Kidney Int:淋巴细胞分析谱可帮助区分实体器官移植后COVID-19的轻重度风险

2021-10-18 MedSci原创 MedSci原创

SOT受者的CD3和CD8淋巴减少与严重COVID-19感染高度相关。

实体器官移植(SOT)受者是感染新冠病毒的高危人群,据报道,这些患者住院死亡率在20%至30%之间。尽管与新冠病毒严重感染相关的共病如血管疾病、肥胖、高血压和糖尿病等在该人群中很常见,但尚不清楚在普通人群中观察到的免疫反应变化是否也存在于SOT患者中。

在这项回顾性研究中,研究者比较了实体器官移植(72%肾移植)中29例轻度和22例重度COVID-19患者的外周血T和B细胞功能和表面标记物以及血清抗体的发展。

研究结果显示,重症COVID-19患者CD3D和CD8D T细胞计数显著降低。然而,活化的CD4D T细胞在严重类型中更常见(2.9% (1.37;5.72) vs. 1.4% (0.68;2.35)),与之平衡的treg比例显著较高(3.9% (2.35;5.87) vs. 2.7% (1.9;3.45))。只有在严重的情况下,NK细胞的比例才会显著下降。在B细胞中,严重形态的过渡性B细胞显著降低(1.2% (0.7;4.2) vs. 3.6% (2.1;6.2))。尽管如此,大多数移植接受者都产生了抗SARS-CoV-2的抗体(轻度和重度分别为77%和83%)。

T细胞(Treg) 在2019年轻型和重型冠状病毒病中的比较

表现为轻度的患者和最初表现为轻度后来发展为重度的患者,T细胞和B细胞标记物的表达存在差异。诊断后出现严重形式的患者与未出现严重形式的轻度形式患者相比,CD3þ或CD8þT细胞较低,CD4þT细胞中PD1或CD39表达较高。若要确定预测疾病严重程度的最佳生物标志物,还需要进一步的研究。

总而言之,本数据显示了COVID-19轻型和重型感染之间的巨大差异,与在普通人群中观察到的情况类似。SOT受者的CD3和CD8淋巴减少与严重COVID-19感染高度相关。未来迫切需进行前瞻性研究,以进一步探索免疫抑制管理的效果。

参考文献:Bello A D , Kamar N , Vergez F , et al. Adaptive lymphocyte profile analysis discriminates mild and severe forms of COVID-19 after solid organ transplantation[J]. Kidney International, 2021(7).

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    2021-10-18 我不是针对谁

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