怀孕三个月时感染 COVID-19 对先天性免疫参数的影响,以及与产科和围产期结局的关系

I. Andrievskaya, K. S. Lyazgiyan, I. V. Zhukovets, E. M. Ustinov
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摘要

目的分析和比较 COVID-19 患者在妊娠三个月内的先天性免疫参数与产科和围产期结果的关系。材料和方法研究包括两组:主组包括妊娠三个月期间患有轻度(子组 1,n = 31)和中度(子组 2,n = 40)COVID-19 的患者;对照组包括妊娠期间未患有 COVID-19 的妇女(n = 22)。通过酶联免疫吸附试验(ELISA),我们测定了血浆中抗SARS-CoV-2免疫球蛋白(Ig)M和IgG、肿瘤坏死因子α(TNFα)、白细胞介素6(IL-6)和γ干扰素(IFNγ)的水平。全血细胞计数在全自动血液分析仪上进行。用流式细胞仪分析单核细胞中 CD-14 和 HLA-DR 抗原的表达。通过逆转录聚合酶链反应(RT-PCR)检测胎盘样本中的 SARS-CoV-2 RNA。结果与轻度 COVID-19 相比,中度 COVID-19 病程与母体血液和脐带血中较低水平的抗 SARS-CoV-2 IgG 和 IFNγ 以及单核细胞较低水平的 CD-14 和 HLA-DR 表达有关。轻度病程的特点是母血中单核细胞数量增加。白细胞和淋巴细胞计数无差异。出生体重和一分钟阿普加评分也无差异。5 分钟后,中度 COVID-19 的 Apgar 评分低于轻度感染。中度 COVID-19 病程会增加早产、新生儿脑缺血、脑室内出血和呼吸窘迫综合征的风险。未发现宫内感染 SARS-CoV-2 的风险。结论妊娠三个月时 COVID-19 的严重程度与先天性免疫失调有关,而先天性免疫失调决定了产科和围产期并发症的性质。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effect of COVID-19 infection in the third trimester of pregnancy on innate immunity parameters, association with obstetric and perinatal outcomes
Aim. To analyze and compare parameters of innate immunity with obstetric and perinatal outcomes in patients with COVID-19 in the third trimester of pregnancy. Materials and methods. The study included 2 groups: the main group encompassed patients with mild (subgroup 1, n = 31) and moderate (subgroup 2, n = 40) COVID-19 during the third trimester of pregnancy; the control group included women who did not have COVID-19 during pregnancy (n = 22). By the enzyme-linked immunosorbent assay (ELISA), we determined the level of anti-SARS-CoV-2 immunoglobulin (Ig)M and IgG, tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6), and interferon gamma (IFNγ) in the blood plasma. Complete blood count was performed on the automated hematology analyzer. Expression of CD-14 and HLA-DR antigens in monocytes was analyzed on the flow cytometer. SARS-CoV-2 RNA in placenta samples was detected by the reverse transcription polymerase chain reaction (RT-PCR). Results. A moderate course of COVID-19 in the third trimester of pregnancy was associated with lower levels of anti-SARS-CoV-2 IgG and IFNγ in the maternal blood and umbilical cord blood, as well as by lower expression of CD-14 and HLA-DR by monocytes compared to mild COVID-19. A mild course of the disease was characterized by an increase in the number of monocytes in the maternal blood. No differences in leukocyte and lymphocyte counts were noted. There were also no differences in birth weight and one-minute Apgar score. At 5 minutes, the Apgar scores for moderate COVID-19 were lower than those for mild infection. The moderate course of COVID-19 increased the risk of preterm birth, neonatal cerebral ischemia, intraventricular hemorrhage, and respiratory distress syndrome. No risk of intrauterine SARS-CoV-2 infection was detected. Conclusion. The severity of COVID-19 in the third trimester of pregnancy is associated with dysregulation of the innate immunity, which determines the nature of obstetric and perinatal complications.
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