Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
Clin Microbiol Infect. 2020 Sep;26(9):1171-1177. doi: 10.1016/j.cmi.2020.06.020. Epub 2020 Jun 27.
Corticosteroids are commonly used as adjuvant therapy for acute respiratory distress syndrome by many clinicians because of their perceived anti-inflammatory effects. However, for patients with severe viral pneumonia, the corticosteroid treatment is highly controversial.
The purpose of this review is to systematically evaluate the effect and potential mechanism of corticosteroid administration in pandemic viral pneumonia.
We comprehensively searched all manuscripts on corticosteroid therapy for influenza, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and SARS coronavirus 2 (SARS-CoV-2) viral pneumonia from the PubMed, EMBASE, Web of Science and Cochrane Library databases.
We systematically summarized the effects of corticosteroid therapy for pandemic viral pneumonia and the potential mechanism of action for corticosteroids in coronavirus disease 2019 (COVID-19).
Observational studies showed that corticosteroid treatment was associated with increased mortality and nosocomial infections for influenza and delayed virus clearance for SARS-CoV and MERS-CoV. Limited data on corticosteroid therapy for COVID-19 were reported. Corticosteroids were used in about a fifth of patients (670/2995, 22.4%). Although clinical observational studies reported the improvement in symptoms and oxygenation for individuals with severe COVID-19 who received corticosteroid therapy, case fatality rate in the corticosteroid group was significantly higher than that in the non-corticosteroid group (69/443, 15.6% versus 56/1310, 4.3%). Compared individuals with non-severe disease, those with severe disease were more likely to receive corticosteroid therapy (201/382, 52.6% versus 201/1310, 15.3%). Although there is no evidence that corticosteroid therapy reduces mortality in people with COVID-19, some improvements in clinical symptoms and oxygenation were reported in some clinical observational studies. Excessive inflammatory response and lymphopenia might be critical factors associated with severity of and mortality from COVID-19. Sufficiently powered randomized controlled trials with rigorous inclusion/exclusion criteria and standardized dose and duration of corticosteroids are needed to verify the effectiveness and safety of corticosteroid therapy.
由于皮质类固醇具有抗炎作用，许多临床医生常将其作为急性呼吸窘迫综合征的辅助治疗药物。然而，对于患有严重病毒性肺炎的患者，皮质类固醇治疗存在很大争议。
本综述旨在系统评估皮质类固醇治疗大流行病毒性肺炎的效果和潜在机制。
我们全面检索了 PubMed、EMBASE、Web of Science 和 Cochrane Library 数据库中关于皮质类固醇治疗流感、严重急性呼吸综合征（SARS）、中东呼吸综合征（MERS）和 SARS 冠状病毒 2（SARS-CoV-2）病毒性肺炎的所有文献。
我们系统总结了皮质类固醇治疗大流行病毒性肺炎的效果以及皮质类固醇在 2019 年冠状病毒病（COVID-19）中的潜在作用机制。
观察性研究表明，皮质类固醇治疗与流感患者死亡率升高和院内感染增加以及 SARS-CoV 和 MERS-CoV 病毒清除延迟有关。COVID-19 皮质类固醇治疗的有限数据。皮质类固醇用于约五分之一的患者（2995 例中的 670 例，22.4%）。尽管临床观察性研究报告称，接受皮质类固醇治疗的重症 COVID-19 患者的症状和氧合情况有所改善，但皮质类固醇组的病死率明显高于非皮质类固醇组（69/443，15.6%对 56/1310，4.3%）。与非重症患者相比，重症患者更有可能接受皮质类固醇治疗（201/382，52.6%对 201/1310，15.3%）。尽管没有证据表明皮质类固醇治疗可降低 COVID-19 患者的死亡率，但一些临床观察性研究报告称，皮质类固醇治疗可改善临床症状和氧合。过度的炎症反应和淋巴细胞减少可能是与 COVID-19 严重程度和死亡率相关的关键因素。需要进行充分的、有严格纳入/排除标准、标准化剂量和疗程的皮质类固醇随机对照试验，以验证皮质类固醇治疗的有效性和安全性。
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