School of Public Health, The University of Hong Kong, Hong Kong.
Am J Med. 2009 Dec;122(12):1150.e11-21. doi: 10.1016/j.amjmed.2009.07.018.
Ribavirin and corticosteroids were used widely as front-line treatments for severe acute respiratory syndrome; however, previous evaluations were inconclusive. We assessed the effectiveness of ribavirin and corticosteroids as the initial treatment for severe acute respiratory syndrome using propensity score analysis.
We analyzed data on 1755 patients in Hong Kong and 191 patients in Toronto with severe acute respiratory syndrome using a generalized propensity score approach.
The adjusted excess case fatality ratios of patients with severe acute respiratory syndrome receiving the combined therapy of ribavirin and corticosteroids within 2 days of admission, compared with those receiving neither treatment within 2 days of admission, were 3.8% (95% confidence interval, -1.5 to 9.2) in Hong Kong and 2.1% (95% confidence interval, -44.3 to 48.5) in Toronto.
Our results add strength to the hypothesis that the combination of ribavirin and corticosteroids has no therapeutic benefit when given early during severe acute respiratory syndrome infection. Further studies may investigate the effects of these treatments later in disease course.
利巴韦林和皮质类固醇曾广泛用于治疗严重急性呼吸综合征的一线治疗；然而，以前的评估结果并不一致。我们使用倾向评分分析评估利巴韦林和皮质类固醇作为严重急性呼吸综合征初始治疗的有效性。
我们使用广义倾向评分方法分析了香港 1755 例和多伦多 191 例严重急性呼吸综合征患者的数据。
与在入院后 2 天内既未接受利巴韦林也未接受皮质类固醇治疗的患者相比，在入院后 2 天内接受利巴韦林和皮质类固醇联合治疗的严重急性呼吸综合征患者的调整后超额病死率比为 3.8%（95%置信区间，-1.5 至 9.2）在香港和 2.1%（95%置信区间，-44.3 至 48.5）在多伦多。
我们的结果进一步支持了利巴韦林和皮质类固醇联合治疗在严重急性呼吸综合征感染早期使用没有治疗益处的假设。进一步的研究可能会在疾病过程的后期研究这些治疗方法的效果。
