Stockman Lauren J, Bellamy Richard, Garner Paul
Centers for Disease Control and Prevention, Respiratory and Enteric Viruses Branch, Atlanta, Georgia, United States of America.
PLoS Med. 2006 Sep;3(9):e343. doi: 10.1371/journal.pmed.0030343.
The SARS outbreak of 2002-2003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options. The World Health Organization (WHO) expert panel on SARS treatment requested a systematic review and comprehensive summary of treatments used for SARS-infected patients in order to guide future treatment and identify priorities for research.
In response to the WHO request we conducted a systematic review of the published literature on ribavirin, corticosteroids, lopinavir and ritonavir (LPV/r), type I interferon (IFN), intravenous immunoglobulin (IVIG), and SARS convalescent plasma from both in vitro studies and in SARS patients. We also searched for clinical trial evidence of treatment for acute respiratory distress syndrome. Sources of data were the literature databases MEDLINE, EMBASE, BIOSIS, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to February 2005. Data from publications were extracted and evidence within studies was classified using predefined criteria. In total, 54 SARS treatment studies, 15 in vitro studies, and three acute respiratory distress syndrome studies met our inclusion criteria. Within in vitro studies, ribavirin, lopinavir, and type I IFN showed inhibition of SARS-CoV in tissue culture. In SARS-infected patient reports on ribavirin, 26 studies were classified as inconclusive, and four showed possible harm. Seven studies of convalescent plasma or IVIG, three of IFN type I, and two of LPV/r were inconclusive. In 29 studies of steroid use, 25 were inconclusive and four were classified as causing possible harm.
Despite an extensive literature reporting on SARS treatments, it was not possible to determine whether treatments benefited patients during the SARS outbreak. Some may have been harmful. Clinical trials should be designed to validate a standard protocol for dosage and timing, and to accrue data in real time during future outbreaks to monitor specific adverse effects and help inform treatment.
2002 - 2003年的严重急性呼吸综合征（SARS）疫情给临床医生带来了一种新的、危及生命的疾病，他们对此毫无治疗经验，也没有关于治疗方案有效性的研究。世界卫生组织（WHO）SARS治疗专家小组要求对SARS感染患者的治疗方法进行系统综述和全面总结，以指导未来的治疗并确定研究重点。
为响应WHO的要求，我们对已发表的关于利巴韦林、皮质类固醇、洛匹那韦和利托那韦（LPV/r）、I型干扰素（IFN）、静脉注射免疫球蛋白（IVIG）以及SARS康复期血浆的文献进行了系统综述，这些文献涵盖体外研究和SARS患者研究。我们还搜索了急性呼吸窘迫综合征治疗的临床试验证据。数据来源为截至2005年2月的文献数据库MEDLINE、EMBASE、BIOSIS以及Cochrane对照试验中央注册库（CENTRAL）。从出版物中提取数据，并使用预定义标准对研究中的证据进行分类。总共有54项SARS治疗研究、15项体外研究和3项急性呼吸窘迫综合征研究符合我们的纳入标准。在体外研究中，利巴韦林、洛匹那韦和I型干扰素在组织培养中显示出对SARS-CoV的抑制作用。在关于利巴韦林的SARS感染患者报告中，26项研究被归类为无定论，4项显示可能有害。7项关于康复期血浆或IVIG的研究、3项I型干扰素研究以及2项LPV/r研究均无定论。在29项关于使用类固醇的研究中，25项无定论，4项被归类为可能造成伤害。
尽管有大量关于SARS治疗的文献报道，但在SARS疫情期间无法确定这些治疗方法是否对患者有益。有些可能是有害的。应设计临床试验来验证剂量和时间的标准方案，并在未来疫情期间实时积累数据，以监测特定不良反应并为治疗提供参考。
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