Abstract
The emergence of 2019 novel coronavirus disease (COVID-19) is currently a global concern. In this study, our goal was to explore the changing expression levels of acute-phase reaction proteins (APRPs) in the serum of COVID-19 patients and to elucidate the immunological characteristics of COVID-19. In the study design, we recruited 72 COVID-19 patients, including 22 cases of mild degree, 38 cases of moderate degree and 12 cases of severe degree. We also recruited 20 patients with community-acquired pneumonia (CAP) and 20 normal control subjects as a comparison. Fasting venous blood was taken to detect the content of complement 3 (C3), complement 4 (C4), C-reactive protein (CRP), serum amyloid A (SAA) and prealbumin (PA). When compared the COVID-19 group with the CAP and normal control groups, respectively, the mean value of CRP and SAA in the COVID-19 group (including mild, moderate and severe patients) had increased significantly (P < 0.01), whereas the mean values of C3, C4 and PA decreased (P < 0.01). For the asymptomatic or mild symptomatic patients with COVID-19, the actual aggravation of disease may be more advanced than the clinical appearances. Meanwhile, the statistical analyses indicated that the development of COVID-19 brought about a significant increase in the content of CRP and SAA (P < 0.01), and a decline in the content of C3, C4 and PA (P < 0.01). These findings suggested that the changes in the level of APRPs could be used as indicators to identify the degree and progression of COVID-19, and the significant changes might demonstrate the aggravation of disease. This study provided a new approach to improve the clinical management plan and prognosis of COVID-19.
Highlights
The 2019 novel coronavirus disease (COVID-19) is a highly infectious pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]
We evaluated the immune response to SARS-CoV-2 by comparing the levels of some acute-phase reaction proteins (APRPs) in the serum among the COVID-19 patients, community-acquired pneumonia (CAP) patients and normal people
In the moderate and severe groups, the APRPs values of the patients changed further with the trend (i.e. C-reactive protein (CRP) and serum amyloid A (SAA) increased, and complement 3 (C3), complement 4 (C4) and PA decreased). These changes in the severe group were greater than that of the moderate group. These findings suggested that the significant changes in the levels of APRPs signalled an aggravation of COVID-19, and the markers of C3 and SAA were more sensitive than C4 and CRP
Summary
The 2019 novel coronavirus disease (COVID-19) is a highly infectious pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. It was first reported in Wuhan, the Hubei province of China and broke out in several places, spreading across the country. Coronaviruses have a capsule membrane and a linear single-stranded RNA genome They are classified into four genera (α, β, γ and δ). The previous studies have shown that the receptor protein of SARS-CoV-2 is angiotensin-converting enzyme 2 (ACE2), which is highly homologous to that of SARS-CoV [5]. In vitro, the cell experiments proved that ACE2 was the receptor protein of SARS-CoV-2 [7]
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