Cov tshuaj tso zis tso zis me me hauv cov neeg mob uas muaj tus kab mob COVID-19-mob raum cuam tshuam ntau dua li cov uas tsis yog-COVID-19-mob raum cuam tshuam

Abstract

Keeb kwm:Mob raum raug mobyog ib qho teeb meem tseem ceeb ntawmkab mob khaus laus nas vais lav 2019(COVID-19). Ob qhov COVID-19- cov txheej txheem tshwj xeeb, xws likev puas tsuaj rau lub raum parenchymalos ntawmtus kab mob ncaj qha, thiabcov mechanisms tsis tshwj xeeb, zoo li covua ntej lub raum raug mob, tau thov kom uakoom nrog COVID-19- cuam tshuam rau lub raum raug mob. Hauv qhov kev tshawb fawb no, peb tsom mus rau elucidateyam ntxwv ntawm COVID-19- koom nrogmob raum,tsom feem ntau ntawm kev tshawb pom cov zis tso zis. Txoj Kev: Peb piv cov tshuaj tso zis tso zis thiab lawv cov koom haum nrog rau lub raum kev ua haujlwm lossis uri nary qhov chaw kho mob tsis sib xws ntawm cov neeg mob.COVID-19thiab tej yam tsis muajCOVID-19 nrog rau mob raum mob. Cov txiaj ntsig: Peb pom tias muaj pes tsawg tus tso zis tso quav thiab theem ntawm N-acetyl- -D glucosaminidase, 1-microglobulin, daim siab-hom fatty acid-binding protein, thiab neutrophil gelatinase-associated lipocalin. nrog qhov hnyav ntawm COVID-19. Tsis tas li ntawd, peb tau pom tias tus naj npawb ntawm cov khoom pov tseg, cov khoom pov tseg hauv epithelial, cov khoom pov tseg pov tseg, thiab cov tshuaj urinary cov cim qhia tau qis dua hauv cov kev kawm uas muaj COVID-19 ntau dua li cov uas tsis muaj COVID-19 nrog rau mob raum mob thaum cov kev kawm tau muab cais raws li lawv lub raum ua haujlwm. Cov ntsiab lus: Cov txiaj ntsig no qhia tau hais tias ua ntej lub raum raug mob tej zaum yuav muaj feem cuam tshuam rau hauv cov kab mob pathogenesisCOVID-19- cuam tshuam rau lub raum raug mobpiv nrog cov tsis-COVID-19-sociatedmob raumtshwm sim los ntawm kev phais lossis sepsis.

Nws yuav siv sij hawm ntev npaum li cas rau CISTANCHE ua haujlwm?

Taw qhia

Kab mob Coronavirus 2019 (COVID-19), uas yog tshwm sim los ntawmmob hnyav ua pa syndrometus mob coronavirus 2 (SARS-CoV-2), tau nce zuj zus mus rau hauv kev sib kis thoob ntiaj teb. Cov ncauj lus nrog COVID-19 nquag ua rau mob ntsws, uas tuaj yeem ua rau ua pa tsis ua pa. Ntau yam teeb meem ntxiv tuaj yeem tshwm sim. Ntawm lawv, cov neeg mob COVID-19 tuaj yeem raug mob raum mob, tshwj xeeb tshaj yog mob raum raug mob (AKI). AKI yog ib qho teeb meem ntau zaus hauv cov neeg mob uas muaj qhov mob hnyav heev COVID-19, thiab daim ntawv tshaj tawm kev tshuaj ntsuam xyuas tau pom tias qhov xwm txheej nruab nrab ntawm AKI yog 11% ntawm txhua tus neeg mob nrog COVID-19 thiab 23% ntawm cov neeg mob hnyav. Cov neeg mob (Gabarre et al., 2020). Raws li cov neeg mob uas muaj COVID{11}} uas muaj kab mob raum tau tshaj tawm tias muaj kev pheej hmoo siab ntawm kev tuag hauv tsev kho mob (Cheng li al., 2020), kev kuaj mob ntxov ntawm lub raum raug mob tuaj yeem txhim kho qhov kev mob tshwm sim.

Tam sim no, cov txheej txheem ntxaws ntxaws ntawm COVID-19- cuam tshuam txog kev raug mob ntawm lub cev tsis tau qhia meej; txawm li cas los xij, ob peb lub tswv yim tau tsim. Angiotensin-converting enzyme 2 (ACE2) thiab transmembrane serine protease 2 (TMPRSS2), uas yog cov protein tseem ceeb hauv kev nkag ntawm SARS-CoV-2 rau hauv tib neeg lub hlwb (Hoffmann et al., 2020), tau qhia zoo hauv podocytes thiab cov tubules ze ze ntawm lub raum (Pan et al., 2020), thiab SARS-CoV- 2 tuaj yeem kis ncaj qha thiab ua rau lub raum puas (Yeung et al., 2016). Ib txoj kev tshawb fawb tsis ntev los no tau pom tias muaj tus kab mob SARS-CoV siab-2 cov kab mob kis tau zoo cuam tshuam nrog rau lub raum teeb meem thiab qhov hnyav ntawm COVID-19 (Caceres et al., 2021). Cov teeb meem xws li thrombosis thiab endothelins kuj nquag pom nyob rau hauv cov ncauj lus nrog COVID-19 (Li et al., 2020 Shimura et al. 2021; Xiong et al., 2020;); Raws li txoj cai, cov teeb meem no tuaj yeem ua rau lub raum tsis zoo. Tsis tas li ntawd, lwm cov txheej txheem tsis tshwj xeeb rau COVID-19 kuj tau raug npaj. Mechanical ventilation vim mob ntsws tsis ua hauj lwm (Vieillard-Baron li al., 2007), txoj cai plawv tsis ua hauj lwm vim myocardial infarction (Bradley li al., 2020, Edler et al., 2020) los yog myocarditis (Bradley li al., 2020) , lossis rhabdomyolysis (Gamboa et al., 1979), uas tuaj yeem ua rau AKI (Legrand et al., 2013), kuj tseem tuaj yeem koom nrog COVID-19- cuam tshuam rau lub raum raug mob. Raws li ob qho tib si COVID-19- cov txheej txheem tshwj xeeb thiab tsis tshwj xeeb tuaj yeem ua tau, kev sib piv cov zis tsis sib xws ntawm cov neeg mob lub raum raug mob los ntawm COVID-19 thiab cov neeg mob raum raug mob los ntawm lwm yam kab mob yuav yog qhov tseem ceeb rau kev nkag siab txog cov kab mob pathophysiological yam ntxwv rau COVID-19- cuam tshuam rau lub raum raug mob. Txog tam sim no, kev kuaj mob raum tom qab lub raum pathologic tau tshaj tawm tias qhov kev kawm histologic ntawm kev raug mob tubular raug mob tsawg dua qhov kev kwv yees raws li qib creatinine nce siab (Santoriello li al., 2020), qhia tias COVID-19- cuam tshuam rau lub raum raug mob tej zaum yuav muaj cov yam ntxwv tshwj xeeb piv nrog cov uas tsis yog-COVID-19- cuam tshuam rau lub raum raug mob.

Kev kuaj zis thiab cov zis tso zis yog qhov qub tshaj plaws thiab feem ntau ua cov kev ntsuam xyuas rau kev ntsuam xyuas cov kab mob pathophysiological ntawm lub raum / urethral system. Cov kev tshawb pom tso zis xws li proteinuria, hematuria, thiab leukocyturia tau tshaj tawm tias cuam tshuam nrog COVID-19- cuam tshuam rau lub raum kev raug mob thiab qhov hnyav ntawm COVID-19 (Allemailem li al., 2021 Chan et al., 2020; Liu et al. ., 2020; Ouahmi et al., 2021; Pei et al., 2020; Yang et al., 2020;), thiab ntau yam tshuaj urinary biomarkers xws li N-acetyl- -D-glucosaminidase (NAG), { {11}}microglobulin ({12}}MG), thiab neutrophil gelatinase-associated lipocalin (NGAL) tau raug thov kom koom nrog AKI hauv tsev kho mob cov neeg mob nrog COVID-19 (Fukao li al., 2021 Huart et al., 2021; Husain-Syed et al., 2020; Luther et al., 2021;). Txawm li cas los xij, cov yam ntxwv ntawm cov tshuaj tso zis tso zis cuam tshuam nrog COVID-19 tseem tsis tau kawm txaus. Txog tam sim no, tsuas yog ib daim ntawv tshaj tawm thiab ib qho kev tshawb fawb tau tshaj tawm cov tshuaj tso zis hauv cov neeg mob nrog COVID-19 thiab tau qhia txog kev sib koom ua ke ntawm granular casts thiab qhov hnyav ntawm COVID-19 (Allemailem li al., 2021 , Fujimaru et al., 2020). Feem ntau, kev tshawb pom cov zis tso zis tuaj yeem ua rau tsis muaj qhov cuam tshuam txog qhov hnyav thiab / lossis ua rau lub raum raug mob. Piv txwv li, muaj lub raum tubular epithelial hlwb (RTEs) thiab granular casts yog pab tau rau kev sib txawv ntawm lub raum raug mob thiab pre-lub raum raug mob (Perazella li al., 2008), thiab waxy casts yog tshaj tawm hais tias muaj feem xyuam rau lub raum tsis ua hauj lwm (Spinelli et al. ib., 2013).

Xav txog cov keeb kwm yav dhau los no, kev tshawb pom cov zis tso zis xav tias yuav muaj txiaj ntsig zoo rau kev ntsuas tsis ncaj ntawm cov theem raug mob raum hauv cov ncauj lus nrog COVID-19. Yog li ntawd, hauv txoj kev tshawb fawb tam sim no, peb tau tshawb xyuas qhov kev koom tes ntawm cov ntshav los yog cov tshuaj tso zis tso zis thiab cov tshuaj tso zis tso zis ntawm cov neeg mob nrog COVID-19 thiab cov ntsiab lus tsis muaj COVID-19 txhawm rau txheeb xyuas cov yam ntxwv ntawm kev kuaj cov zis thiab kwv yees. cov txheej txheem hauv qab rau COVID-19- cuam tshuam rau lub raum raug mob.

Cov ntaub ntawv thiab cov txheej txheem

Cov kawm

Cov qauv zis seem tau sau los ntawm 88 tus neeg mob nrog COVID-19 (tag nrho: 279 tus qauv; qhov nruab nrab: 3 tus qauv rau ib tus neeg mob; ntau yam: 1-16 tus qauv) kuaj mob siv RT-PCR. Qhov hnyav ntawm COVID-19 tau txhais raws li hauv qab no: me me tsis xav tau kev kho pa oxygen; nruab nrab, yuav tsum tau kho cov pa oxygen tab sis tsis yog siv tshuab ua pa; thiab hnyav, xav tau kev txhawb nqa tshuab ua pa. Peb kuj tau sau cov tshuaj tso zis los ntawm 78 tus neeg mob (tag nrho: 147 tus qauv; qhov nruab nrab: 2 tus qauv rau ib tus neeg mob; ntau yam: 1–9 qhov kuaj) nrog rau mob raum mob los ntawm qhov tsis yog-COVID-19 yam, uas tau mus rau qhov xwm txheej ceev los yog intensive care unit (ICU). Cov zis tso zis seem tau muab khaws cia tom qab kev kuaj sim niaj hnub, thiab cov supernatant tau khaws cia ntawm -80 degree . Cov yam ntxwv ntawm cov kev kawm tau piav qhia hauv Table 1.

Txoj kev tshawb fawb tam sim no tau ua raws li cov txheej txheem kev coj ncaj ncees uas tau teev tseg hauv Kev Tshaj Tawm ntawm Helsinki. Sau ntawv tso cai rau kev soj ntsuam kuaj tau los ntawm qee tus neeg mob. Rau cov neeg koom nrog uas tau sau ntawv tso cai tsis tuaj yeem tau txais vim tias lawv tau raug tshem tawm lossis hloov chaw hauv tsev kho mob, tau txais kev pom zoo pom zoo hauv daim ntawv xaiv tawm ntawm lub vev xaib, raws li hauv qab no. Cov neeg mob tau txais kev ceeb toom txog qhov kev kawm ntawm lub vev xaib, thiab cov neeg uas tsis xav mus kawm hauv txoj kev tshawb fawb no raug cais tawm. Txoj kev tshawb fawb tsim tau pom zoo los ntawm University of Tokyo Medical Research Center Ethics Committee, uas zam qhov yuav tsum tau sau ntawv tso cai thaum sau ntawv tso cai tsis tuaj yeem tau txais vim tias cov qauv khaws cia tau siv thiab tag nrho cov ntaub ntawv uas tau siv hauv qhov kev tshawb fawb rov qab no tau raug siv. tau txais los ntawm cov ntaub ntawv kho mob (3683, 3333-101, 3333-140, thiab 2020206NI).

Kev kuaj zis

Kev kuaj cov zis tso zis tau ua los ntawm kev siv phau ntawv microscopy thiab ua raws li Nyiv Pawg Neeg Saib Xyuas Kev Ntsuas Cov Qauv (JCCLS). RTEs raug suav rau ib lub zog loj ntawm kev saib (/HPF), thiab cov zis tso zis tau muab faib ua hyaline casts (HyaC), granular casts (GraC), epithelial casts (RTEC), thiab waxy casts (WaxC), thiab lawv cov lej raug suav. rau tag nrho cov teb (/WF). Rau kev ntsuas cov cim ntsuas hauv cov zis, peb siv cov tshuaj reagents hauv qab no: urinary creatinine (uCr) tau ntsuas los ntawm kev ntsuas enzyme (L-type Wako CRE • M; FUJIFILM Wako Pure Chemical, Osaka, Nyiv); tag nrho cov protein (TP) (Micro TP test Wako; FUJIFILM Wako) tau ntsuas siv cov pyrogallol liab txoj kev; microalbumin (μAlb) (Auto Wako microalbumin; FU JIFILM Wako) tau ntsuas siv turbidimetric immunoassay (TIA); NAG (Ltype Wako NAG; Wako, Nyiv) tau ntsuas los ntawm kev ntsuas enzyme; 1-MG (LZtest 'Eiken' 1-M; Eiken Chemical, Nyiv) tau ntsuas siv latex agglutination turbidimetry; daim siab hom fatty acid-binding protein (L-FABP) (NORUDIA L-FABP; SEK ISUI MEDICAL, Nyiv) tau ntsuas siv latex agglutination turbidimetry; thiab NGAL (U-NGAL Abbott; Abbott, Nyiv) tau ntsuas los ntawm chemiluminescence immunoassay (CLIA). Urinary specific gravity (SG) raug ntsuas los ntawm kev ntsuas cov zis automated urine chem ical analyzer US-3500 (Eiken Chemical, Nyiv) thiab cov zis sodium yog ntsuas los ntawm txoj kev electrode. Kev koom tes ntawm kev raug mob ua ntej lub raum tau lees paub thaum SG yog 1.020 lossis siab dua lossis zis sodium yog 20 mmol / L lossis qis dua, qhov kev koom tes ntawm lub raum raug mob tau kwv yees thaum SG yog 1.010 lossis qis dua lossis zis Na yog 40 mmol / L los yog siab dua.

Kev txheeb cais

Kev txheeb xyuas cov ntaub ntawv tau ua tiav siv SPSS (Chicago, IL). Qhov kev sim Kruskal-Wallis tau siv los sib piv cov zis cov kua qaub thiab cov cim tso zis raws li qhov hnyav ntawm cov ntsiab lus nrog COVID-19. Qhov kev sim chi-square thiab Mann-Whitney U kuaj tau siv los sib piv cov cim tso zis thiab cov naj npawb ntawm cov zis cov kua qaub ntawm cov ncauj lus nrog thiab cov uas tsis muaj COVID-19, thiab Spearman correlation test tau siv los txheeb xyuas lub koom haum. nruab nrab ntawm cov cim tso zis thiab cov zis tso zis ntawm cov ntsiab lus. Kev txheeb xyuas qhov tseem ceeb tau suav tias yog P tus nqi < 0.05.

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