Department of Palliative Care, The Sixth Affiliated Hospital of Dali University, The Third People's Hospital of Kunming, China.
Department of Clinical Laboratory, The Sixth Affiliated Hospital of Dali University, The Third People's Hospital of Kunming, China.
Biomed Res Int. 2020 Sep 23;2020:2854186. doi: 10.1155/2020/2854186. eCollection 2020.
To evaluate the role of short-term low-dose glucocorticoids in mild COVID-19 patients.
We conducted a retrospective, cross-sectional, single-center study in Kunming, China. A total of 33 mild COVID-19 cases were divided into two treatment groups (with and without glucocorticoids, methylprednisolone, were used in this setting), and the absolute value of peripheral blood lymphocyte count; CD3+, CD4+, and CD8+ T cell counts; and the time to achieve negative transformation of a nucleic acid pharyngeal swab were recorded. Peripheral blood lymphocyte and T cell counts were compared between the treatment group and 25 healthy individuals. At the point of time when there was a 50% accumulation conversion rate (positive to negative nucleic acid on pharyngeal swab), and the nucleic acid turned negative in half of the patients in two groups, the peripheral blood lymphocyte and T cell counts were compared between treatment groups.
The mean cumulative time for the 50% negative conversion rate of the nucleic acid in the pharyngeal swab was 17.7 ± 5.1 days and 13.9 ± 5.4 days in the glucocorticoid group and the nonglucocorticoid group, respectively. The absolute peripheral blood lymphocyte count and the T cell subset count in the glucocorticoid group were lower than those in the nonglucocorticoid group. When the nucleic acid turned negative in half of the patients, the absolute value of peripheral blood lymphocyte count and CD4+ T cells of the glucocorticoid group and the nonglucocorticoid group was not significantly different; the CD3+ and CD8+ T cells in the glucocorticoid group were lower than those in the nonglucocorticoid group. The absolute peripheral blood lymphocyte count, CD3+ T cells, and CD4+ T cells in the glucocorticoid group were lower than those of the healthy group during the whole disease period, and CD8+ T cells returned to normal at 19-21 days of the disease period. There was no significant difference between the nonglucocorticoid group and the healthy group for absolute peripheral blood lymphocyte and CD8+ T cells; moreover, CD3+ T cells and CD4+ T cells were lower in the nonglucocorticoid group than those in the healthy group from the day of admission to the 18th day and returned to normal at the period of 19-21 days. The absolute peripheral lymphocyte count ( = 0.048, effect size = 0.727) and T cell subset count (CD3: = 0.042, effect size = 0.655; CD4: < 0.01, effect size = 0.599; and CD8: = 0.034, effect size = 0.550) in the nonglucocorticoid group were higher than those in the glucocorticoid group, and the difference between the groups was statistically significant.
This study found that the use of short-term, low-dose glucocorticoids does not negatively influence the clinical outcome, without affecting the final clearance of viral nucleic acid in mild COVID-19 patients.
评估短期小剂量糖皮质激素在轻症 COVID-19 患者中的作用。
我们在中国昆明进行了一项回顾性、横断面、单中心研究。33 例轻症 COVID-19 患者被分为两组（使用和不使用糖皮质激素，在此设置中使用甲泼尼龙），并记录外周血淋巴细胞计数绝对值；CD3+、CD4+和 CD8+T 细胞计数；以及达到咽拭子核酸阴性转化的时间。将治疗组与 25 名健康个体的外周血淋巴细胞和 T 细胞计数进行比较。当出现 50%累积转化率（咽拭子核酸阳性转为阴性）时，以及两组中一半患者的核酸转为阴性时，比较治疗组之间的外周血淋巴细胞和 T 细胞计数。
咽拭子核酸 50%阴性转化率的平均累积时间在糖皮质激素组和非糖皮质激素组分别为 17.7±5.1 天和 13.9±5.4 天。糖皮质激素组的外周血淋巴细胞计数绝对值和 T 细胞亚群计数均低于非糖皮质激素组。当一半患者的核酸转为阴性时，糖皮质激素组和非糖皮质激素组的外周血淋巴细胞计数绝对值和 CD4+T 细胞无显著差异；糖皮质激素组的 CD3+和 CD8+T 细胞低于非糖皮质激素组。在整个疾病期间，糖皮质激素组的外周血淋巴细胞计数绝对值、CD3+T 细胞和 CD4+T 细胞均低于健康组，而 CD8+T 细胞在疾病第 19-21 天恢复正常。非糖皮质激素组与健康组之间在外周血淋巴细胞计数绝对值和 CD8+T 细胞方面无显著差异；此外，非糖皮质激素组从入院第 1 天到第 18 天的 CD3+T 细胞和 CD4+T 细胞均低于健康组，而在第 19-21 天恢复正常。非糖皮质激素组的外周血淋巴细胞计数绝对值（ = 0.048，效应量 = 0.727）和 T 细胞亚群计数（CD3： = 0.042，效应量 = 0.655；CD4： < 0.01，效应量 = 0.599；CD8： = 0.034，效应量 = 0.550）均高于糖皮质激素组，组间差异具有统计学意义。
本研究发现，短期小剂量使用糖皮质激素不会对轻症 COVID-19 患者的临床结局产生负面影响，也不会影响病毒核酸的最终清除。
