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关于恢复期血浆治疗COVID-19的(一点)阐明
(A Little) Clarity on Convalescent Plasma for Covid-19


Louis M. Katz ... 呼吸系统疾病 • 2021.02.18
相关阅读
• 恢复期血浆治疗重症COVID-19患者 • 恢复期血浆在治疗COVID-19方面有潜在效用

被动免疫疗法自19世纪末开始使用,1901年首届诺贝尔生理学或医学奖得主因白喉患者的血清疗法获奖。在1918年流感大流行期间,恢复期患者血清被用于治疗流感,并取得了一些明显成功1。如今,免疫球蛋白已被用于预防和治疗各种感染,包括呼吸道合胞病毒、巨细胞病毒及乙型肝炎或甲型肝炎病毒感染。最近,研究者评估了应用被动免疫疗法治疗严重急性呼吸综合征(SARS)、中东呼吸综合征和埃博拉病毒病。静脉输入人免疫球蛋白使免疫球蛋白缺乏症的治疗发生了革命性的变化。

有人提议将抗SARS-CoV-2的恢复期血浆用于治疗COVID-19患者。甲型流感的治疗经验给了我们启示,一项荟萃分析提示,在患者发展成危重症之前早期采取治疗可能是被动免疫疗法对甲型流感病毒有效的重要预测因素1。该荟萃分析的作者承认,关于早期治疗的现有证据质量较低。恢复期血浆和超免疫球蛋白治疗甲型流感和SARS患者的研究进行的另外一项荟萃分析提示,“如果在发病后早期使用恢复期血浆”,可降低死亡率2。然而,在一项随机、对照试验中,H1N1流感康复患者的高滴度恢复期血浆对儿童和成人住院患者的重症甲型流感无效3





作者信息

Louis M. Katz, M.D.
From the Mississippi Valley Regional Blood Center, Davenport, IA.

 

参考文献

1. Luke TC, Kilbane EM, Jackson JL, Hoffman SL. Meta-analysis: convalescent blood products for Spanish influenza pneumonia: a future H5N1 treatment? Ann Intern Med 2006;145:599-609.

2. Mair-Jenkins J, Saavedra-Campos M, Baillie JK, et al. The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis 2015;211:80-90.

3. Beigel JH, Aga E, Elie-Turenne M-C, et al. Anti-influenza immune plasma for the treatment of patients with severe influenza A: a randomised, double-blind, phase 3 trial. Lancet Respir Med 2019;7:941-950.

4. Li L, Zhang W, Hu Y, et al. Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening covid-19 a randomized clinical trial. JAMA 2020;324:460-470.

5. Simonovich VA, Burgos Pratx LD, Scibona P, et al. A randomized trial of convalescent plasma in Covid-19 severe pneumonia. N Engl J Med 2021;384:619-629.

6. Agarwal A, Mukherjee A, Kumar G, Chatterjee P, Bhatnagar T, Malhotra P; PLACID Trial Collaborators. Convalescent plasma in the management of moderate covid-19 in adults in India: open label phase II multicentre randomised controlled trial (PLACID Trial). BMJ 2020;371:m3939-m3939.

7. Joyner MJ, Carter RE, Senefeld JW, et al. Convalescent plasma antibody levels and the risk of death from Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2031893.

8. Salazar E, Christensen PA, Graviss EA, et al. Treatment of COVID-19 patients with convalescent plasma reveals a signal of significantly decreased mortality. Am J Pathol 2020;190:2290-2303.

9. Infectious Diseases Society of America. Clarifying the Emergency Use Authorization framework for COVID-19 convalescent plasma: considerations for clinicians prepared jointly by the Infectious Diseases Society of America and AABB. November 18, 2020 (https://www.idsociety.org/globalassets/covid-19-real-time-learning-network/therapeutics-and-interventions/convalescent-plasma/aabb-idsa-convalescent-plasma-eua--final.pdf. opens in new tab).

10. Libster R, Pérez Marc G, Wappner D, et al. Early high-titer plasma therapy to prevent severe Covid-19 in older adults. N Engl J Med 2021;384:610-618.

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