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浙江大学学报（医学版）
浙江大学学报（医学版）  2020, Vol. 49 Issue (2): 227-231    DOI: 10.3785/j.issn.1008-9292.2020.03.06
原著     
血浆置换和托珠单抗治疗六例2019冠状病毒病(COVID-19)重型患者临床分析
骆嵩1(),杨丽娟2,王春1,刘传苗3,李殿明4
1. 蚌埠医学院第一附属医院神经内科, 安徽 蚌埠 233004
2. 蚌埠医学院第一附属医院儿科, 安徽 蚌埠 233004
3. 蚌埠医学院第一附属医院感染科, 安徽 蚌埠 233004
4. 蚌埠医学院第一附属医院呼吸科, 安徽 蚌埠 233004
Clinical observation of 6 severe COVID-19 patients treated with plasma exchange or tocilizumab
LUO Song1(),YANG Lijuan2,WANG Chun1,LIU Chuanmiao3,LI Dianming4
1. Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
2. Department of Pediatrics, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
3. Department of Infectious Diseases, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
4. Department of Respiratory Medicine, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
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摘要：

目的: 分析血浆置换和托珠单抗治疗2019冠状病毒病（COVID-19）重型患者的疗效。方法: 回顾性分析2020年1月25日至2月25日在蚌埠医学院第一附属医院感染应急病区接受治疗的6例COVID-19重型患者的临床资料（3例采用血浆置换治疗，3例采用托珠单抗治疗）。观察血浆置换和托珠单抗治疗对患者体内过度炎症反应的抑制作用。结果: 血浆置换治疗后，3例患者C反应蛋白和IL-6水平下降明显，淋巴细胞和凝血酶原时间均有改善；托珠单抗治疗后，3例患者炎症水平未见明显下降，淋巴细胞计数和凝血酶原时间也无明显改善。结论: COVID-19重型患者采用血浆置换治疗后炎症因子水平明显降低或恢复正常，而托珠单抗治疗患者炎症因子下降不明显。因此对于炎症反应强烈的COVID-19重型患者，血浆置换可能是首选。
关键词： 2019冠状病毒病;  严重急性呼吸综合征冠状病毒2;  新型冠状病毒肺炎;  危重病;  血浆置换;  托珠单抗    
Abstract:

Objective: To observe the clinical effect of plasma exchange and tocilizumab in treatment of patients with severe coronavirus disease 2019 (COVID-19). Methods: Six patients with severe COVID-19 admitted in First Affiliated Hospital of Bengbu Medical College from January 25 to February 25, 2020. Three patients were treated with plasma exchange and three patients were treated with tocilizumab. The effect on excessive inflammatory reaction of plasma exchange and tocilizumab was observed. Results: The C-reactive protein (CRP) and IL-6 levels were significantly decreased and the lymphocyte and prothrombin time were improved in 3 patients after treatment with plasma exchange; while inflammation level was not significantly decreased, and lymphocyte and prothrombin time did not improve in 3 patients treated with tocilizumab. Conclusion: For severe COVID-19 patients with strong inflammatory reaction, plasma exchange may be preferred.
Key words: Coronavirus disease 2019    Severe acute respiratory syndrome coronavirus 2    Novel coronavirus pneumonia    Critical illness    Plasma exchange    Tocilizumab
收稿日期: 2020-03-06 出版日期: 2020-03-13
:  R512.99  
基金资助: 蚌埠医学院第一附属医院领先新技术项目(2019091);蚌埠医学院自然科学基金(BYKY1673, 1790);安徽省高校自然科学研究重点项目(KJ2019A0364);中匈科学合作基金-青年学者计划(2019)
作者简介: 骆嵩(1986—)，男，硕士，主治医师，主要从事脑血管病及危重病研究；E-mail：542462407@qq.com; https://orcid.org/0000-0002-0939-7249
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引用本文:

骆嵩,杨丽娟,王春,刘传苗,李殿明. 血浆置换和托珠单抗治疗六例2019冠状病毒病(COVID-19)重型患者临床分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 227-231.

LUO Song,YANG Lijuan,WANG Chun,LIU Chuanmiao,LI Dianming. Clinical observation of 6 severe COVID-19 patients treated with plasma exchange or tocilizumab. J Zhejiang Univ (Med Sci), 2020, 49(2): 227-231.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.06    或    http://www.zjujournals.com/med/CN/Y2020/V49/I2/227

例序 白细胞计数
(×109/L)		 淋巴细胞计数
(×109/L)		 血小板计数
(×109/L)		 血红蛋白
(g/L)		 ALT
(U/L)		 AST
(U/L)		 总胆红素
(μmol/L)		 肌酐
(μmol/L)		 PT(s) C反应蛋白
(mg/L)		 IL-6
(pg/mL)
  ALT：丙氨酸转氨酶；AST：天冬氨酸转氨酶；PT：凝血酶原时间.
病例1
  治疗前 4.36 0.56 158 142 33 47 14.8 70 12.4 84.81 12.14
  治疗后 9.31 1.26 260 139 12 18 5.8 62 11.3 9.20 4.33
病例2
  治疗前 10.59 1.07 205 134 30 41 10.6 66 12.8 123.1 12.20
  治疗后 11.22 2.72 209 139 26 37 10.5 66 11.7 20.1 2.55
病例3
  治疗前 8.84 0.52 203 136 17 34 29.1 59 13.9 196.3 142.90
  治疗后 8.05 0.79 142 116 49 40 16.0 58 12.5 84.2 6.48
表 1  采用血浆置换治疗的3例2019冠状病毒病重型患者治疗前后实验室检查结果对照
例序 白细胞计数
(×109/L)		 淋巴细胞计数
(×109/L)		 血小板计数
(×109/L)		 血红蛋白
(g/L)		 ALT
(U/L)		 AST
(U/L)		 总胆红素
(μmol/L)		 肌酐
(μmol/L)		 PT(s) C反应蛋白
(mg/L)		 IL-6
(pg/mL)
  ALT：丙氨酸转氨酶；AST：天冬氨酸转氨酶；PT：凝血酶原时间.
病例4
  治疗前 5.25 0.84 181 113 30 50 16.8 59 10.3 35.35 75.52
  治疗后 8.74 1.80 294 122 51 26 8.6 67 10.9 7.63 62.43
病例5
  治疗前 8.36 1.99 246 127 17 33 11.7 77 14.0 74.3 15.67
  治疗后 6.67 1.74 265 120 22 26 8.5 87 15.0 15.9 16.34
病例6
  治疗前 14.23 0.62 235 124 16 20 4 60 10.3 24.6 13.39
  治疗后 6.35 0.61 232 118 15 17 7.1 61 11.1 8.8 17.98
表 2  采用托珠单抗治疗的3例2019冠状病毒病重型患者治疗前后实验室检查结果对照
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