中国药物警戒 ›› 2021, Vol. 18 ›› Issue (10): 910-914.
DOI: 10.19803/j.1672-8629.2021.10.03

• 新型冠状病毒肺炎药物治疗研究专栏 • 上一篇    下一篇

糖皮质激素在早期干预快速进展新型冠状病毒肺炎患者的临床研究

李新刚1,2, 关春爽3, 鹿星梦2, 穆雪纯1, 王爱彬1, 张婷玉1, 葛子若1, 徐艳利1, 陈志海1,*, 宋蕊1#   

  1. 1首都医科大学附属北京地坛医院感染性疾病诊疗中心, 北京 100015;
    2首都医科大学附属北京地坛医院内分泌科, 北京 100015;
    3首都医科大学附属北京地坛医院放射科, 北京 100015
  • 收稿日期:2021-06-07 出版日期:2021-10-15 发布日期:2021-10-27
  • 通讯作者: *陈志海,男,硕士,主任医师,感染性疾病。E-mail：chenzhihai0001@126.com。#为共同通信作者。
  • 作者简介:李新刚,男,硕士,副主任医师,传染病合并内分泌系统疾病。
  • 基金资助:
    国家重点研发计划（2020YFC0848300）

Glucocorticoid Therapy for Early Intervention in Quick Progression of Hospitalized Patients with COVID-19

LI Xingang1,2, GUAN Chunshuang3, LU Xingmeng2, MU Xuechun1, WANG Aibin1, ZHANG Tingyu1, GE Ziruo1, XU Yanli1, CHEN Zhihai1*, SONG Rui1#   

  1. 1Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
    2Department of Endocrinology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;
    3Department of Radiology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2021-06-07 Online:2021-10-15 Published:2021-10-27

PDF (PC)

104

摘要： 目的 探讨地塞米松10 mg/5 mg序贯7日治疗新型冠状病毒肺炎（coronavirus disease 2019,COVID-19）患者病情进展中的临床应用。方法 选取2020年1月20日至2021年3月20日,首都医科大学附属北京地坛医院感染性疾病诊疗中心,COVID-19患者住院病情进展后应用糖皮质激素治疗32例,同时通过倾向性评分匹配病情进展非糖皮质激素治疗32例患者作为对照。结果 与常规治疗组相比,糖皮质激素治疗组在吸氧时间、胸CT好转天数、临床症状缓解时间进入ICU治疗患者比例均有明显减少;且病程第4、7、14天C-反应蛋白、粒淋比值恢复快,差异均有统计学意义（P<0.01）。AI辅助肺CT系统显示,在病程的第4天,糖皮质激素组的全肺炎病灶体积,全肺炎症病灶平均密度恢复均优于常规治疗组且差异有统计学意义（P<0.05）。在病程的第4天、第7天,糖皮质激素组的全肺炎症病灶体积/全肺容积优于常规治疗组且差异有统计学意义（P<0.05）。2组新冠病毒核酸转阴时间和住院时间差异没有统计学意义（P>0.05）。结论 地塞米松10 mg/5 mg序贯7日治疗对阻断COVID-19患者病情进展可能有效,在诊治过程中可以尝试使用。

关键词: 新型冠状病毒, 新型冠状病毒肺炎, 糖皮质激素, 地塞米松, 临床应用, 倾向性评分

Abstract: Objective To explore the clinical application of sequential therapy with dexamethasone 10mg/5mg in the treatment of COVID-19. Methods Cases of COVID-19 who were hospitalized in Beijing Ditan Hospital between January 20, 2020 and March 20, 2021 were retrospectively investigated. By propensity score matching, 32 patients in the glucocorticoid-treated group and another 32 patients in the control group were selected. Results Compared with the control group, the duration of oxygen inhalation, time taken by chest improvement shown by CT, clinical complete remission and the proportion of patients treated in ICUs in the glucocorticoid group were significantly shortened or reduced. On the fourth, seventh and fourteenth day of the course, levels of C-reactive protein and NE/LY recovered quickly（P<0.01）. AI-assisted CT showed that there was significant difference in the volume of inflammation lesions of the total lung and average density of lesions of the total lung between the two groups on the fourth day of the course（P<0.05）. There was significant difference in the percentage of volumes of inflammation lesions of the total lung on the fourth and seventh day of the course（P<0.05）. There was no statistically significant difference in the time taken by clearance of SARS-CoV-2 RNA and lengths of hospital stay between the two groups（P>0.05）. Conclusion Dexamethasone 10mg/5mg sequential therapy may be an effective treatment for progression of hospitalized patients with COVID-19, and can be tried in the process of diagnosis and treatment.

Key words: SARS-CoV-2, COVID-19, glucocorticoid, dexamethasone, clinical application, propensity score

中图分类号: