Sauñe Patricia Merab, Bryce-Alberti Mayte, Portmann-Baracco Arianna Sibila, Accinelli Roberto Alfonso
Facultad de Medicina, Universidad Privada San Juan Bautista, José Antonio Ave, 302-304, Chorrillos District, Lima, Peru.
Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Honorio Delgado Ave. 430, San Martín de Porres District, Lima, Peru.
Respir Med Case Rep. 2020 Sep 12;31:101221. doi: 10.1016/j.rmcr.2020.101221. eCollection 2020.
We present two cases of severe COVID-19 that were rejected by medical institutions. The management of the disease was done at home with methylprednisolone (MP) pulse therapy for three days. This resulted in a favorable evolution and resolution of most symptoms. COVID-19 infection presents as asymptomatic disease, non-severe symptomatic disease, and severe respiratory inflammatory disease. The first two forms are dependent on viral response and a "cytokine storm" is responsible for the progression into severe disease. Glucocorticoids (GC) reduce inflammation by different mechanism depending of their concentration. Pulses lead to overall apoptosis of immune cells. Studies using pulse MP as treatment for SARS-CoV-1 showed clinical improvement and decreased incidence of ARDS compared with patients who received low dose steroid treatment. Inhibition of excessive inflammation through timely administration of GC in the early stage of inflammatory cytokine storm effectively prevents the occurrence of ARDS.
我们报告了两例被医疗机构拒收的重症新型冠状病毒肺炎病例。在家中采用甲基强的松龙（MP）脉冲疗法对这两例疾病进行了三天的治疗。这导致了大多数症状的良好转归和缓解。新型冠状病毒肺炎感染表现为无症状疾病、非重症症状性疾病和重症呼吸道炎症性疾病。前两种形式取决于病毒反应，而“细胞因子风暴”是疾病进展为重症的原因。糖皮质激素（GC）根据其浓度通过不同机制减轻炎症。脉冲疗法导致免疫细胞整体凋亡。使用脉冲MP治疗严重急性呼吸综合征冠状病毒1（SARS-CoV-1）的研究表明，与接受低剂量类固醇治疗的患者相比，临床症状有所改善，急性呼吸窘迫综合征（ARDS）的发病率降低。在炎症细胞因子风暴的早期及时给予GC抑制过度炎症，可有效预防ARDS的发生。
