与细胞因子相关的上腺功能和COVID-19的非危急病患者的结局
N Athanasiou1, A Diamantopoulos2, C Keskinidou1
1First Department of Critical Care Medicine & Pulmonary Services, School of Medicine, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece.
Journal of endocrinological investigation
|September 13, 2023
概括
在COVID-19患者中皮质醇水平升高可能表明严重疾病和死亡风险增加. 葡萄糖皮质激素诱导的氨酸拉链表达 (GILZ) 是一个有希望的,虽然目前没有,预测中度病例死亡率的标记.
科学领域:
- 内分泌学 在内分泌学.
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
背景情况:
- 下垂体-垂体-上腺 (HPA) 轴在应激反应和免疫调节中起着至关重要的作用.
- COVID-19是一种严重的呼吸系统疾病,可以触发失调的炎症反应.
- 了解HPA轴功能与COVID-19严重程度之间的相互作用对于患者管理至关重要.
研究的目的:
- 在COVID-19患者中调查下丘脑-垂体-上腺 (HPA) 轴功能障碍和疾病进展之间的关联.
- 为了确定HPA轴标记能否预测严重的COVID-19结果,包括呼吸系统恶化和死亡率.
主要方法:
- 一项队列观察性研究,涉及149名患有呼吸道感染的患者,包括104名SARS-CoV-2阳性 (C+) 和45名SARS-CoV-2阴性 (NC) 个体.
- 测量皮质醇, adrenocorticotropic 激素 (ACTH), dehydroepiandrosterone 硫酸盐 (DHEA-S),葡萄糖皮质素受体α (GCR-α),葡萄糖皮质素诱导的氨酸拉链 (GILZ) 表达和细胞因子水平.
- 排除已知上腺疾病或混药物使用 (葡萄皮质皮质激素) 的患者.
主要成果:
- 在C+和NC患者之间,基线皮质醇水平没有显著差异.
- 所有患者的皮质醇水平与ACTH和IL-6正相关,特别是C+患者的IL-6.
- 较高的皮质醇水平与呼吸功能恶化或死亡的风险增加有关.
- 在C+患者中,GCR-α表达显著更高,在C+非幸存者中,GCR-α和GILZ表达均升高.
结论:
- 皮质醇水平可以作为COVID-19疾病严重程度的指标.
- 葡萄糖皮质醇诱导的氨酸拉链 (GILZ) 表达显示出在中度COVID-19中作为死亡率预测标记物的潜力.
- 皮质醇升高可能会确定中度COVID-19患者的病情恶化风险较高,需要及早的医疗照顾.
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