Ntu Ⅰ:COVID-19 Kab mob hauv lub raum hloov cov neeg txais
Mar 04, 2022
Hu rau: emily.li@wecistanche.com
Los ntawm 21 Lub Peb Hlis 2020 cov kab mob cuam tshuam txog tus kabmob tshiab SARS-CoV-2 tau cuam tshuam rau tib neeg los ntawm 177 lub tebchaws thiab ua rau 11,252 tus neeg tuag thoob ntiaj teb. Tsis tshua paub txog qhov pheej hmoo, kev nthuav qhia, thiab cov txiaj ntsig ntawm SARS-CoV-2 (COVID-19) kev kis kab mob hauvraumcov neeg tau txais kev hloov pauv, uas tej zaum yuav muaj kev pheej hmoo siab vim kev tiv thaiv kab mob mus ntev, comorbidity, thiab residual chronicraumkab mob. Txawm tias COVD-19 feem ntau yog kab mob ua pa, thaum mob hnyav, nws tuaj yeem ua rauraumthiab ntau lub cev tsis ua haujlwm. Nws tsis paub yog tias cov neeg mob immunocompromised muaj kev pheej hmoo siab ntawm cov kab mob hnyav dua. Yog li, peb tshaj tawm txog xya kis ntawm COVID-19 hauvraumhloov pauvcov neeg tau txais txiaj ntsig (hnub nyoog nruab nrab 54 xyoo (ntau 45-69), peb tus poj niam, los ntawm ib pawg ntawm 2082 tswj hwm cov neeg mob hloov pauv) nyob rau lub sijhawm rau lub lis piam hauv peb lub tsev kho mob sab qab teb London. Ob ntawm xya tus neeg mob tau nthuav tawm hauv peb lub hlis ntawm kev hloov pauv. Zuag qhia tag nrho, ob leeg tau tswj hwm los ntawm tus neeg mob sab nraud, tab sis tseem tshuav tsib qhov yuav tsum tau mus pw hauv tsev kho mob, plaub hauv cov tsev kho mob hnyav. Txhua tus neeg mob tau pom cov tsos mob ua pa thiab ua npaws. Lwm yam kev kho mob muaj xws li hypoxia, hauv siab crepitation, lymphopenia, thiab siab C-reactive protein. Qhov siab heev D dimer, ferritin, thiab troponin theem tau tshwm sim nyob rau hauv cov mob hnyav thiab tej zaum yuav muaj tshwm sim. Kev txhaj tshuaj tiv thaiv kab mob tau hloov kho hauv rau ntawm xya tus neeg mob. Peb cov neeg mob uas mob hnyav tau mob ntshav qab zib. Hauv peb lub lis piam ua raws li ib tus neeg mob tau zoo, thiab ib tus neeg mob tuag. Yog li, peb qhov kev tshawb pom qhia tias COVD-19 kis tau rau hauvraumhloov pauvCov neeg mob yuav mob hnyav, yuav tsum tau txais kev saib xyuas mob hnyav. Cov tsos mob feem ntau yog ua pa thiab cuam tshuam nrog kub taub hau. Cov neeg mob feem ntau tau txo lawv txoj kev tiv thaiv kab mob thiab tau txais kev kho mob nrog kev txhawb nqa.
Cistanche tuaj yeem kho mob raum
Tus kab mob tshiab coronavirus 2019 (lossis tus kab mob coronavi-rus 2019 [COVID-19]) tus kab mob. uas tshwm sim hauv lub nroog Wuhan, hauv Hubei xeev, Tuam Tshoj, thaum Lub Kaum Ob Hlis 2019 sib koom nrog qhov zoo sib xws hauv nws cov qauv genomic nrog rau tus mob ua pa nyuaj ua pa nyuaj (SARS-CoV) uas ua rau SARS thoob ntiaj teb kis thoob ntiaj teb xyoo 2003 thiab Middle East ua pa mob. (MERS) epidemic in 2012(MERS-CoV), and even closer similarities to bat SARS-like betacoronavirus (bat-SL-CoVZC45 betacoronavirus and bat-SL-CoVZXC21):2. Thaum Lub Kaum Ob Hlis 31, 2019, thiab Lub Peb Hlis 27, 2020.532692COVID-19cov neeg mob thiab 24.077 tus neeg tuag thoob ntiaj teb tau txheeb xyuas tias yog tshwm sim los ntawm tus kab mob RNA tshiab uas muaj npe hu ua SARS-CoV-2.In United Kingdom Thaum Lub Ib Hlis 31, 2020, thiab Lub Peb Hlis 20, 2020, 3983 tus neeg mob tau txheeb pom nrog 177 (4 feem pua ntawm cov neeg mob kuaj) tuag. 11, 2020, thiab 176 lub teb chaws raug cuam tshuam txog lub Peb Hlis 27, 2020.
Tus kab mob SARS tau tshaj tawm tias muaj kev cuam tshuam rau cov menyuam yaus thiab cov neeg laus hloov lub raum hloov pauv hauv Hong Kong, nrog cov kab mob tsawg dua rau cov menyuam yaus. Ib tus neeg mob hloov lub siab tau tuag los ntawm tus kab mob SARS-CoV hauv xyoo 2003. Tus kab mob MERS tus mob coronavirus tau muaj kev cuam tshuam ntau yam rau cov neeg tau txais kev hloov lub raum. Hauv 1 daim ntawv tshaj tawm ntawm 2 tus neeg mob raum hloov pauv, ib tus tuag ntawm cov kab mob ua pa thiab mob hnyavraumraug mobthaum lwm tus ciaj sia. Rau qhov zoo tshaj plaws ntawm peb txoj kev paub, tsuas yog 1 tus neeg mob hloov lub raum tau tshaj tawm hauv cov ntaub ntawv uas raug mob los ntawm COVID-19 tus kab mob hauv Wuhan, Tuam Tshoj, thiab txhim kho 13 hnub tom qab nkag mus rau hauv tsev kho mob." 63-xyoo. -laus cov neeg tau txais kev hloov pauv hauv lub raum tau nthuav tawm ua npaws, mob hauv siab, hnoos, qog ntshav qis, ntshav siab C-reactive protein (CRP), thiab lub hauv siab txawv txav hauv lub hauv siab suav tomography scan rau Lub Ob Hlis 2, 2020. Tacrolimus thiab mycophenolate tswj tau raug txiav. Nrog oxygen, methylprednisolone, umifenovir, moxifloxacin, biapenem, iv. Ig, nqus tau inter-feron-U, thiab pantoprazole.
Tab 1| Cov yam ntxwv kho mob thiab qhov tshwm sim ntawm 7 lub raum hloov pauv cov neeg mob nrog KEVD-19 kab mob
Peb tshaj tawm ntawm no thawj 7 kis ntawm COVID. 19 nyob rau hauv cov neeg tau txais kev hloov lub raum nyob rau sab qab teb London tsev kho mob.
Case
Peb tau pom 7 qhov xwm txheej ntawm cov neeg tau txais kev hloov lub raum nrog cov pov thawj COVID-19 tus kab mob nyob rau sab qab teb London thaum Lub Peb Hlis 2020. Cov neeg mob no tau piav qhia hauv no, thiab lawv cov yam ntxwv tseem ceeb tau sau tseg hauv Cov Lus 1 thiab 2.
Table 2|Cov ntshav ntsuas thaum muaj tus kab mob COVID-19
Tus neeg mob 1.Ib tug txiv neej A48- xyoo nrog tus neeg pub dawb tuagraumhloov pauvxyoo 1989 nrog rau lub raum hloov pauv tsis tau (kwv yees glomerular pom tus nqi [eGFRl: 15-18 ml / min ib 1.73 m)) hu ua National Health Service (111) pab-kab hauv thawj lub lim tiam ntawm Lub Peb Hlis 2020 nrog hnoos, ua npaws , thiab ua tsis taus pa me me. Nws tau kuaj pom muaj tus kab mob COVID-19 los ntawm qhov ntswg thiab caj pas swabs thaum Lub Peb Hlis 2. Raws li nws tau txais kev kho mob zoo, nws raug hais kom nyob hauv tsev thiab cais nws tus kheej. Nws cov tshuaj tiv thaiv kab mob yog azathioprine 75 mg ib hnub ib zaug (OD) thiab prednisolone 5 mg OD, uas tsis hloov pauv, Nws tsis nyob ntawm angiotensin-hloov enzyme inhibitor thiab / lossis angiotensin receptor blocker thaum lub sijhawm nthuav qhia. Nws tau ua kom rov zoo tag nrho. Kev hloov pauvraummuaj nuj nqinyob ruaj khov.
Tus neeg mob 2.Ib tus poj niam muaj hnub nyoog 67- xyoo muaj insulin-dependant hom 2 mob ntshav qab zib mellitus thiab theem kawgraumkab mobntawm kev kho hemodialysis rau 4 xyoo tau txais ib tus neeg tuag raum hloov pauv hauv lub Peb Hlis 2019. Nws eGFR yog 45 txog 55 ml / min rau 1.73 m *. Nws tau tswj hwm ntawm tacrolimus nrog qib ntawm 5 thiab 8 ng / ml, mycophenolate mofetil (MMF) 250 mg ob zaug ib hnub (BD), thiab prednisolone 5 mg OD. Nws lwm cov tshuaj suav nrog ramipril, aspirin, alfacalcidol, thiab amiloride. Nws nthuav tawm thaum Lub Peb Hlis 5 nrog hnoos. ua npaws, thiab ua tsis taus pa. Chest X-ray qhia ob sab patchy consolidation (Daim duab la). SARS-CoV-2 RNA polymerase chain reaction tests los ntawm qhov ntswg thiab caj pas kab mob swabs tau zoo. Bronchial ntxuav rau pneumocystis polymerase saw cov tshuaj tiv thaiv yog qhov tsis zoo, zoo li cov ntshav polymerase saw tshuaj tiv thaiv rau cytomegalovirus DNA. Tsis muaj lwm yam kev kuaj mob microbiological zoo. Nws yog hypoxic nrog peripheral oxygen saturation ntawm 86 feem pua thiab qhov ua pa ntawm 26 ua pa / min, yog li nws tau raug xa mus rau chav kho mob hnyav (TU) thiab pib ua pa tsis ua pa (kev ua pa tsis tu ncua rau hom 1 ua pa tsis ua haujlwm. ) thiab tom qab intubation thiab qhov cua raws li nws qhov chaw kho mob deteriorated. Ntshav qab zib CRP yog 83 mg / l.hemoglobin 110 g / . nrog tag nrho cov cell dawb suav, thiab lymphopenia me me (lymphocyte suav 0.8 × 10 degree /). Nws raug kho nrog broad-spectrum tshuaj tua kab mob. Tsis muaj cov tshuaj tiv thaiv kab mob tshwj xeeb tau muab. MMF tau tso tseg. Tsawg-dose tacrolimus tau pib txuas ntxiv tab sis nres 1 hnub ua ntej tuag. Hnub 3 tom qab nkag mus, nws tsim mob raum raug mob (AKI, nrog rau cov ntshav creatinine nce mus rau 225 umol / l.Nws nyob ruaj khov ntawm lub tshuab ua pa nrog txo cov pa oxygen thiab kev txhim kho hauv lub ntsws infiltrates ntawm lub hauv siab X-ray (Daim duab 1b) Tab sis tsis zoo li qub thaum Lub Peb Hlis 16 nrog cov ntshav siab lactate thiab lactate dehydrogenase ntau ntau thiab nce siab ntawm CRP mus rau 190. Nws tau tsim cov metabolic acidosis hnyav rau kev kho ntawm qhov nruam venovenous hemodiafiltration, tej zaum vim muaj qhov tshwm sim hauv plab (mob plab thiab / lossis. intra-abdominal sepsis), Nws deteriorate sai thiab tuag rau lub Peb Hlis 17.
Daim duab 1|Case 2: Chest X-ray (a) ntawm kev nkag mus qhia ob sab patchy consolidation thiab (b) 8 hnub tom qab qhia kev txhim kho hauv ntsws infiltrates.
Tus neeg mob 3.Ib tug 54- poj niam muaj hnub nyoog muaj keeb kwm ntawm tus neeg laus polycysticraumkab mob, kawg-stageraumkab mobNyob rau hauv 2012, nyob rau hauv hemodialysis rau 7 xyoo thiab tau txais ib tug tuag pub raum hloov nyob rau hauv lub Kaum Ob Hlis 2019. Tsis ntev tom qab ntawd, nws tau ntsib ib tug rov ntawm cytomegalovirus kab mob thiab tsim tom qab hloov ntshav qab zib mellitus. Nws cov tshuaj suav nrog BD koob tshuaj tacrolimus 11 mg thiab MMF 500 mg thiab OD koob tshuaj prednisolone 5 mg, amlodipine 5 mg, aspirin 75 mg, bisoprolol 2.5 mg, co-trimoxazole 480 mg, doxazosin 2 mg, isoniazid omepr 300 mg, , pyridoxine 25 mg, thiab gliclazide 120 mg thiab 80 mg (sawv ntxov thiab yav tsaus ntuj). Peb lub hlis tom qab tus neeg tuag pub raum hloov pauv, thaum Lub Peb Hlis 10, nws tau nthuav tawm ua pa luv rau lub chaw kho mob xwm txheej ceev. Ntawm qhov kev ntsuam xyuas thawj zaug, nws cov pa oxygen saturations yog 60 feem pua nrog lub plawv dhia ntawm 105 neeg ntaus / min thiab ntshav siab ntawm 190/99 mm Hg. Nws tau pib tam sim ntawd ntawm kev ua pa zoo txuas ntxiv thiab nws cov pa oxygen saturations tau zoo tuaj rau 87 feem pua. Auscultation ntawm lub hauv siab qhia dav crepitations thiab nws lub hauv siab X-ray pom ob sab pulmonary infiltrates (Ntxiv daim duab S1A). Nws tau pom tias muaj qhov zoo rau SARS-CoV-2 RNA. Nws cytomegalovirus, adenovirus, thiab lwm yam tshuaj tiv thaiv kab mob ua pa nrog rau atypical pneumonia serologies tsis zoo. Tsis muaj lwm yam kev kuaj mob microbiological zoo. Nws tsim cov yam ntxwv ntawm tus mob ua pa nyuaj siab thiab AKI (creatinine 242 μmol / l, lub hauv paus 132 μumol / l).
Nws txoj kev ua pa tsis zoo sai sai hauv chav kho mob xwm txheej ceev thiab nws xav tau kev tso pa tawm 8 teev tom qab thiab txuas ntxiv ua pa tam sim no. MMF raug tso tseg thaum Lub Peb Hlis 10 thiab tacrolimus thaum Lub Peb Hlis 16. Cov tshuaj tua kab mob dav dav thiab tshuaj tiv thaiv kab mob, oseltamivir tau tswj hwm. Nws kuj tau kho empirically rau pneumocystis nrog koob tshuaj co-trimoxazole. Serum CRP txo los ntawm 329 mg / hnub ntawm kev nkag mus rau 169 mg / l 7 hnub tom qab. Nws tau los ua anuric thiab pib nruam venovenous hemofiltration, uas txuas ntxiv mus. Nws lub hauv siab X-ray zaum kawg tau pom qee qhov kev daws teeb meem ntawm pulmonary infiltrates.
Cistanche tiv thaiv kab mob raum
REFERENCES
1. WuF, Zhao S, Yu B, thiab al.Anew coronavirus cuam tshuam nrog tib neeg ua pa kab mob hauv Suav teb. Xwm. 2020579:265-269.
2. Lu R, Zhao X, Li J, et al. Genomic characterization thiab epidemiology ntawm 2019 tshiab tus mob coronavirus: cuam tshuam rau tus kab mob keeb kwm thiab receptor khi. Lancet. 2020; 395:{4}}.
3. Johns Hopkins University of Medicine—Coronavirus Resource Center. Coronavirus COVID-19 kis thoob ntiaj teb los ntawm Center for Systems Science thiab Engineering (CSSE) ntawm Johns Hopkins University.Mar 27, 2020. Muaj nyob ntawm: https://coronavirus jhu.edu/map.html. Tau txais los ntawm Mar 27, 2020.
4. UK tsoom fwv. Tus naj npawb ntawm tus mob coronavirus(COVID{1}}) tus neeg mob thiab pheej hmoo hauv UK 2020.Available ntawm: https://www.govuk/govemment/publications/covid-19-track-coronavirus-cases.Accessed April 14, 2020.
5. Chiu MC. Kev pom zoo kev tswj hwm ntawm cov neeg mob lub raum tsis muaj zog tiv thaiv kab mob SARS. Pediatr Nephrol. 2003; 18:1204-1205.
6. Kumar D, Tellier R, Draker R, et al. Mob hnyav ua pa nyuaj (SARS) nyob rau hauv tus neeg tau txais daim siab hloov pauv thiab cov lus qhia rau kev kuaj mob SARS.Am J Transplant.2003; 3:977-981.
7. AlGhamdi M, Mushtaq F, Awn N, Shalhoub S.MERS CoV infections in two renal transplant recipients: a case report.Am J Transplant.2015;15:1101-1104.
8. Zhu L, Xu X, Ma K, et al. Kev rov ua tiav ntawm COVID-19 mob ntsws nyob rau hauv tus neeg tau txais kev hloov pauv lub raum nrog kev tiv thaiv kab mob mus ntev [e-pub ua ntej luam tawm]. Am J Transplant.https://doi.org/10.1111/ajt.15869. Tau txais los ntawm Mar 27, 2020.
9. ZhouF, Yu T, Du R, et al. Cov chav kho mob thiab cov xwm txheej txaus ntshai rau kev tuag ntawm cov neeg laus hauv tsev kho mob nrog COVID-19 hauv Wuhan, Tuam Tshoj: kev tshawb fawb rov qab. Lancet. 2020; 395:{4}}.
10. Phanish MK, Hull RP, Andrews PA, thiab al.Immunological kev pheej hmoo stratification thiab tailored minimization ntawm immunosuppression nyob rau hauv cov neeg tau txais kev hloov lub raum. 2020: 21: 92, NPE
