndipo zomwe apeza zimawonetsa chibayo.Ngati wodwalayo akukumana ndi zotsatirazi, matendawa ndi ovuta: (a) kupuma kwa kupuma (kupuma ≥30 kupuma / min);(b) kupumula chala magazi oxygen machulukitsidwe ≤93%;(c) kuthamanga kwa mpweya wa okosijeni (PO2)) / gawo lothandizira O2 (Fi O2) ≤300 mm Hg (1 mm Hg = 0.133 kPa).Ngati wodwalayo akukumana ndi zotsatirazi, matendawa ndi ovuta kwambiri: (a) kulephera kupuma komwe kumafuna mpweya wabwino wa makina;(b) kunjenjemera;(c) kulephera kwa chiwalo china chomwe chimafuna chithandizo mu chipinda cha odwala kwambiri (ICU).Malinga ndi zomwe tafotokozazi, odwala 52 adapezeka kuti akudwala kwambiri m'milandu iwiri, odwala kwambiri m'milandu isanu, ndipo odwala 45 amadwala kwambiri.
Odwala onse, kuphatikizapo odwala, odwala kwambiri komanso odwala kwambiri, amathandizidwa motsatira ndondomeko zotsatirazi: (a) General adjuvant therapy;(b) Mankhwala oletsa tizilombo toyambitsa matenda: lopinavir/ritonavir ndi α-interferon;(c) Mlingo wa mankhwala achi China ukhoza kusinthidwa malinga ndi momwe wodwalayo alili.
Kafukufukuyu adavomerezedwa ndi Komiti Yowunikiranso ya Research Institute of Nanning Fourth Hospital ndipo idagwiritsidwa ntchito kusonkhanitsa chidziwitso cha odwala.
Kusanthula kwa hematology yamagazi: kusanthula kwanthawi zonse kwa hematology yamagazi ozungulira kumachitika pa Mindray BC-6900 hematology analyzer (Mindray) ndi Sysmex XN 9000 hematology analyzer (Sysmex).Kusala kudya kwa ethylenediaminetetraacetic acid (EDTA) anticoagulant magazi anasonkhanitsidwa m'mawa pamene wodwalayo adagonekedwa kuchipatala.Kuwunika kosasinthasintha pakati pa osanthula magazi awiriwa kunatsimikiziridwa motsatira njira zoyendetsera khalidwe la labotale.Pakuwunika kwa hematology, kuwerengera ndi kusiyanitsa kwa maselo oyera a magazi (WBC), maselo ofiira a m'magazi (RBC) ndi index zimapezedwa limodzi ndi magawo omwaza ndi ma histogram.
Flow cytometry ya T lymphocyte subpopulations: BD (Becton, Dickinson ndi Company) FACSCalibur yothamanga cytometer inagwiritsidwa ntchito poyesa kufufuza kwa cytometry kuti ifufuze ma T cell subpopulations.Unikani zambiri ndi pulogalamu ya MultiSET.Kuyeza kunkachitika motsatira ndondomeko zoyendetsera ntchito komanso malangizo a wopanga.Gwiritsani ntchito chubu chotolera magazi cha EDTA kuti mutenge 2 ml ya magazi a venous.Sakanizani chitsanzocho pang'onopang'ono potembenuza chubu lachitsanzo kangapo kuti mupewe condensation.Zitsanzo zikasonkhanitsidwa, zimatumizidwa ku labotale ndikuwunikiridwa mkati mwa maola 6 kutentha kwachipinda.
Kusanthula kwa Immunofluorescence: Mapuloteni a C-reactive (CRP) ndi procalcitonin (PCT) adawunikidwa atangomaliza kusanthula pogwiritsa ntchito zitsanzo zamagazi zomwe zidafufuzidwa ndi hematology, ndikuwunikidwa pa FS-112 immunofluorescence analyzer (Wondfo Biotech Co., LTD.) kusanthula.) Tsatirani malangizo a wopanga ndi ndondomeko za labotale.
Unikani seramu ya alanine aminotransferase (ALT) ndi aspartate aminotransferase (AST) pa HITACHI LABOSPECT008AS chemical analyzer (HITACHI).Nthawi ya prothrombin (PT) idawunikidwa pa STAGO STA-R Evolution analyzer (Diagnostica Stago).
Reverse transcription quantitative polymerase chain reaction (RT-qPCR): Gwiritsani ntchito ma tempuleti a RNA otalikirana ndi swabs za nasopharyngeal kapena zotulutsa zam'munsi za kupuma kuti mupangire RT-qPCR kuti muzindikire SARS-CoV-2.Nucleic acids adalekanitsidwa pa SSNP-2000A nucleic acid automatic separation platform (Bioperfectus Technologies).Zida zodziwira zidaperekedwa ndi Sun Yat-sen University Daan Gene Co., Ltd. ndi Shanghai BioGerm Medical Biotechnology Co., Ltd. Thermal cycle inachitidwa pa ABI 7500 thermal cycler (Applied Biosystems).Zotsatira za mayeso a viral nucleoside zimatanthauzidwa kuti zabwino kapena zoipa.
Pulogalamu ya SPSS 18.0 idagwiritsidwa ntchito posanthula deta;t-test, t-test yodziyimira pawokha, kapena Mann-Whitney U adagwiritsidwa ntchito, ndipo mtengo wa P <.05 unkaonedwa kuti ndi wofunika.
Odwala asanu omwe anali odwala kwambiri komanso awiri odwala kwambiri anali okalamba kuposa omwe ali m'gulu laling'ono (69.3 vs. 40.4).Tsatanetsatane wa 5 odwala kwambiri ndi odwala 2 omwe akudwala kwambiri akuwonetsedwa mu Matebulo 1A ndi B. Odwala kwambiri ndi odwala kwambiri nthawi zambiri amakhala ochepa mu T cell subsets ndi chiwerengero chonse cha lymphocyte, koma chiwerengero cha maselo oyera a magazi ndi pafupifupi, kupatulapo odwala. ndi maselo oyera a magazi okwera (11.5 × 109 / L).Ma neutrophils ndi monocytes nthawi zambiri amakhala okwera.Miyezo ya seramu ya PCT, ALT, AST ndi PT ya odwala awiri omwe anali odwala kwambiri komanso wodwala m'modzi yemwe anali kudwala kwambiri anali okwera, ndipo PT, ALT, AST ya wodwala 1 wodwala kwambiri komanso odwala awiri omwe anali kudwala kwambiri anali ogwirizana.Pafupifupi odwala onse 7 anali ndi CRP yayikulu.Ma Eosinophils (EOS) ndi basophils (BASO) amakhala otsika mwa odwala kwambiri komanso odwala kwambiri (Table 1A ndi B).Gulu 1 limatchula kufotokoza kwanthawi zonse kwa magawo a hematological mwa anthu akuluakulu aku China.
Kusanthula kwachiwerengero kunasonyeza kuti musanayambe chithandizo, CD3 +, CD4 +, CD8 + T maselo, lymphocytes okwana, RBC kugawa m'lifupi (RDW), eosinophils ndi basophils anali otsika kwambiri kuposa pambuyo mankhwala (P = .000,. 000, .000, .012, . 04, .000 ndi .001).Zizindikiro zotupa za neutrophils, neutrophil / lymphocyte ratio (NLR) ndi CRP musanayambe chithandizo zinali zapamwamba kwambiri kuposa pambuyo pa chithandizo (P = .004, .011 ndi .017, motsatira).Hb ndi RBC zinachepa kwambiri pambuyo pa chithandizo (P = .032, .026).PLT inawonjezeka pambuyo pa chithandizo, koma sizinali zofunikira (P = .183) (Table 2).
Ma cell a T cell (CD3 +, CD4 +, CD8 +), ma lymphocyte onse ndi ma basophils a odwala kwambiri komanso odwala kwambiri anali otsika kwambiri kuposa odwala omwe ali ndi vuto (P = .025, 0.048, 0.027, 0.006 ndi .046).Miyezo ya neutrophils, NLR, PCT ndi CRP mu odwala kwambiri komanso odwala kwambiri anali apamwamba kwambiri kuposa odwala omwe ali ndi odwala (P = .005, .002, .049 ndi .002, motsatira).Odwala kwambiri komanso odwala kwambiri anali ndi PLT yochepa kusiyana ndi odwala omwe ali ochepa;komabe, kusiyana sikunali kofunika kwambiri (Table 3).
Ma CD3+, CD8+, okwana ma lymphocyte, mapulateleti, ndi ma basophils a odwala opitilira zaka 50 anali otsika kwambiri kuposa a odwala osakwana zaka 50 (P = .049, 0.018, 0.019, 0.010 ndi .039, motsatana), pomwe opitilira Ma neutrophils a Odwala a zaka 50, chiŵerengero cha NLR, CRP ndi RDW zinali zapamwamba kwambiri kuposa za odwala osakwana zaka 50 (P = .0191, 0.015, 0.009, ndi .010, motsatira) (Table 4).
COVID-19 imayamba chifukwa cha matenda a coronavirus SARS-CoV-2, omwe adawonekera koyamba ku Wuhan, China mu Disembala 2019. Mliri wa SARS-CoV-2 unafalikira mwachangu pambuyo pake ndikupangitsa mliri wapadziko lonse lapansi.1-3 Chifukwa cha chidziwitso chochepa cha miliri ndi matenda a kachilombo ka HIV, chiwerengero cha anthu omwe amafa kumayambiriro kwa mliriwu ndi chapamwamba.Ngakhale kulibe mankhwala oletsa tizilombo toyambitsa matenda, kasamalidwe kotsatira ndi chithandizo cha COVID-19 kwasintha kwambiri.Izi ndi zoona makamaka ku China pamene mankhwala adjuvant amaphatikizidwa ndi mankhwala achi China kuti athetse matenda oyambirira komanso apakati.Odwala 26 a COVID-19 apindula pakumvetsetsa bwino za kusintha kwa ma pathological ndi magawo a labotale a matendawa.matenda.Kuyambira nthawi imeneyo, chiwerengero cha anthu omwe amafa chatsika.Mu lipotili, palibe omwe amwalira pakati pa milandu 52 yomwe idawunikidwa, kuphatikiza 7 odwala kwambiri komanso odwala kwambiri (Table 1A ndi B).
Kuwunika kwachipatala kwapeza kuti odwala ambiri omwe ali ndi COVID-19 achepetsa ma lymphocyte ndi ma T cell subpopulations, omwe amagwirizana ndi kuopsa kwa matendawa.13, 27 Mu lipotili, anapeza kuti CD3 +, CD4 +, CD8 + T maselo, lymphocytes okwana, RDW pamaso pa mankhwala, eosinophils ndi basophils anali otsika kwambiri kuposa pambuyo mankhwala (P = .000, .000, .000, .012, .04, .000 ndi .001).Zotsatira zathu zikufanana ndi malipoti am'mbuyomu.Malipotiwa ali ndi tanthauzo lachipatala pakuwunika kuopsa kwa COVID-19.8, 13, 23-25, 27, pomwe zotupa zimawonetsa ma neutrophils, neutrophils/lymphocyte ratio (NLR ) Ndi CRP mutalandira chithandizo chisanachitike kuposa chithandizo (P = .004, . 011 ndi .017, motsatana), zomwe zazindikirika ndikunenedwa kale mwa odwala a COVID-19.Chifukwa chake, magawowa amawonedwa ngati zizindikiro zothandiza pochiza COVID-19.8.Pambuyo pa chithandizo, 11 hemoglobini ndi maselo ofiira a magazi adachepetsedwa kwambiri (P = .032, 0.026), kusonyeza kuti wodwalayo anali ndi magazi m'thupi panthawi ya chithandizo.Kuwonjezeka kwa PLT kunawonedwa pambuyo pa chithandizo, koma sizinali zofunikira (P = .183) (Table 2).Kuchepa kwa ma lymphocyte ndi ma T cell subpopulations amaganiziridwa kuti akugwirizana ndi kuchepa kwa ma cell ndi apoptosis akamadziunjikira m'malo otupa omwe amalimbana ndi kachilomboka.Kapena, mwina adadyedwa ndi kutulutsa kwakukulu kwa ma cytokines ndi mapuloteni otupa.8.29 Mukuwona kwathu, ma lymphocytes ndi T cell subsets adachira pambuyo pa chithandizo, ndipo milandu yonse ya 52 idachiritsidwa (Table 1).Miyezo yambiri ya neutrophils, NLR, ndi CRP inawonedwa isanayambe chithandizo, ndiyeno inachepa kwambiri pambuyo pa chithandizo (P = .004, .011, ndi .017, motsatira) (Table 2).Ntchito ya maselo a T cell mu matenda ndi kuyankha kwa chitetezo cha mthupi zanenedwa kale.29, 31-34
Popeza chiwerengero cha odwala kwambiri komanso odwala kwambiri ndi ochepa kwambiri, sitinachite kafukufuku wowerengera pazigawo zapakati pa odwala kwambiri komanso odwala kwambiri komanso odwala omwe ali ndi pakati.Maselo a T cell (CD3 +, CD4 +, CD8 +) ndi ma lymphocyte onse a odwala kwambiri komanso odwala kwambiri amakhala otsika kwambiri kuposa odwala omwe ali odziletsa.Miyezo ya neutrophils, NLR, PCT, ndi CRP mu odwala kwambiri komanso odwala kwambiri anali apamwamba kwambiri kuposa odwala omwe ali ndi odwala (P = .005, .002, .049, ndi .002, motsatira) (Table 3).Kusintha kwa magawo a labotale kumagwirizana ndi kuopsa kwa COVID-19.35.36 Chifukwa cha basophilia sichidziwika bwino;izi zikhoza kukhala chifukwa cha kudya chakudya pamene akulimbana ndi kachilomboka pa malo matenda ofanana lymphocytes.35 Kafukufukuyu adapeza kuti odwala omwe ali ndi COVID-19 adachepetsanso ma eosinophils;14 Komabe, deta yathu sinasonyeze kuti chodabwitsa ichi chikhoza kukhala chifukwa cha chiwerengero chochepa cha milandu yovuta komanso yovuta yomwe ikuwonetsedwa mu phunziroli.
Chochititsa chidwi n'chakuti, tapeza kuti mwa odwala kwambiri komanso odwala kwambiri, pali mgwirizano wabwino pakati pa PT, ALT, ndi AST, zomwe zimasonyeza kuti kuwonongeka kwa ziwalo zambiri kunachitika pakuwukira kwa kachilomboka, monga tafotokozera m'mawu ena.37 Chifukwa chake, atha kukhala magawo atsopano ofunikira pakuwunika momwe angayankhire komanso momwe amachiritsira COVID-19.
Kufufuza kwina kunasonyeza kuti ma CD3+, CD8+, ma lymphocyte okwana, mapulateleti ndi ma basophils a odwala opitirira zaka 50 anali otsika kwambiri kuposa odwala osakwana zaka 50 (P = P = .049, .018, .019, .010 ndi. 039, motsatana), pamene milingo ya neutrophils, NLR, CRP, ndi RBC RDW mwa odwala opitilira zaka 50 inali yayikulu kwambiri kuposa ya odwala osakwana zaka 50 (P = .0191, 0.015, 0.009, ndi .010 , motsatira) (Gulu 4) .Zotsatirazi zikufanana ndi malipoti am'mbuyomu.14, 28, 29, 38-41 Kuchepa kwa T cell subpopulations ndi kuchuluka kwa CD4 +/CD8 + T cell kumagwirizana ndi kuopsa kwa matenda;milandu ya okalamba imakhala yovuta kwambiri;Choncho, ma lymphocyte ambiri adzadyedwa mu chitetezo cha mthupi kapena kuwonongeka kwambiri.Momwemonso, RBC RDW yapamwamba ikuwonetsa kuti odwalawa ayamba kuchepa magazi.
Zotsatira za kafukufuku wathu zimatsimikiziranso kuti magawo a hematological ndi ofunikira kwambiri pakumvetsetsa bwino zakusintha kwachipatala kwa odwala a COVID-19 komanso kuwongolera chitsogozo chamankhwala ndi matenda.
Liang Juanying ndi Nong Shaoyun adasonkhanitsa deta ndi chidziwitso chachipatala;Jiang Liejun ndi Chi Xiaowei adasanthula deta;Dewu Bi, Jun Cao, Lida Mo, ndi Xiaolu Luo anachita kusanthula mwachizolowezi;Huang Huayi anali ndi udindo wotsogolera ndi kulemba.
Chonde onani imelo yanu kuti mupeze malangizo okhazikitsanso mawu achinsinsi.Ngati simulandira imelo mkati mwa mphindi 10, adilesi yanu ya imelo mwina simungalembetse ndipo mungafunike kupanga akaunti yatsopano ya Wiley Online Library.
Ngati adilesi ikufanana ndi akaunti yomwe ilipo, mudzalandira imelo yokhala ndi malangizo oti mutengenso dzina lolowera
Nthawi yotumiza: Jul-22-2021