糖皮质激素在普通型新冠肺炎治疗中的探索

doi:10.3877/cma.j.issn.1674-6902.2020.04.014

目的

探讨糖皮质激素在普通冠状病毒病(COVID-19)患者治疗中的作用。

方法

对2020年1月24日至3月5日在我院救治的COVID-19的51例普通型患者进行回顾性分析研究。根据患者发热、炎症指标、胸部CT等，充分评估患者发展为重型/危重型的风险，将患者分为低危组19例、中危组21例、高危组11例，高危组给予早期、小剂量、短疗程糖皮质激素治疗。

结果

三组在性别和年龄构成比上无统计学差异(P>0.05)；三组患者平均住院天数及核酸平均转阴天数均无统计学差异(P>0.05)；高危组较中危组及低危组患者入院时C-反应蛋白比较有统计学差异(P<0.05)；高危组较中危组白介素-6差异无统计学意义(P＝0.552)，但两组较低危组比较差异均具有统计学意义(P<0.05)；高危组、中危组较、低危组入院时外周血淋巴细胞总数有差异(P<0.05)，但高危组出院时淋巴细胞总数较入院时无差异(P>0.05)。

结论

对COVID-2019普通型部分患者早期使用小剂量、短疗程的糖皮质激素，具有快速抑制炎症反应，阻断其向重型/危重型转化的可能，在新冠肺炎的救治中有一定的临床应用价值。

关键词: 新冠病毒病, 糖皮质激素, 普通型

Objective

To investigate the role of glucocorticoids in the treatment of the patients with novel coronavirus pneumonia (corona virus disease-2019, COVID-19).

Methods

An exploratory study was performed on the 51 patients with COVID-19 treated in our hospital from January 24 to March 5, 2020. We fully evaluated the risk of the patients developing into severe/critically severe types according to the patients′fever, inflammation index, and chest CT, etc. The patients were divided into a low-risk group (n=19), a medium-risk group (n=21) and a high-risk group (n=11). The high-risk group was given early, small dose and short course of glucocorticoids treatment.

Results

There was no statistical difference in the gender and age composition among the three groups (P>0.05), and there was no statistical difference in the average hospitalization days and the average number of days of negative nucleic acid transfer among the three groups, either (P>0.05). However, there was significant difference in C-reactive protein (CRP) between the high-risk group and the low-risk group (P<0.05). There was no significant difference in interleukin-6 (IL-6) between the high-risk group and the middle-risk group (P=0.552), but there was significant difference between the two groups and the low-risk group (P<0.05). On patients′admission, the total lymphocytes in the peripheral blood in the high-risk group and the middle-risk group were different from that of the low risk group (P<0.05). However, at patients′discharge, there was no statistical difference in the total lymphocytes in the high-risk group (P>0.05) compared with that on admission.

Conclusion

The early use of small dose and short course of glucocorticoids in the patients with common type of COVID-19 has the possibility of rapidly inhibiting the inflammatory response and blocking the development into severe/critical types, which may have certain clinical application values.

Key words: Coronavirus disease 2019, Glucocorticoid, Common type

表1 各组患者入院时CRP、IL-6及外周血L淋巴细胞计数的比较

组　别	组别	CRP	IL-6	LYM(入院时)	LYM(出院时)
低危组	19	6.07±4.26	4.72±3.71	1.59±0.50	1.62±0.32
中危组	21	18.86±10.61^a	19.83±16.99^a	1.19±0.43^a	1.58±0.48
高危组	11	49.53±27.72^b	30.25±21.71^a	1.03±0.58^a	1.43±0.62^c

表1 各组患者入院时CRP、IL-6及外周血L淋巴细胞计数的比较

组　别	组别	CRP	IL-6	LYM(入院时)	LYM(出院时)
低危组	19	6.07±4.26	4.72±3.71	1.59±0.50	1.62±0.32
中危组	21	18.86±10.61^a	19.83±16.99^a	1.19±0.43^a	1.58±0.48
高危组	11	49.53±27.72^b	30.25±21.71^a	1.03±0.58^a	1.43±0.62^c

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Effect of glucocorticoids on treatment of common patients with corona virus disease-2019

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Effect of glucocorticoids on treatment of common patients with corona virus disease-2019