| 摘要: |
| 目的 探究血清IL-6在高龄奥密克戎变异株感染者中的临床意义，以及合并基础疾病与血清IL-6水平的相关性。方法 纳入2022年4－6月入住海军军医大学（第二军医大学）第一附属医院感染科、严重急性呼吸综合征冠状病毒2 RNA检测呈阳性的高龄（＞80岁）奥密克戎变异株感染患者22例，采用流式细胞学检测法测定血清IL-6水平，采用免疫比浊法测定CRP水平。根据影像学检查有无肺炎表现将患者分为肺炎组（16例）和无肺炎组（6例），根据病情分为重症组（重型和危重型，5例）和非重症组（轻型和普通型，17例），采用二分类logistic回归模型和ROC曲线分析血清IL-6、CRP水平与病情严重程度和是否进展为肺炎的相关性，同时探究合并基础疾病与血清IL-6水平的关系。结果 22例患者中轻型6例、普通型11例、重型3例、危重型2例。肺炎组基线血清IL-6水平高于无肺炎组[（20.16±12.36）pg/mL vs（5.42±1.57）pg/mL，P＝0.009]，肺炎组和无肺炎组基线血清CRP水平差异无统计学意义（P＞0.05）；重症组和非重症组基线血清IL-6和CRP水平差异均无统计学意义（P均＞0.05）。logistic回归分析显示，基线血清IL-6、CRP水平可能与感染奥密克戎变异株后进展为肺炎有关，但均无统计学意义（OR＝2.407，95% CI 0.915~6.328；OR＝1.030，95% CI 0.952~1.114）；ROC曲线分析显示，基线血清IL-6、CRP预测患者进展为肺炎的AUC值分别为0.969（95% CI 0.900~1.000）、0.656（95% CI 0.380~0.932），两者AUC值差异有统计学意义（Z＝2.154，P＝0.030）。有无高血压病、糖尿病、冠心病、慢性肾脏病、慢性阻塞性肺疾病的患者基线血清IL-6水平、重症患者占比、肺炎患者占比差异均无统计学意义（P均＞0.05）。合并1种、2种、3种及以上基础疾病的高龄奥密克戎变异株感染者基线血清IL-6水平分别为12.50（9.15，21.75）、23.55（9.63，50.10）、10.90（5.20，18.88）pg/mL，差异无统计学意义（P＞0.05）。结论 在奥密克戎变异株感染患者中，有肺炎表现者血清IL-6水平明显增高且与病情进展有关，对高龄新型冠状病毒肺炎患者病情判断、疗效及预后评估有重要的指导意义。 |
| 关键词: 80岁以上老年人 新型冠状病毒肺炎 奥密克戎变异株 严重急性呼吸综合征冠状病毒2 白细胞介素6 基础疾病 |
| DOI：10.16781/j.CN31-2187/R.20220504 |
| 投稿时间：2022-06-15修订日期：2022-08-15 |
| 基金项目: |
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| Clinical significance of serum interleukin 6 in elderly patients infected with severe acute respiratory syndrome coronavirus 2 omicron variant and its correlation with underlying diseases |
| DONG Xu1△,XU Ai-jing1△,GE Ling-ling1,CHEN Yi1,YANG Ming2,XUE Jian-ya1* |
(1. Department of Infectious Diseases, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Internal Medicine Training Base, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-firsts author.
*Corresponding author) |
| Abstract: |
| ObjectiveTo investigate the clinical significance of serum interleukin 6 (IL-6) in elderly patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant and its correlation with underlying diseases.MethodsA total of 22 elderly patients (> 80 years old) infected with omicron variant, who were admitted to Department of Infectious Diseases, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. to Jun. 2022 and tested positive for SARS-CoV-2 RNA, were included. The level of serum IL-6 was measured by flow cytometry, and the level of serum C reactive protein (CRP) was measured by immunonephelometry. Patients were divided into pneumonia group (16 cases) and non-pneumonia group (6 cases) according to the imaging examination results, and were divided into severe group (severe and critical type, 5 cases) and non-severe group (mild and normal type, 17 cases) according to the condition. Binary logistic regression model and receiver operating characteristic (ROC) curve were used to analyze the correlation between serum IL-6 and CRP levels and the severity of the disease and whether it would progress to pneumonia. Meanwhile, the relationships between underlying diseases and serum IL-6 level were explored.ResultsAmong the 22 patients, 6 were mild, 11 were normal, 3 were severe, and 2 were critical. The baseline serum IL-6 level in the pneumonia group was significantly higher than that in the non-pneumonia group ([20.16±12.36] pg/mL vs [5.42±1.57] pg/mL, P＝0.009), and there was no significant difference in baseline serum CRP level between the 2 groups (P > 0.05). There were no significant differences in baseline serum IL-6 or CRP levels between the severe group and the non-severe group (both P > 0.05). Logistic regression analysis showed that the baseline serum IL-6 and CRP might be related to pneumonia after infection with omicron variant (odds ratio [OR]＝2.407, 95% confidence interval [CI] 0.915-6.328; OR＝1.030, 95% CI 0.952-1.114). ROC curve analysis showed that the area under curve values of serum IL-6 and CRP in predicting the progression to pneumonia were 0.969 (95% CI 0.900-1.000) and 0.656 (95% CI 0.380-0.932), respectively, with statistical significance (Z＝2.154, P＝0.030). There were no significant differences in the baseline serum IL-6 level or proportions of severe patients or pneumonia patients among patients with or without hypertension, diabetes mellitus, coronary heart disease, chronic kidney disease or chronic obstructive pulmonary disease (all P > 0.05). The baseline serum IL-6 levels of the omicron variant infected elderly patients with 1, 2, and 3 or more underlying diseases were 12.50 (9.15, 21.75), 23.55 (9.63, 50.10), and 10.90 (5.20, 18.88) pg/mL, respectively, with no statistical significance (P > 0.05).ConclusionFor omicron variant infected patients, serum IL-6 level is significantly increased in patients with pneumonia manifestations and is correlated with disease progression. Serum IL-6 level is of great guiding significance to judge disease progression and evaluate efficacy and prognosis of elderly coronavirus disease 2019 patients. |
| Key words: aged 80 years over coronavirus disease 2019 omicron variant severe acute respiratory syndrome coronavirus 2 interleukin 6 underlying diseases |
