背景虽然人口统计学和临床因素,如年龄,某些合并症,性别与COVID-19结果相关,这些研究主要在附属于大型学术医疗中心的城市人群中进行.很少有研究关注农村人口,这些研究也表征了炎性细胞因子和趋化因子的更广泛变化。方法2020年6月至2021年3月在阿比林进行了一项单中心研究,德州,美国。如果患者去医院治疗COVID-19,有常规护理提供的额外生物材料,年龄在0到110岁之间。没有排除标准。患者特征,症状表现,从电子健康记录中提取临床实验室结果。通过蛋白质微阵列分析血液样本以定量40个免疫生物标志物。结果共纳入122例患者,其中81人(66%)入住普通非危重住院病房,37人(30%)被送进重症监护病房,其中4人(3.2%)为门诊患者.在这个农村人口中,大多数住院的COVID-19患者是老年人,男性,肥胖,退休人员。非危重患者的主要症状是呼吸急促,发烧,和疲劳。门诊患者的铁蛋白水平平均低于住院患者,而非重症和门诊患者的乳酸脱氢酶(LDH)水平低于重症监护病房。炎症生物标志物与炎症级联反应呈正相关且一致。白细胞介素(IL)-10呈正相关,血小板源性生长因子与炎症生物标志物呈负相关。≥65岁的患者的LDH和7种细胞因子/趋化因子(粒细胞-巨噬细胞集落刺激因子(GM-CSF),白细胞介素IL-1b,IL-6,IL-10,IL-11,巨噬细胞炎性蛋白(MIP)-1d,和IL-8),而其他五种免疫分子(细胞间粘附分子1(ICAM-1),单核细胞趋化蛋白1(MCP-1),金属蛋白酶组织抑制剂2(TIMP-2),与<65岁的患者相比,IL-2和IL-4)显着降低。女性的LDH和10种细胞因子/趋化因子(GM-CSF,IL-1b,IL-6,IL-10,IL-11,IL-15,IL-16,MIP-1a,MIP-1d,和IL-8),而TIMP-2和IL-4的水平显着低于男性患者。结论该农村住院患者队列的临床特征与国家报告的数据有些不同。社会的贡献,环境,应调查医疗保健获取因素。我们确定了免疫反应标志物中年龄和性别相关的差异,需要进一步研究以确定潜在的分子机制和对COVID-19发病机制的影响。
Background Although demographic and clinical factors such as age, certain comorbidities, and sex have been associated with COVID-19 outcomes, these studies were largely conducted in urban populations affiliated with large academic medical centers. There have been very few studies focusing on rural populations that also characterize broader changes in inflammatory cytokines and chemokines. Methodology A single-center study was conducted between June 2020 and March 2021 in Abilene, Texas, USA. Patients were included if they presented to the hospital for treatment of COVID-19, had extra biological materials from routine care available, and were between the ages of 0 to 110 years. There were no exclusion criteria. Patient characteristics, symptom presentation, and clinical laboratory results were extracted from electronic health records. Blood specimens were analyzed by protein microarray to quantitate 40 immunological biomarkers. Results A total of 122 patients were enrolled, of whom 81 (66%) were admitted to the general non-critical inpatient unit, 37 (30%) were admitted to the intensive or critical care units, and four (3.2%) were treated outpatient. Most hospitalized COVID-19 patients in this rural population were elderly, male, obese, and retired individuals. Predominant symptoms for non-critical patients were shortness of breath, fever, and fatigue. Ferritin levels for outpatient patients were lower on average than those in an inpatient setting and lactate dehydrogenase (LDH) levels were noted to be lower in non-critical and outpatient than those in the intensive care unit setting. Inflammatory biomarkers were positively correlated and consistent with inflammatory cascade. Interleukin (IL)-10 was positively correlated while platelet-derived growth factor was negatively correlated with inflammatory biomarkers. Patients ≥65 years had significantly higher levels of LDH and seven cytokines/chemokines (granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin IL-1b, IL-6, IL-10, IL-11, macrophage inflammatory protein (MIP)-1d, and IL-8) while levels of five other immune molecules (intercellular adhesion molecule 1 (ICAM-1), monocyte chemoattractant protein 1 (MCP-1), tissue inhibitor of metalloproteinase 2 (TIMP-2), IL-2, and IL-4) were significantly lower compared to those <65 years. Females had significantly higher levels of LDH and 10 cytokines/chemokines (GM-CSF, IL-1b, IL-6, IL-10, IL-11, IL-15, IL-16, MIP-1a, MIP-1d, and IL-8) while levels of TIMP-2 and IL-4 were significantly lower than male patients. Conclusions The clinical characteristics of this rural cohort of hospitalized patients differed somewhat from nationally reported data. The contributions of social, environmental, and healthcare access factors should be investigated. We identified age and sex-associated differences in immunological response markers that warrant further investigation to identify the underlying molecular mechanisms and impact on COVID-19 pathogenesis.