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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2020年05期

页码:

586-591

栏目:

论著

出版日期:

2020-10-20

文章信息/Info

Title:

A retrospective analysis of adjuvant glucocorticoid therapy for severe COVID-19

作者:

刘 熙¹; 朱天怡²; 王美菊¹; 李聪聪²; 徐 瑜¹; 郭 亮¹; 张文静¹; 王 斌¹; 胡明冬¹; 李 琦¹; 马 壮²; 宋 青³

400037 重庆,陆军(第三)军医大学第二附属医院呼吸与危重症医学中心¹ 110016 沈阳,中国人民解放军北部战区总医院呼吸与重症医学科² 100853 北京,中国人民解放军总医院第一医学中心急危重症中心³

Author(s):

Liu Xi¹;  Zhu Tianyi²;  Wang Meiju¹;  Li Congcong²;  Xu Yu¹;  Guo Liang¹;  Zhang Wenjing¹;  Wang Bin¹;  Hu Mingdong¹;  Li Qi¹;  Ma Zhuang²;  Song Qing³.

¹Center of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Army Medical University, Chongqing 400037, China; ²Department of Respiratory and Critical Care Medicine, Northern Theater General Hospital of PLA, Shenyang 110016, China; ³Department of Critical Care Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China

关键词:

重型新型冠状病毒肺炎;  严重急性呼吸综合征冠状病毒-2;  糖皮质激素;  回顾性分析

Keywords:

Severe coronavirus disease 2019;  Severe acute respiratory syndrome coronavirus 2;  Glucocorticoid;  Retrospective analysis

分类号:

R563

DOI:

10.3877/cma.j.issn.1674-6902.2020.05.002

摘要:

目的 探讨糖皮质激素辅助治疗对重型新型冠状病毒肺炎(COVID-19)患者的影响,为进一步优化COVID-19的治疗策略提供参考。方法 纳入某医院普通病区2020年2月28日在院且被确诊为重型COVID-19的195例患者,根据有无糖皮质激素用药史分为激素组和非激素组。回顾性分析各组患者一般资料、激素用药情况、病程中不同阶段的体温、当日最佳指氧饱和度、血常规相关信息、C反应蛋白(CRP)、降钙素原(PCT)及相关不良反应发生情况、咽拭子SARS-CoV-2核酸转阴时间和转归。结果 激素组和非激素组患者均以男性为主,平均年龄相近(63.01±11.93 vs. 62.20±14.26)岁,临床症状、合并基础疾病、病程、抗病毒治疗、体温等情况基本一致(P>0.05)。激素组指氧饱和度低于非激素组[96(92～98)vs. 97(95～98),P<0.05]。激素组白细胞计数和中性粒细胞绝对值在正常范围但明显高于非激素组(P<0.05),淋巴细胞绝对值明显低于非激素组[0.90(0.68～1.10)vs. 1.29(0.93～1.62),P<0.05],CRP明显高于非激素组[34.56(9.69～62.27)vs. 7.60(2.19～37.28),P<0.05]。经治疗,激素组(激素干预后)指氧饱和度较非激素组(入院后1周)更优[99(98～99)vs. 98(97～99),P<0.05],白细胞计数和中性粒细胞绝对值有所增加且明显高于非激素组(入院1周后)(P<0.05)但仍在正常范围内,淋巴细胞计数明显回升且与非激素组(入院后1周)相近[1.39(1.08～2.18)vs. 1.36(1.05～1.82),P>0.05]; CRP值回落且与非激素组(入院后1周)相近(P>0.05)。对激素组按激素累积剂量行亚组分析无阳性发现。各组患者咽拭子SARS-CoV-2核酸转阴时间中位数相近[20.00(15.00～26.00)d vs. 19.00(13.00～23.00)d],组间无差异(P>0.05)。激素组共报告6例、8人次不良反应,男性为主,年龄多在70岁以上,均报告血糖较基线水平明显升高,其中2例还出现血压较基线水平明显升高。非激素组无不良反应报告。各组患者均好转出院,无病情恶化和死亡报告。因数据缺失较多,为避免偏倚,PCT未予纳入分析。结论 在缺乏高级别循证医学证据支持的抗病毒药物情况下,在强化治疗的基础上给予重症COVID-19患者适当剂量和疗程的激素治疗,可能改善氧合,使患者更多临床获益,且用药风险可控,转归预期好。但本项目存在一定局限性,开展激素辅助治疗COVID-19的随机对照研究是必要的。

Abstract:

Objective To analyze the effects of adjuvant glucocorticoid therapy on severe patients with COVID-19 in order to optimize the treatment for severe COVID-19. Methods 195 patients confirmed as severe COVID-19 in non-ICU wards of one Hospital hospitalizing on Feb 28, 2020, were enrolled and divided into glucocorticoid treatment group(GC group)and non-glucocorticoid treatment group(non-GC group)by medication history. We retrospectively analyzed all patients'data including general information, glucocorticoid therapy information, temperature and best value of SpO₂ in one day when recorded, some results of complete blood count, values of C reaction protein(CRP)and procalcitonin(PCT), glucocorticoid associated adverse reaction, pharyngeal swab SARS-CoV-2 nucleic acid negative time and final outcomes. Results Patients in both groups were characterized by male, similar average age(63.01±11.93 vs. 62.20±14.26, years)and with no significant difference on clinical characters, comorbidity, clinical course, antiviral therapy and temperature. Value of SPO₂ in GC group was lower than which in non-GC group[96(92-98)vs. 97(95-98),(P<0.05)]. Values of WBC and absolute neutrophil count(ANC)in GC group were normal but significantly higher than which in non-GC group. Compared with non-GC group, value of absolute lymphocyte count in GC group was significantly lower [0.90(0.68-1.10)vs. 1.29(0.93-1.62), P<0.05] and value of CRP in the same group was significantly higher [34.56(9.69-62.27)vs. 7.60(2.19-37.28), P<0.05]. After treating, value of SpO₂ in GC group was significantly higher than which in non-GC group [99(98-99)vs. 98(97-99), P<0.05)] admitted into hospital one week later. Mean while, values of WBC and ANC in GC group rose respectively, compared to the baseline level,and were significantly higher than which in non-GC group but normal. And value of absolute lymphocyte count in GC group rose significantly and was similar to which in non-GC group [1.39(1.08-2.18)vs.1.36(1.05-1.82), P>0.05], after treating, but with no difference. GC group's patients'value of CRP significantly fell down and was similar to which in non-GC group admitted into hospital one week later. Analyses of subgroups divided by the accumulated dose of glucocorticoid showed no significant difference. Pharyngeal swab SARS-CoV-2 nucleic acid negative median time in both groups were similar with no statistical difference. Six cases of hyperglycemia, including blood pressure significantly higher than baseline level in two of the above, were observed in GC group, characterized by male and elder than 70 years. No case with adverse reaction was observed in non-GC group. All patients in both groups were discharged from hospital after recovery with no deterioration and death. Values of PCT in both groups were not analysed in order to avoiding bias for data missing. Conclusion The appropriate dose and course of glucocorticoid with other intensive treating may improve oxygenation of severe COIVD-19 patients and help the patients obtain more clinical benefits with controlled risk and favorable outcomes, for the absence of high grade level evidence-based medical recommendation for antiviral therapy. However, there are some limitations in our study and it is necessary to research the adjuvant glucocorticoid therapy for COVID-19 by a randomized controlled trial.

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备注/Memo

备注/Memo:

基金项目: 国家自然科学基金青年科学基金项目(81700072) 通信作者: 李 琦, Email: liqioliver@sina.com 马 壮, Email: ma_tianyi@163.com 宋 青, Email: songqing3010301@sina.com

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更新日期/Last Update: 2020-10-20