상위피인용논문
충남대학교 의과대학
Chan-Ki Min1,2,*, Shinhye Cheon3,*, Na-Young Ha1,2,*, Kyung Mok Sohn3,*, Yuri Kim1,2, Abdimadiyeva Aigerim1,2, Hyun Mu Shin1,2, Ji-Yeob Choi2,4, Kyung-Soo Inn5, Jin-Hwan Kim6, Jae Young Moon7, Myung-Sik Choi1, Nam-Hyuk Cho1,2,8 & Yeon-Sook Kim3
1Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Republic of Korea. 2Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea. 3Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea. 4Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. 5Department of Pharmaceutical Science, College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea. 6Department of Radiology, Chungnam National University School of Medicine, Daejeon, Republic of Korea. 7Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Republic of Korea. 8Institute of Endemic Disease, Seoul National University Medical Research Center and Bundang Hospital, Seoul, Republic of Korea.
*These authors contributed equally to this work.
Correspondence and requests for materials should be addressed to N.-H.C. or Y.-S.K.
Abstract
Despite the ongoing spread of MERS, there is limited knowledge of the factors affecting its severity and outcomes. We analyzed clinical data and specimens from fourteen MERS patients treated in a hospital who collectively represent a wide spectrum of disease severity, ranging from mild febrile illness to fatal pneumonia, and classified the patients into four groups based on severity and mortality. Comparative and kinetic analyses revealed that high viral loads, weak antibody responses, and lymphopenia accompanying thrombocytopenia were associated with disease mortality, whereas persistent and gradual increases in lymphocyte responses might be required for effective immunity against MERS-CoV infection. Leukocytosis, primarily due to increased neutrophils and monocytes, was generally observed in more severe and fatal cases. The blood levels of cytokines such as IL-10, IL-15, TGF-β, and EGF were either positively or negatively correlated with disease mortality. Robust induction of various chemokines with differential kinetics was more prominent in patients that recovered from pneumonia than in patients with mild febrile illness or deceased patients. The correlation of the virological and immunological responses with disease severity and mortality, as well as their responses to current antiviral therapy, may have prognostic significance during the early phase of MERS.
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