Lancet Rheumato: 重症新冠肺炎:白介素抑制可用,但不能都用!

2021-02-05 Nebula MedSci原创

如何用白介素抑制剂治疗重度新冠肺炎患者?

重度新冠肺炎患者对新冠病毒感染产生了危及生命的超级炎症反应。白介素(IL)-1或IL-6抑制剂被用于治疗这类患者,但这些方案的相对有效性仍不确定。本研究旨在对比IL-1和IL-6抑制用于呼吸功能不全和过度炎症反应的住院治疗的新冠肺炎患者的疗效。

主要终点是存活率,次要终点是死亡或器械通气的复合结局。

2020年2月25日-5月20日,共招募了392位受试患者,其中275位未接受白介素抑制剂治疗,62位接受了IL-1抑制剂anakinra,55位接受了IL-6抑制剂(29位接受了tocilizumab和26位接受了sarilumab)。

在多变量分析中,与未接受白介素抑制剂治疗的患者相比,接受IL-1抑制治疗的患者的死亡风险显著降低(风险比[HR] 0.450, 95%CI 0.204-0.990, p=0.047),但接受IL-6抑制治疗的患者的死亡风险无明显差异(0.900,0.412-1.966, p=0.79)。此外,无论是接受IL-1抑制还是IL-6抑制治疗的患者的不良临床预后风险均与未接受白介素抑制剂治疗的患者无明显差异(HR分别为0.866[p=0.63]和0.882[p=0.71])。

根据C反应蛋白水平分类的患者的预后

对于C反应蛋白升高的患者,接受IL-6抑制治疗的患者的死亡风险和不良临床预后风险均较未接受白介素抑制治疗的患者明显降低(HR分别为0.990[p=0.031]和0.995[p=0.0021])。

根据血清乳酸脱氢酶水平分类的患者的预后

对于血清乳酸脱氢酶水平降低的患者,采用IL-1抑制剂和IL-6抑制剂治疗均可降低死亡风险;但血清乳酸脱氢酶水平升高的患者采用白介素抑制剂治疗与死亡和不良临床预后风险增加相关(死亡:IL-1和IL-6抑制剂的HR分别为1.009[p=0.028]和1.006[p=0.0028];不良临床预后:1.006[p=0.0031]和1.005[p=0.0016])。

综上,IL-1抑制可显著降低住院治疗的呼吸功能不全的高炎症反应的新冠肺炎患者的死亡率,但IL-6抑制无此效益。IL-6抑制在C反应蛋白水平显著升高的亚组患者中有积极疗效,对于血清乳酸脱氢酶水平降低的患者,IL-1和IL-6抑制均可获得积极作用。

原始出处:

Giulio Cavalli, et al. Interleukin-1 and interleukin-6 inhibition compared with standard management in patients with COVID-19 and hyperinflammation: a cohort study. The Lancet Rheumatology. February 03, 2021.

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    2021-07-20 howi
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    2021-02-06 carrotlyl

    严谨

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1831010, encodeId=c9eb183101000, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Jul 20 19:41:26 CST 2021, time=2021-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1372149, encodeId=28b413e21497e, content=<a href='/topic/show?id=6ca1e1621c4' target=_blank style='color:#2F92EE;'>#白介素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71621, encryptionId=6ca1e1621c4, topicName=白介素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0e95336, createdName=budeshao, createdTime=Sun Feb 07 08:41:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579682, encodeId=06be15e968230, content=<a href='/topic/show?id=490795953ed' target=_blank style='color:#2F92EE;'>#重症新冠肺炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95953, encryptionId=490795953ed, topicName=重症新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f4216549541, createdName=ms5439512287675881, createdTime=Sun Feb 07 08:41:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923178, encodeId=f2ce9231e817, content=严谨, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sat Feb 06 07:36:01 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923101, encodeId=2b4c9231019e, content=什么情况下可以用, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200914/f1df8506d5cb4909bac2efc340b6c1fe/dcc6dd2dbec44613838b555fbe723804.jpg, createdBy=686b1371609, createdName=liyu7822, createdTime=Fri Feb 05 22:06:35 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029084, encodeId=64af1029084d1, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Feb 05 20:41:26 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034155, encodeId=2f0a1034155ed, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Fri Feb 05 20:41:26 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923061, encodeId=07cb92306168, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Fri Feb 05 17:46:13 CST 2021, time=2021-02-05, status=1, ipAttribution=)]
    2021-02-05 liyu7822

    什么情况下可以用

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1831010, encodeId=c9eb183101000, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Jul 20 19:41:26 CST 2021, time=2021-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1372149, encodeId=28b413e21497e, content=<a href='/topic/show?id=6ca1e1621c4' target=_blank style='color:#2F92EE;'>#白介素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71621, encryptionId=6ca1e1621c4, topicName=白介素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0e95336, createdName=budeshao, createdTime=Sun Feb 07 08:41:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579682, encodeId=06be15e968230, content=<a href='/topic/show?id=490795953ed' target=_blank style='color:#2F92EE;'>#重症新冠肺炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95953, encryptionId=490795953ed, topicName=重症新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f4216549541, createdName=ms5439512287675881, createdTime=Sun Feb 07 08:41:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923178, encodeId=f2ce9231e817, content=严谨, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sat Feb 06 07:36:01 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923101, encodeId=2b4c9231019e, content=什么情况下可以用, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200914/f1df8506d5cb4909bac2efc340b6c1fe/dcc6dd2dbec44613838b555fbe723804.jpg, createdBy=686b1371609, createdName=liyu7822, createdTime=Fri Feb 05 22:06:35 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029084, encodeId=64af1029084d1, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Feb 05 20:41:26 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034155, encodeId=2f0a1034155ed, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Fri Feb 05 20:41:26 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923061, encodeId=07cb92306168, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Fri Feb 05 17:46:13 CST 2021, time=2021-02-05, status=1, ipAttribution=)]
    2021-02-05 公卫新人

    新冠肺炎,疫情何时才能消失

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1831010, encodeId=c9eb183101000, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Jul 20 19:41:26 CST 2021, time=2021-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1372149, encodeId=28b413e21497e, content=<a href='/topic/show?id=6ca1e1621c4' target=_blank style='color:#2F92EE;'>#白介素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71621, encryptionId=6ca1e1621c4, topicName=白介素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0e95336, createdName=budeshao, createdTime=Sun Feb 07 08:41:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579682, encodeId=06be15e968230, content=<a href='/topic/show?id=490795953ed' target=_blank style='color:#2F92EE;'>#重症新冠肺炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95953, encryptionId=490795953ed, topicName=重症新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f4216549541, createdName=ms5439512287675881, createdTime=Sun Feb 07 08:41:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923178, encodeId=f2ce9231e817, content=严谨, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sat Feb 06 07:36:01 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923101, encodeId=2b4c9231019e, content=什么情况下可以用, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200914/f1df8506d5cb4909bac2efc340b6c1fe/dcc6dd2dbec44613838b555fbe723804.jpg, createdBy=686b1371609, createdName=liyu7822, createdTime=Fri Feb 05 22:06:35 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029084, encodeId=64af1029084d1, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Feb 05 20:41:26 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034155, encodeId=2f0a1034155ed, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Fri Feb 05 20:41:26 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923061, encodeId=07cb92306168, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Fri Feb 05 17:46:13 CST 2021, time=2021-02-05, status=1, ipAttribution=)]
    2021-02-05 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1831010, encodeId=c9eb183101000, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Tue Jul 20 19:41:26 CST 2021, time=2021-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1372149, encodeId=28b413e21497e, content=<a href='/topic/show?id=6ca1e1621c4' target=_blank style='color:#2F92EE;'>#白介素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71621, encryptionId=6ca1e1621c4, topicName=白介素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0e95336, createdName=budeshao, createdTime=Sun Feb 07 08:41:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1579682, encodeId=06be15e968230, content=<a href='/topic/show?id=490795953ed' target=_blank style='color:#2F92EE;'>#重症新冠肺炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95953, encryptionId=490795953ed, topicName=重症新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9f4216549541, createdName=ms5439512287675881, createdTime=Sun Feb 07 08:41:26 CST 2021, time=2021-02-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923178, encodeId=f2ce9231e817, content=严谨, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210127/50a003c4097845e182c08afd64d8a509/bd766dfebe9c40e0bca2dae964601bdc.jpg, createdBy=22de5454917, createdName=carrotlyl, createdTime=Sat Feb 06 07:36:01 CST 2021, time=2021-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923101, encodeId=2b4c9231019e, content=什么情况下可以用, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200914/f1df8506d5cb4909bac2efc340b6c1fe/dcc6dd2dbec44613838b555fbe723804.jpg, createdBy=686b1371609, createdName=liyu7822, createdTime=Fri Feb 05 22:06:35 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1029084, encodeId=64af1029084d1, content=新冠肺炎,疫情何时才能消失, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Fri Feb 05 20:41:26 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1034155, encodeId=2f0a1034155ed, content=顶刊就是不一样,质量很高,内容精彩!学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=goodbing, createdTime=Fri Feb 05 20:41:26 CST 2021, time=2021-02-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=923061, encodeId=07cb92306168, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Fri Feb 05 17:46:13 CST 2021, time=2021-02-05, status=1, ipAttribution=)]
    2021-02-05 zb1235672

    学习了

    0

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