危重症 COVID-19 期间血栓细胞肺周转率的时间依赖性变化

Q4 Medicine Critical care explorations Pub Date : 2024-07-16 eCollection Date: 2024-07-01 DOI:10.1097/CCE.0000000000001128
Nikolai Ravn Aarskog, Ronja Hallem, Jakob Strand Godhavn, Morten Rostrup
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引用次数: 0

摘要

目标背景:正常情况下,肺巨核细胞是循环中血小板的重要来源,导致动脉血中的血小板计数高于静脉血。在危重的 COVID-19 中,由于免疫血栓形成,血小板可能会被肺从血液循环中清除,这可能会导致静脉血中的血小板计数高于动脉血中的血小板计数。在本研究中,我们通过测量动静脉血小板差异,研究了 COVID-19 危重症期间肺部血小板周转随时间的变化。我们假设,在疾病的早期阶段,由于免疫血栓形成,循环中的血小板会在肺部净清除,而在后期阶段,随着肺部功能恢复正常,血小板会在肺部净释放:设计:队列研究,重复测量动脉和中心静脉血小板计数:地点:一所大型大学医院的重症监护室:31名危重COVID-19患者入住重症监护室,接受有创或无创机械通气:测量和主要结果我们发现动静脉血小板差异与症状出现时间之间存在明显的正相关。这一结果表明,在疾病的早期阶段,动静脉血小板差异为负值,因此肺部会清除血小板;在晚期阶段,动静脉血小板差异为正值,因此肺部会释放血小板。大多数个体动静脉血小板差异小于分析的方差系数:这项研究的结果支持了我们的假设,即危重 COVID-19 早期的特点是由于免疫血栓形成导致循环中的血小板被肺部清除,而晚期的特点是血小板的肺部释放恢复正常。然而,在大多数病例中,动静脉血小板差异太小,无法从个体层面说明肺部血小板清除和释放的情况。
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Time-Dependent Changes in Pulmonary Turnover of Thrombocytes During Critical COVID-19.

Objectives background: Under normal conditions, pulmonary megakaryocytes are an important source of circulating thrombocytes, causing thrombocyte counts to be higher in arterial than venous blood. In critical COVID-19, thrombocytes may be removed from the circulation by the lungs because of immunothrombosis, possibly causing venous thrombocyte counts to be higher than arterial thrombocyte counts. In the present study, we investigated time-dependent changes in pulmonary turnover of thrombocytes during critical COVID-19 by measuring arteriovenous thrombocyte differences. We hypothesized that the early stages of the disease would be characterized by a net pulmonary removal of circulating thrombocytes because of immunothrombosis and that later stages would be characterized by a net pulmonary release of thrombocytes as normal pulmonary function is restored.

Design: Cohort study with repeated measurements of arterial and central venous thrombocyte counts.

Setting: ICU in a large university hospital.

Patients: Thirty-one patients with critical COVID-19 that were admitted to the ICU and received invasive or noninvasive mechanical ventilation.

Interventions: None.

Measurements and main results: We found a significant positive association between the arteriovenous thrombocyte difference and time since symptom debut. This finding indicates a negative arteriovenous thrombocyte difference and hence pulmonary removal of thrombocytes in the early stages of the disease and a positive arteriovenous thrombocyte difference and hence pulmonary release of thrombocytes in later stages. Most individual arteriovenous thrombocyte differences were smaller than the variance coefficient of the analysis.

Conclusions: The results of this study support our hypothesis that early stages of critical COVID-19 are characterized by pulmonary removal of circulating thrombocytes because of immunothrombosis and that later stages are characterized by the return of normal pulmonary release of thrombocytes. However, in most cases, the arteriovenous thrombocyte difference was too small to say anything about pulmonary thrombocyte removal and release on an individual level.

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CiteScore
5.70
自引率
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审稿时长
8 weeks
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