PDF(Pubmed)
Abstract：
This case series reviews four critically ill patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [coronavirus disease 2019 (COVID-19)] suffering from pneumatosis intestinalis (PI) during their hospital admission. All patients received the biological agent tocilizumab (TCZ), an interleukin (IL)-6 antagonist, as an experimental treatment for COVID-19 before developing PI. COVID-19 and TCZ have been independently linked to PI risk, yet the cause of this relationship is unknown and under speculation. PI is a rare condition, defined as the presence of gas in the intestinal wall, and although its pathogenesis is poorly understood, intestinal ischemia is one of its causative agents. Based on COVID-19\'s association with vasculopathic and ischemic insults, and IL-6\'s protective role in intestinal epithelial ischemia-reperfusion injury, an adverse synergistic association of COVID-19 and TCZ can be proposed in the setting of PI. To our knowledge, this is the first published, single center, case series of pneumatosis intestinalis in COVID-19 patients who received tocilizumab therapy.
摘要：
本病例系列回顾了四名感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）[2019年冠状病毒病（COVID-19）]的重症患者在入院期间患有肠气（PI）。所有患者都接受了生物制剂托珠单抗（TCZ），白细胞介素（IL）-6拮抗剂，作为发展PI之前对COVID-19的实验性治疗。COVID-19和TCZ与PI风险独立相关，然而，这种关系的原因是未知和猜测。PI是一种罕见的情况，定义为肠壁中存在气体，尽管对其发病机制知之甚少，肠缺血是其致病因素之一。基于COVID-19与血管病变和缺血性损伤的相关性，IL-6在肠上皮缺血再灌注损伤中的保护作用,在PI设置中可以提出COVID-19和TCZ的不良协同关联。据我们所知,这是第一次发表，单中心,接受托珠单抗治疗的COVID-19患者肠道肺炎病例系列。
