I can see the status bar

Chapter 1029 D+4 day (4) (dissertation)
The logic of using tocilizumab is actually very simple and clear.Even if Sun Lien started from the beginning, it would only take a total of ten minutes.

The use of tocilizumab is essentially an extremely bold attempt.It can even be regarded as a standard procedure for a large-scale experiment - bold assumptions, careful verification, serious experiments, and finally conclusions.Of course, the current progress is still in the "serious experiment" step, but the facts are now in front of us, and it is hard to imagine that Sun Lien's experiment will end up with unfavorable results as a conclusion.

After listening to Sun Lien's introduction, several experts were silent for a while, and then looked at the computer screen, hesitating to speak.

"It's... that simple?" Song Wen had seen the medication and experiment plan submitted by Sun Lien.But she did not expect that the reason why Sun Lien decided to use tocilizumab was so simple-most of the critically ill patients had severe and obvious elevation of interleukin-6 (IL-6).Therefore, it is considered that the lung injury and consolidation suffered by the patient belong to the cytotoxic injury caused by the immune system, and as a starting point, it is believed that reducing the patient's interleukin-6 may help prevent the inflammatory storm and prevent further lung parenchymal lesions .

There is no problem with this logic itself, and it is also very concise and direct.But the problem is... Sun Lien's thinking logic seems to be a little too straightforward.

It is true that most patients have elevated interleukin-6, but there are many other things that are elevated.Not to mention creatinine and lactate levels, which represent markers of damage, other immune signature markers, such as the number of immune cells such as CD4+ and CD6+, also rose rapidly.The relationship between interleukin-6 and immune storm is still in the research stage, and various studies and hypotheses are still evenly matched, and it is difficult to gain wide acceptance.

And Sun Lien aimed at interleukin-6 and hit it with one shot, and at the same time achieved a pretty good result.This had to make the experts feel that "newborn calves are not afraid of tigers", and envied Sun Lien's "good luck".

In scientific research work, few people can find the key nodes so simply and directly.Many discoveries and cognitions that seem to be taken for granted now have gradually achieved their current results after generations of geniuses have worked hard and worked hard all their lives.There are too many counter-intuitive relationships in scientific research. There are so many such relationships that when later researchers put forward hypotheses, they always have to think more, verify more, and analyze more.

To take the simplest example, I am afraid that no one thinks that ice cream can cause Americans to drown.But if the monthly sales of ice cream in the United States and the number of drowning deaths are made into icons, anyone who is not blind can see that the two data trends are highly consistent.

Those with normal logical thinking can understand that there is no direct connection between ice cream and drowning itself.They are closely related to another factor - temperature changes.The hotter the weather, the more people eat ice cream.At the same time, more and more people choose to swim to escape the heat.That's why these two data show a closely related trend, and may even mislead people into thinking that "ice cream causes drowning".

Another example is even more surprising.This set of data is a comparison of the incidence of malaria and the incidence of malignant tumors in various regions of the world.

Intuitively through the data relationship, people can find a rule - the higher the incidence of malaria, the lower the incidence of malignant tumors.If you understand directly through the data, perhaps people can draw a conclusion that malaria can treat or prevent malignant tumors.

After adding logic for reasoning and analysis, normal people will think that the relationship between the incidence of malaria and the incidence of malignant tumors has nothing to do with it.In general, places with higher malaria incidence are more backward economically, with shorter average life expectancy, poorer medical care and lower pollution levels than places with low malaria incidence.The diagnosis of malignant tumors is highly related to age, medical level and environmental factors, so there is such a difference.

In other words, the relationship between malaria, tumors, and economic level is basically the same as the relationship between "ice cream, drowning deaths, and the temperature at that time".The reason they appear to be highly consistent is that the two data are themselves highly correlated with another hidden condition.

Therefore, it is not that a high level of interleukin-6 must have a direct causal relationship with the immune storm.The connection between them is likely to be more subtle.

At the same time, logical and reasoning analysis may not necessarily lead to correct conclusions.The logic that the malaria infection rate is inversely proportional to the incidence of malignant tumors seems to be completely explained by the logic mentioned above.But some unbelieving doctors have studied this, and a new experimental treatment project group has been born-by injecting malaria parasites into patients who are terminally ill and resistant to conventional chemotherapy drugs, so as to treat malignant tumors the goal of.

This treatment group is still in preliminary experiments, but the results so far are quite encouraging-out of the thirty patients treated, ten have survived for more than one year, and the treatment effect of five can be judged to be effective. Three of them were deemed clinically cured.

This is a very remarkable result, but it is a terminal cancer patient who is resistant to conventional chemotherapy and even targeted drugs.

Logical analysis and common sense deduction cannot guarantee that the obtained results are true and credible. To prove the hypothesis, more rigorously designed experiments and appropriate and sufficient data conclusions are required.

And this is the point that shocked this group of experts - there is no design experiment, no data conclusions, and even no exclusion analysis. How can Sun Lien lock this key indicator and still achieve results?

"When you conducted this experiment, why didn't you consider other indicators? There are many other immune indicators in severe and critically ill patients?" Song Wen asked the question that other experts were most concerned about. Do you start with interleukin-6?"

"Because I can't intervene in other indicators." Sun Li'en replied dignifiedly, "Other immune system indicators are difficult to target for intervention. If it's just a one-brained suppression of the immune response, then simply use the hormone shock—" He After a pause, he continued, "We don't have any effective antiviral treatment now. If we want to clear the virus, we can only hope that the patient's immune system will work quickly. Using hormones to suppress the immune response, the patient's ability to clear the virus The ability will be weakened. The course of the disease will definitely become longer, and the organ damage caused by non-autoimmunity will expand... These are all bad news. Interleukin-6 is an indicator and inflammatory marker that we can target for intervention, and at the same time in clinical The observed changes in the patient's condition are also in line with speculation—the increase in interleukin-6 leads to a decrease in the number of peripheral blood lymphocytes, and at the same time stimulates T cells to destroy lung tissue through cytotoxicity, and the weakened phagocytosis leads to dead cells that cannot be removed in time, resulting in interstitial pneumonia-like injury."

Song Wen's expression was wonderful, she raised her eyebrows and asked, "Since the idea of ​​controlling interleukin-6 to control damage is just a guess, you don't have direct evidence at hand... What if you guess wrong?"

"Patients receiving tocilizumab are all voluntary, and other treatments are continuing at the same time." Sun Lien replied, "As a clinical trial, the treatment plan of tocilizumab is definitely not ideal or even advisable. After all, we What is being done now is personalized treatment with thousands of people and thousands of strategies, and there are too many variables that cannot be controlled. But now is a special period, and I am not doing tocilizumab treatment to publish a journal with a high impact factor, but to save people. As long as I can Just let the patient get better—I can hand over all the treatment data on my side. If teachers are interested in doing this project, I can fully cooperate and never hide any secrets. It can even be said that I hope all teachers can discuss this project as soon as possible. After the research is carried out and the research on tocilizumab is implemented, this drug treatment can be quickly rolled out, so that more lives can be saved."

(End of this chapter)