托珠单抗在新型冠状病毒肺炎的应用研究探讨

2019年12月以来,新型冠状病毒肺炎(Coronavirus Disease 2019,COVID-19)在武汉暴发并蔓延至全国,给整个社会带来巨大的挑战。部分COVID-19感染者早期发病并不十分凶险,但后期会突然加速进展,病人很快进入多脏器功能衰竭的状态,李兰娟院士等提出了"细胞因子风暴"概念。但目前并没有特效药物,认为IL-6是诱发细胞因子风暴的重要通路,本文结合相关文献的复习和分析,旨在综述IL-6受体阻断剂托珠单抗在新型冠状病毒肺炎危重患者使用的可行性。     

TH17 responses in cytokine storm of COVID-19: An emerging target of JAK2 inhibitor Fedratinib

COVID-19 emerges as a pandemic disease with high mortality. Development of effective prevention and treatment is an urgent need. We reviewed TH17 responses in patients with SARS-CoV-2 and proposed an FDA approved JAK2 inhibitor Fedratinib for reducing mortality of patients with TH17 type immune profiles.     

中药在抗新型冠状病毒肺炎（COVID-19）引起的细胞因子风暴中的应用分析

2019年12月底新型冠状病毒肺炎(COVID-19)在我国爆发,截止2020年2月23日已感染超7万人,感染者遍布全球28个国家和地区。其传染性强,传播迅速广泛,重症患者可出现急性呼吸窘迫综合征、多器官衰竭等严重并发症。而病毒感染引起的免疫过度激化导致的"细胞因子风暴"是重症患者产生严重并发症的重要原因。目前《新型冠状病毒感染的肺炎诊疗方案》中采用糖皮质激素作为免疫抑制剂,用于遏制重症患者的免疫激化反应,但是糖皮质激素的使用可能会造成二次感染、病程延长等不良预后,且存在严重后遗症风险。而中药在整体免疫调控方面具有明显优势,目前在COVID-19临床治疗中,中西医结合治疗也收到了积极效果。从免疫调控作用入手,分析了单味中药及中药方剂在遏制COVID-19引起的免疫过度激化及细胞因子风暴、抗急性肺损伤的潜在应用价值,有望对现有的诊疗方案中药临床应用做有益补充,发挥抗击疫情的重要作用。     

Nano-curcumin therapy,a promising method in modulating inflammatory cytokines in COVID-19 patients

BackgroundAs an ongoing worldwide health issue, Coronavirus disease 2019 (COVID–19) has been causing serious complications, including pneumonia, acute respiratory distress syndrome (ARDS), and multi-organ failure. However, there is no decisive treatment approach available for this disorder, which is primarily attributed to the large amount of inflammatory cytokine production. We aimed to identify the effects of Nano-curcumin on the modulation of inflammatory cytokines in COVID-19 patients.MethodForty COVID-19 patients and 40 healthy controls were recruited and evaluated for inflammatory cytokine expression and secretion. Subsequently, COVID-19 patients were divided into two groups: 20 patients receiving Nano-curcumin and 20 patients as the placebo group. The mRNA expression and cytokine secretion levels of IL-1β, IL-6, TNF-α and IL‐18 were assessed by Real‐time PCR and ELISA, respectively.ResultOur primary results indicated that the mRNA expression and cytokine secretion of IL-1β, IL-6, TNF-α, and IL-18 were increased significantly in COVID-19 patients compared with healthy control group. After treatment with Nano-curcumin, a significant decrease in IL-6 expression and secretion in serum and in supernatant (P = 0.0003, 0.0038, and 0.0001, respectively) and IL-1β gene expression and secretion level in serum and supernatant (P = 0.0017, 0.0082, and 0.0041, respectively) was observed. However, IL-18 mRNA expression and TNF-α concentration were not influenced by Nano-curcumin.ConclusionNano-curcumin, as an anti-inflammatory herbal based agent, may be able to modulate the increased rate of inflammatory cytokines especially IL-1β and IL-6 mRNA expression and cytokine secretion in COVID-19 patients, which may cause an improvement in clinical manifestation and overall recovery.     

干扰素联合炎琥宁治疗小儿手足口病的临床效果评价

目的 探究干扰素联合炎琥宁治疗小儿手足口病的效果观察.方法 选取2016年4月—2019年3月医院收治的手足口病患儿104例,依随机数字表分为参照组和干预组,各52例.参照组患儿应用干扰素治疗,干预组患儿加用炎琥宁治疗.观察两组患儿的治疗效果、临床症状消退时间、黏附分子表达量和心肌酶水平.结果 干预组患儿治疗总有效率为90.38%,明显高于参照组患儿的75%;干预组患儿发热、口腔溃疡和手足皮疹的消退时间均明显短于参照组患儿(P<0.05);两组患儿治疗后的CD44、ICAM-1、VCAM-1、CK、LDH和CK-MB水平均明显低于治疗前水平(P<0.05),且干预组患儿治疗后的CD44、ICAM-1、VCAM-1、CK、LDH和CK-MB水平均明显低于参照组患儿治疗后水平(P<0.05).结论 干扰素联合炎琥宁治疗小儿手足口病的效果显著.     

Coronavirus and cardiovascular manifestations-getting to the heart of the matter

Coronavirus disease has unarguably been the largest pandemic of recent times. Over 150 million cases have occurred worldwide, and more than 3 million have succumbed to the disease. Cardiac manifestations can have varied presentations from an asymptomatic troponin rise to fulminant myocarditis. The pathogenesis of myocardial damage could be direct or indirect, including inflammation, coronary spasm, plaque rupture, and cytokine storm. Thromboembolism is also an important feature of cardiovascular affliction with both arterial and venous systems being affected. Hence, anticoagulation has also been a matter of debate. Fulminant myocarditis is the most severe form and can lead to circulatory shock with a high mortality. Management of cardiac patients with coronavirus disease 2019(COVID-19) infection is not considerably different from non-COVID-19 cardiovascular disease, but interaction between cardiovascular drugs and antiCOVID-19 therapy requires careful attention. More recently, vaccines have emerged as a ray of hope for the disease. But simultaneously, there have been reports of thromboembolism following vaccination. In this review, we discuss the various aspects of coronavirus disease affecting of heart and its management.     

冠状病毒感染对心血管系统的损伤及可能机制

冠状病毒(coronavirus,CoVs)感染主要累及肺部,但对心血管系统损伤作用也不容忽视。CoVs感染引起的心脏损伤并非罕见,其发生与病情的严重程度密切相关。本文首先从CoVs引起心血管损伤的证据入手,进一步探讨了CoVs对心肌的直接损伤,以及肾素血管紧张素(RAS)系统激活和细胞因子风暴与炎症反应对心血管损伤的可能作用机制。相关心血管损伤的可能机制包括,(1)病毒直接作用:CoVs在心肌细胞复制,损伤心肌;(2)RAS系统激活:感染CoVs后,心脏血管紧张素转化酶2(angiotensin-converting enzyme 2,ACE2)的表达下调,激活RAS系统,使得血管紧张素Ⅱ(AngiotensinⅡ,AngⅡ)收缩血管功能增强,Ang1-7保护心脏效应减弱;(3)诱发细胞因子风暴:循环细胞因子和全身炎症反应引起心脏损伤;(4)其他:包括低氧血症和儿茶酚胺心脏毒性。本文就相关内容作一综述,为后续的详尽机制和治疗策略研究提供思路。     

糖尿病患者饥饿感中医病机浅识

糖尿病患者饥饿感病机有胃火炽盛、胃强脾弱、脾胃虚弱、瘀热消谷、痰热消谷等。糖尿病初期,痰热、火热之证常见,患者出现多食易饥表现,应考虑痰热消谷、火热消谷,选用白虎汤、玉女煎、消渴方等加减治疗;病程日久,火热伤阴,壮火食气,出现气阴两虚等表现,此时出现多食易饥症状,则需考虑胃强脾弱、脾胃虚弱等病机,采用半夏泻心汤、附子理中丸、参苓白术散等治疗;瘀血贯穿糖尿病始终,故在使用以上方法治疗糖尿病患者消谷易饥效果欠佳时,可考虑瘀热消谷的因素,采用桃核承气汤、白虎汤合桂枝茯苓丸治疗。糖尿病与痰湿关系密切,针对该病机引起的饥饿感,在清热的同时,还应化痰除湿。糖尿病病程日久患者,饥饿感病机复杂,宜"观其脉证,知犯何逆,随证治之"。