【摘要】 目的 探讨新型冠状病毒感染（coronavirus disease 2019, COVID-19）患者血浆外泌体免疫膜蛋白含量与病情进展的相关性、在监测COVID-19的临床分型及其病情转归中的潜在价值。方法 选取2022年11—12月首都医科大学附属北京佑安医院COVID-19患者及献血者25例，根据临床症状分型分为健康组、轻症型、普通型、重症型及危重型5组，每组各5例。采用超速离心法提取血浆中的外泌体，采用Amnis量化成像流式细胞仪分析外泌体表面免疫膜蛋白的含量。比较各组外泌体免疫膜蛋白主要组织相容性复合体Ⅰ类（major histocompatibility complex class Ⅰ, MHC Ⅰ）、主要组织相容性复合体Ⅱ类（major histocompatibility complex class Ⅱ, MHC Ⅱ）、免疫抑制分子程序性死亡受体1(programmed cell death protein 1, PD-1)的阳性率。结果 25例COVID-19患者及献血者中男13例，女12例，年龄34～92岁，平均（67.1±19.6）岁。轻症型[（2.40±1.45）%]、重症型[（3.51±1.44）%]及危重型[（3.67±2.04）%] MHCⅠ外泌体阳性率低于健康组[（16.42±3.79）%]和普通型[（14.81±3.30）%]；危重型[（0.23±0.08）%] PD-1外泌体阳性率高于健康组[（0.07±0.05）%]、轻症型[（0.08±0.03）%]和普通型[（0.05±0.04）%]，差异均有统计学意义（P <0.05）;5组MHC Ⅱ外泌体阳性率的比较，差异无统计学意义（P> 0.05）。结论 COVID-19患者血浆外泌体免疫膜蛋白的含量与病程进展有明显的相关性。外泌体免疫膜蛋白MHC-Ⅰ、PD-1的检测有助于COVID-19临床分型和（危）重症型病例的预测。更多还原

【Abstract】 Objective To explore the correlation between the content of plasma exosome immune membrane protein in coronavirus disease 2019(COVID-19) patients and the progression of the disease, and to clarify the potential value of the exosomes immune membrane protein levels in predicting the clinical typing of COVID-19 and its disease regression.Methods A total of 25 patients with COVID-19 and blood donors in Beijing Youan Hospital from November 2022 to December 2022 were included, and were devided into healthy group, mild type, common type, severe type and critical type according to clinical symptoms, with five cases in each group. The exosomes in plasma were extracted by ultracentrifugation,and the content of immune membrane proteins on the surface of exosomes was analyzed by Amnis quantitative imaging flow analysis. The positive rates of major histocompatibility complex class Ⅰ(MHC Ⅰ), major histocompatibility complex class Ⅱ(MHC Ⅱ) and programmed cell death protein 1(PD-1) of immune membrane proteins in exosomes of all groups were compared. Results Among the 25 cases of COVID-19 patients and blood donors, there were 13 males and 12 females, aged from 34 to 92 years, with an average of(67.1 ± 19.6) years. The positive rate of MHC Ⅰ exosomes in mild type [(2.40 ±1.45)% ], severe type [(3.51 ± 1.44)% ] and critical type [(3.67 ± 2.04)% ] were lower than those in healthy group [(16.42 ±3.79)%] and common type [(14.81 ± 3.30)%]. The positive rate of PD-1 exosomes in severe type [(0.23 ± 0.08)%] was higher than those in healthy group [(0.07 ± 0.05)% ], mild type [(0.08 ± 0.03)% ] and common type [(0.05 ± 0.04)% ], and the differences were statistically significant(P < 0.05). There was no statistical difference in the positive rate of MHC Ⅱexosomes among the five groups(P > 0.05). Conclusions The content of plasma exosome immune membrane protein in COVID-19 patients has obvious correlation with the progression of the disease. The detection of exosome immune membrane protein MHC Ⅰ and PD-1 is helpful for clinical classification of COVID-19 and prediction of(critical) severe cases.更多还原