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Objective:To evaluate the role of interleukin-6 (IL-6) and CD4 + T-lymphocytopenia in assessing the severity and prognosis of coronavirus disease 2019 (COVID-19). Methods:A prospective observational study was conducted. Forty-five patients with COVID-19 admitted to Henan Provincial People's Hospital from January 13 to March 13, 2020 were enrolled and divided into normal group (13 cases), severe group (20 cases), critically severe group (12 cases) according to the severity of the disease. A total of 15 healthy subjects receiving physical examinations during the same period were collected as the healthy control group. Clinical data were collected to compare the clinical characteristics, general test results, IL-6 and CD4 + T-lymphocytopenia levels of patients in different disease severity groups and healthy control group. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each indicator for the severity of COVID-19. Multivariate Cox regression analysis was used to analyze the risk factors affecting the prognosis of COVID-19 patients, and Kaplan-Meier survival curve analysis was performed. Results:The age of the critically severe group was significantly higher than that of the severe and normal groups (years old: 66.91±17.01 vs. 59.35±18.07, 40.23±12.61, both P < 0.05), and the negative conversion time of the 2019 novel coronavirus (2019-nCoV) was significantly longer than that of the severe and normal groups (days: 19.00±10.66 vs. 18.00±7.18, 9.31±3.49, both P < 0.05). With the increase of the severity of disease, white blood cell count (WBC), C-reactive protein (CRP), calcitonin (PCT), total bilirubin (TBil), troponin I (TnI), IL-6, D-dimer and other indicators were significantly increased, while lymphocyte count (LYM), platelet count (PLT), CD4 +, CD8 +, oxygenation index (PaO 2/FiO 2) were significantly decreased (all P < 0.01). ROC curve showed that PaO 2/FiO 2, IL-6 and CD4 + had certain predictive value for disease severity of COVID-19, the area under the ROC curve (AUC) of them were 0.903, 0.871, 0.689, and the 95% confidence interval (95% CI) were 0.806-0.949, 0.769-0.974, 0.542-0.853; the best cut-off values were 196.00 mmHg (1 mmHg = 0.133 kPa), 6.02 ng/L, 355 cells/μL, respectively; the sensitivity were 73.3%, 99.3%, 73.3%, and the specificity were 96.6%, 62.1%, 65.5%, respectively. Multivariate Cox regression analysis showed that age, PaO 2/FiO 2, high IL-6 and low CD4 + (IL-6≥6.02 ng/L and CD4 + < 355 cells/μL) were independent risk factors affecting the prognosis of COVID-19 [hazard ratio ( HR) was 1.077, 0.053 and 3.490, respectively, all P < 0.05]. Kaplan-Meier survival analysis showed that when both high IL-6 and low CD4 + (IL-6≥6.02 ng/L and CD4 + < 355 cells/μL) were present, the mean time of adverse prognosis was (20.53±5.71) days; when increased IL-6 and decreased CD4 + were inconsistent, the mean time of adverse prognosis was (53.21±3.16) days. Conclusions:The levels of IL-6 and CD4 + T-lymphocytopenia are closely related to the severity of COVID-19 disease. When IL-6 ≥ 6.02 ng/L and CD4 + < 355 cells/μL occur simultaneously, the prognosis is poor.
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Objective To investigate the expression of vitronectin (VN) in placental basal plate and its relationship with the pathogenesis of severe preeclampsia.Methods From March 2010 to December 2011,17 patients with early-onset severe preeclampsia who delivered in the Second Hospital of Jilin University were recruited as the early-onset severe preeclampsia group; and 16 women were recruited as the late-onset severe preeclampsia group.Meanwhile,15 healthy pregnant women who delivered before 34 weeks were defined as the early control group (termination of pregnancy was carried out because of fetal heart malformations),and 15 healthy pregnant women delivered after 34 weeks were defined as the late control group.Imnunohistochemistry and semi-quantitative reverse transcription (RT)-PCR were used to investigate the expression of VN protein and mRNA in the placental infarct center and its surrounding tissue of placental basal plate.The levels of serum prothrombin time (PT),part thromboplastin time (APTT) and fibrinogen (FIb) were detected and the international normalized ratio (INR) was calculated.The correlation of abnormal coagulation markers and VN expression levels in the early-onset severe preeclampsia group and the early control group was studied.Results (l) VN protein was detected in all placental basal plate of the four groups.It was highly expressed in the necrotic tissue of placental infarct center and weakly expressed in the tissue far from the infarcted area.(2) The mean levels of VN protein expression in placental basal plate of the early-onset severe preeclampsia group,the late-onset severe preeclampsia group,the late control group and the early control group were 0.152 ± 0.019,0.113 ± 0.023,0.095 ± 0.014 and 0.055 ± 0.010,respectively.And the differences between the groups were statistically significant (P ＜ 0.01).The VN protein expression in placental infarct center,infarct edge,peri-infarct tissue and tissue far from the infarcted area gradually reduced,and the differences were statistically significant (P ＜ 0.01).Compared with the same areas of each group,the differences were not statistically significant (P ＞ 0.05).(3) VN mRNA were detectable in infarct center,infarct edge,per-infarct tissue and tissue far from the infarcted area of placental basal plate.In the early-onset severe preeclampsia group and the early control group,it was statistically higher in infarct center than in tissue far from the infarcted area (P ＜ 0.05).(4) PT of the early-onset severe preeclampsia group was (9.45 ± 0.63) s,significantly shorter than that of the early control group [(9.88 ± 0.17) s,P ＜ 0.05].While there was no statistically significant difference in APTT,FIB and INR among the four groups (P ＞ 0.05).(5) In the early-onset severe preeclampsia group,VN expression level and PT were significantly negative correlated (r =-0.612,P ＜0.05) ; while in the early control group there was no correlation (r =0.489,P ＞ 0.05).Conclusion VN was highly expressed in placental basal plate of the early-onset severe preeclampsia group,which caused the imbalance of coagulation and fibrinolysis system and the pathogenesis of severe preeclampsia.
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Objective To study the effect of 99Tc-MDP on receptor activator of nuclear factor-κB ligand/osteoprotegerin (RANKL/OPG) system of collagen-induced arthritis (CIA) rat. Methods The CIA was established by subcutaneous injection with type Ⅱ collagen and complete Freud's adjuvant to rats, except the group (n=8, treated with 99Tc-MDP). The histopathological changes of joints were scored based on the extent of infiltration of inflammatory cells, cartilage destruction and bone erosion. The serum levels of RANKL/OPG were tested with ELISA, and the synovial membrane levels of RANKL/OPG were tested with Western blot.Repeated ANOVA and one way ANOVA were used for statistical analysis. Results The MTX group relative value of RANKL/OPG in serum [35 d (1.076±0.016), 42 d (1.140±0.005), 49 d (1.155±0.023)], and in synovial membrane (1.156±0.014), and the histopathological scores [synovial membrane (1.8±0.5), cartilage (1.9±0.6), bone (1.8±0.5) ] were lower than model group ( 1.269±0.025, 1.296±0.015, 1.340±0.011 ), (2.9±0.4, 2.6±0.5, 2.6±0.5), ( 1.340±0.013 )(P＜0.01 ). And all above index of 99Tc-MDP group ( 1.035±0.034,0.986±0.019, 0.991±0.020), (1.5±0.5, 1.4±0.5, 1.2±0.5), (0.098±0.026) were notably lower than the MTX treat ment group (P＜0.01). Conclusion 99Tc-MDP may retard the progression of the disease by decreasing the relative RANKL/OPG expression and it can initiate its effect earlier than MTX.