Cárdenas Graciela, Torres-García Diana, Cervantes-Torres Jacquelynne, Rosales-Mendoza Sergio, Fleury Agnes, Fragoso Gladis, Laclette Juan Pedro, Sciutto Edda
Instituto Nacional de Neurología y Neurocirugía, Manuel Velasco Suárez, Ciudad de México, México.
Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México.
Arch Med Res. 2021 Feb;52(2):143-150. doi: 10.1016/j.arcmed.2020.10.014. Epub 2020 Oct 26.
The Chinese outbreak of SARS-CoV-2 during 2019 has become pandemic and the most important concerns are the acute respiratory distress syndrome (ARDS) and hyperinflammation developed by the population at risk (elderly and/or having obesity, diabetes, and hypertension) in whom clinical evolution quickly progresses to multi-organ dysfunction and fatal outcome. Immune dysregulation is linked to uncontrolled proinflammatory response characterized by the release of cytokines (cytokines storm). A proper control of this response is mandatory to improve clinical prognosis. In this context, glucocorticoids are able to change the expression of several genes involved in the inflammatory response leading to an improvement in acute respiratory distress. Although there are contradictory data in the literature, in this report we highlight the potential benefits of glucocorticoids as adjuvant therapy for hyperinflammation control; emphasizing that adequate dosage, timing, and delivery are crucial to reduce the dysregulated peripheral-and neuro-inflammatory response with minimal adverse effects. We propose the use of the intranasal route for glucocorticoid administration, which has been shown to effectively control the neuro-and peripheral-inflammatory response using low doses without generating unwanted side effects.
2019年中国爆发的新型冠状病毒肺炎已成为大流行病，最令人担忧的是急性呼吸窘迫综合征（ARDS）以及高危人群（老年人和/或患有肥胖症、糖尿病和高血压的人）出现的过度炎症反应，这些人的临床病情迅速发展为多器官功能障碍和致命后果。免疫失调与以细胞因子释放（细胞因子风暴）为特征的不受控制的促炎反应有关。适当控制这种反应对于改善临床预后至关重要。在这种情况下，糖皮质激素能够改变参与炎症反应的多个基因的表达，从而改善急性呼吸窘迫。尽管文献中有相互矛盾的数据，但在本报告中，我们强调了糖皮质激素作为控制过度炎症的辅助治疗的潜在益处；强调适当的剂量、时机和给药方式对于以最小的不良反应减少失调的外周和神经炎症反应至关重要。我们建议采用鼻内途径给予糖皮质激素，已证明该途径使用低剂量就能有效控制神经和外周炎症反应，且不会产生不良副作用。
