在COVID-19诱导的细胞因子释放综合征中,影响tocilizumab治疗结果的主要因素是什么?

IF 1.3 Q4 RHEUMATOLOGY European journal of rheumatology Pub Date : 2022-07-01 DOI:10.5152/eurjrheum.2022.21010
Cansu Akleylek, Seray Gizem Gür, İbrahim Halil Sever, Safiye Koçulu Demir, Esin Çevik, Egemen Eken, Zafer Gökkaya, Yonca Çağatay, Neslihan Yılmaz
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引用次数: 2

摘要

目的:新冠病毒病-2019 (COVID-19)相关细胞因子释放综合征/巨噬细胞激活综合征(MAS)的治疗建议质量仍然较差。IL-6作为细胞因子风暴的主要介质是重要的治疗靶点。本研究的目的是评估托珠单抗(TCZ)的疗效和影响治疗结果的因素。方法:回顾性研究27例经中西医结合治疗的新冠肺炎患者。本研究中的所有患者在标准治疗的基础上接受TCZ(静脉注射,剂量为8mg kg1)治疗。观察10 ~ 14天的临床改善情况(生存和耗氧量下降)及继发感染率。结果:27例患者中,重症监护病房(ICU)接受TCZ治疗的14例(51.8%),需要有创机械通气(IMV)治疗的7例(25.9%)。15例(55.6%)患者表现出良好的临床反应(4例从ICU出院,11例在非ICU床位随访的患者出现需氧量下降)。在Murray肺损伤评分高、PO2/FiO2比低、IMV低、入住ICU的患者中,TCZ的疗效明显较差(P < 0.05)。在多变量分析中发现低氧血症的严重程度是一个独立的危险因素(P < 0.05)。继发细菌感染率明显高于插管组(P < 0.01)和ICU组(P < 0.01)。结论:TCZ对新型冠状病毒相关MAS疗效有限。治疗结果最重要的预测指标是低氧血症的严重程度。此外,IMV和/或ICU与预后差和高副作用相关。因此,还需要进行对照试验来确定TCZ的适应症和治疗时机。
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What are the main factors affecting the outcome of tocilizumab therapy in COVID-19-induced cytokine release syndrome?

Objective: Recommendations for the treatment of cytokine release syndrome/macrophage activation syndrome (MAS) associated with coronavirus disease-2019 (COVID-19) are still of poor quality. IL-6 is an important therapeutic target as a main mediator of cytokine storm. The aim of our study was to evaluate the tocilizumab (TCZ) efficacy and factors affecting the therapy outcome.

Methods: This retrospective study included 27 patients treated with TCZ for COVID-19-MAS. All patients in this study were treated with TCZ (intravenously, at a dose of 8 mg kg1 ) in addition to standard therapy. Clinical improvement (survival and decreased oxygen demand) on the 10-14th days and secondary infection rate were assessed.

Results: In our 27 treated patients, 14 (51.8%) received TCZ in the intensive care unit (ICU) and seven (25.9%) were need to invasive mechanical ventilation (IMV). Fifteen (55.6%) of these patients revealed a good clinical response (four patients discharge from the ICU and 11 patients who followed-up in nonICU beds showed a decrease in oxygen demand). TCZ was significantly less effective in patients having high Murray lung injury score, low PO2/FiO2 ratio, IMV, and ICU admission (P < .05). Severity of hypoxemia was found as a single independent risk factor in the multivariable analysis (P < .05). Secondary bacterial infections rate was significantly higher in intubated patients (P < .01) or treated in the ICU (P ¼ .01).

Conclusion: TCZ was showed limited efficacy for COVID-19-related MAS. The most important predictive indicator for therapy outcome was found as the severity of hypoxemia. In addition, IMV and/or ICU was associated with the poor outcome and high side effect. So, controlled trials are still needed to confirm the indications and timing of TCZ therapy.

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