自1/20~3/25,五名實驗室確診武漢肺炎重症患者(35~65歲,2名女性)接收恢復者血漿輸血治療。五名重症患者皆符合下列資格:發展快速的嚴重肺炎,即使使用抗病毒藥物病毒量仍高,PAO2/FIO2<300,及使用呼吸器。與治療前之臨床現象做比較,有四名患者體溫在3天內恢復正常,器官衰竭指數降低,且PAO2/FIO2在12天內增加,病毒量減少,SARS-CoV-2 ELSA及中和抗體量增加,呼吸窘迫症候群緩減;三名病者在2周內脫離呼吸器。在37天後,5名患者中有3名出院,2名狀況穩定。這項觀察仍需臨床試驗證實其成效。

(財團法人國家衛生研究院 莊淑鈞博士摘要整理)

IMPORTANCE Coronavirus disease 2019 (COVID-19) is a pandemic with no specific therapeutic agents and substantial mortality. It is critical to find new treatments.

OBJECTIVE To determine whether convalescent plasma transfusion may be beneficial in the treatment of critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

DESIGN, SETTING, AND PARTICIPANTS Changes of body temperature, Sequential Organ Failure Assessment (SOFA) score (range 0-24, with higher scores indicating more severe illness), PAO2/FIO2, viral load, serum antibody titer, routine blood biochemical index, ARDS, and ventilatory and extracorporeal membrane oxygenation (ECMO) supports before and after convalescent plasma transfusion.

RESULTS All 5 patients (age range, 36-65 years; 2 women) were receiving mechanical ventilation at the time of treatment and all had received antiviral agents and methylprednisolone. Following plasma transfusion, body temperature normalized within 3 days in 4 of 5 patients, the SOFA score decreased, and PAO2/FIO2 increased within 12 days (range, 172-276 before and 284-366 after). Viral loads also decreased and became negative within 12 days after the transfusion, and SARS-CoV-2–specific ELISA and neutralizing antibody titers increased following the transfusion (range, 40-60 before and 80-320 on day 7). ARDS resolved in 4 patients at 12 days after transfusion, and 3 patients were weaned from mechanical ventilation within 2 weeks of treatment. Of the 5 patients, 3 have been discharged from the hospital (length of stay: 53, 51, and 55 days), and 2 are in stable condition at 37 days after transfusion.

CONCLUSIONS AND RELEVANCE In this preliminary uncontrolled case series of 5 critically ill patients with COVID-19 and ARDS, administration of convalescent plasma containing neutralizing antibody was followed by improvement in their clinical status. The limited sample size and study design preclude a definitive statement about the potential effectiveness of this treatment, and these observations require evaluation in clinical trials.

Author:Chenguang Shen, Zhaoqin Wang, Fang Zhao, et al.
原文連結:https://jamanetwork.com/journals/jama/fullarticle/2763983