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新型冠状病毒肺炎(corona virus disease 2019, COVID-19)以发热、干咳和乏力为主要表现,主要通过飞沫及密切接触传播,且人群普遍易感。2020年3月12日,WHO宣布COVID-19已经具备大流行特征。研究[1-3]指出,血清D-二聚体水平与肺炎病人的病情严重程度及预后紧密相关。KILIÇ等[4]发现H1N1感染的病毒性肺炎病人血清D-二聚体升高,并且同疾病严重程度相关。在《新型冠状病毒肺炎诊疗方案(试行第七版)》中,外周血炎症因子如C反应蛋白(C reactive protein, CRP)及白细胞介素-6(interleukin, IL-6)进行性上升作为早期预警指标,提示CRP及IL-6对COVID-19疾病严重程度具有重要意义。关于D-二聚体、CRP和IL-6在非COVID-19社区获得性肺炎(community acquired pneumonia,CAP)及COVID-19中的表达差异,以及D-二聚体同CRP及IL-6在COVID-19病人中的相关性,目前鲜有文献报道。截至2020年3月15日,安徽省阜阳市累计报告确诊COVID-19病人155例,均在阜阳市第二人民医院住院并已治愈出院。根据排除标准,笔者对在本院治愈出院的128例COVID-19病人进行回顾性分析,以期探讨血清D-二聚体、CRP及IL-6在COVID-19病人中的临床意义及相关性。
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与对照组相比,COVID-19普通型组血清D-二聚体、CRP水平显著下降(P < 0.01)。血清IL-6水平在2组之间比较差异无统计学意义(P>0.05)(见表 1)。
分组 D-二聚体/(mg/L) CRP/(mg/L) IL-6/(pg/mL) 对照组 0.40(0.28,0.67) 29.15(4.95,81.32) 14.05(5.10,29.42) 普通型组 0.25(0.19,0.37) 8.80(1.78,23.05) 11.05(5.00,24.65) z 5.05 4.80 0.62 P < 0.01 < 0.01 >0.05 表 1 对照组及COVID-19普通型组血清D-二聚体、CRP及IL-6水平比较[M(P25, P75)]
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普通型、重型及危重型COVID-19病人血清D-二聚体、CRP及IL-6水平比较差异有统计学意义(P < 0.01),其中重型组和危重型组的血清D-二聚体、CRP及IL-6水平均高于普通型组(P < 0.05)(见表 2)。
分组 D-二聚体/(mg/L) CRP/(mg/L) IL-6/(pg/mL) 普通型组 0.24(0.19,0.37) 8.80(1.77,23.05) 11.05(5.00,24.65) 重型组 0.42(0.29,0.61)* 38.40(17.52,69.55)* 36.20(22.12,56.35)* 危重型组 0.94(0.71,6.26)* 147.75(51.05,218.12)* 209.65(50.15,515.32)* χ2 20.89 26.50 25.47 P < 0.01 < 0.01 < 0.01 注:与普通型组比较*P < 0.05 表 2 不同分型COVID-19病人血清D-二聚体、CRP及IL-6水平比较[M(P25, P75)]
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COVID-19病人中血清D-二聚体水平和CRP及IL-6均呈正相关(rs=0.347和0.277,P < 0.01)。
D-二聚体、C反应蛋白及白细胞介素-6在新型冠状病毒肺炎的临床意义及相关性分析
Analysis of clinical significance and correlation of D-dimer, C reactive protein and interleukin-6 in COVID-19
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摘要:
目的探讨血清D-二聚体、C反应蛋白(C reactive protein,CRP)、白细胞介素-6(interleukin-6,IL-6)在新型冠状病毒肺炎(corona virus disease 2019,COVID-19)病人的临床意义及相关性分析。 方法回顾性分析COVID-19确诊病人128例,根据临床分型分为普通型组(102例)、重型组(22例)和危重型组(4例),选取90例非COVID-19且非重症的社区获得性肺炎病人作为对照组,比较对照组和普通型组血清D-二聚体、CRP及IL-6的水平,比较普通型组、重症组和危重症组血清D-二聚体、CRP及IL-6的水平,分析COVID-19病人血清D-二聚体与CRP、IL-6的相关性。 结果普通型组血清D-二聚体和CRP水平均低于对照组(P < 0.05),2组血清IL-6水平比较差异无统计学意义(P>0.05)。普通型、重型及危重型COVID-19病人血清D-二聚体、CRP及IL-6水平比较差异有统计学意义(P < 0.01)。其中重型组和危重型组的血清D-二聚体、CRP及IL-6水平均高于普通型组(P < 0.05)。COVID-19病人中D-二聚体水平与CRP及IL-6水平均呈正相关(P < 0.01)。 结论血清D-二聚体、CRP及IL-6水平有助于评估COVID-19病人病情严重程度及预后。 Abstract:ObjectiveTo investigate the clinical significance and correlation of the serum levels of D-dimer, C reactive protein(CRP) and interleukin-6(IL-6) in corona virus disease 2019(COVID-19). MethodsThe clinical data of 128 COVID-19 patients were retrospectively analyzed, and the patients were divided into the ordinary group(102 cases), severe group(22 cases) and critical group(4 cases) according to the clinical classification.Ninety non-COVID-19 and non-severe community-acquired pneumonia patients were set as the control group.The differences of the serum levels of D-dimer, CRP and IL-6 between the control group and ordinary group, and among the ordinary group, severe group and critical group were compared.The correlation between the serum levels of D-dimer and CRP, IL-6 in patients with COVID-19 were analyzed. ResultsThe serum levels of D-dimer and CRP in ordinary group were lower than those in control group(P < 0.05), and there was no statistical significance in the serum level of IL-6 between two groups(P>0.05).There were statistical significance in the serum levels of D-dimer, CRP and IL-6 among the ordinary group, severe group and critical group(P < 0.01).The serum levels of D-dimer, CRP and IL-6 in severe group and critical group were higher than those in ordinary group(P < 0.05), and the serum levels of D-dimer in COVID-19 patients were positively correlated with the serum levels of CRP and IL-6(P < 0.01). ConclusionsThe serum levels of D-dimer, CRP and IL-6 are conducive to assess the severity and prognosis of patients with COVID-19. -
Key words:
- corona virus disease 2019 /
- D-dimer /
- C reactive protein /
- interleukin-6
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表 1 对照组及COVID-19普通型组血清D-二聚体、CRP及IL-6水平比较[M(P25, P75)]
分组 D-二聚体/(mg/L) CRP/(mg/L) IL-6/(pg/mL) 对照组 0.40(0.28,0.67) 29.15(4.95,81.32) 14.05(5.10,29.42) 普通型组 0.25(0.19,0.37) 8.80(1.78,23.05) 11.05(5.00,24.65) z 5.05 4.80 0.62 P < 0.01 < 0.01 >0.05 表 2 不同分型COVID-19病人血清D-二聚体、CRP及IL-6水平比较[M(P25, P75)]
分组 D-二聚体/(mg/L) CRP/(mg/L) IL-6/(pg/mL) 普通型组 0.24(0.19,0.37) 8.80(1.77,23.05) 11.05(5.00,24.65) 重型组 0.42(0.29,0.61)* 38.40(17.52,69.55)* 36.20(22.12,56.35)* 危重型组 0.94(0.71,6.26)* 147.75(51.05,218.12)* 209.65(50.15,515.32)* χ2 20.89 26.50 25.47 P < 0.01 < 0.01 < 0.01 注:与普通型组比较*P < 0.05 -
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