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大剂量静脉注射维生素 C 对重症 COVID-19 肺炎患者有益：一项回顾性病例系列研究。

Beneficial aspects of high dose intravenous vitamin C on patients with COVID-19 pneumonia in severe condition: a retrospective case series study.

机构信息

Emergency Department of Ruijin Hospital, School of Medicine Shanghai Jiao Tong University, Shanghai, China.

Department of Infectious Disease, Shanghai Public Health Clinical Center, Shanghai, China.

出版信息

Ann Palliat Med. 2021 Feb;10(2):1599-1609. doi: 10.21037/apm-20-1387. Epub 2020 Nov 17.

DOI:10.21037/apm-20-1387

PMID:33222462

Abstract

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a global public health event without specific therapeutic agents till now. We aim to determine if high dose intravenous vitamin C (HDIVC) was effective for COVID-19 patients in severe condition.

METHODS

COVID-19 patients admitted in Shanghai Public Health Clinical Center from January 22, 2020 to April 11, 2020 were retrospectively scrolled. The enrolled patients were those with confirmed diagnosis of severe or critical COVID-19 pneumonia, who received HDIVC within 24 hours after disease aggravation. Main clinical outcomes obtained from 3-5 days (day 3) and 7-10 days (day 7) after HDIVC were compared to the ones just before (day 0) HDIVC.

RESULTS

Totally, twelve patients were enrolled including six severe [age of mean, 56; interquartile range (IQR), 32-65 years, 3 men] and six critical (age of mean, 63; IQR, 60-82 years, 4 men) patients. The dosage of vitamin C [median (IQR), mg/kg (body weight)/day] were [162.7 (71.1-328.6)] for severe and [178.6 (133.3-350.6)] for critical patients. By Generalized estimating equation (GEE) model, C-reactive protein (CRP) was found to decrease significantly from day 0 to 3 and 7 (severe: 59.01±37.9, 12.36±22.12, 8.95±20.4; critical: 92.5±41.21, 33.9±30.2, 59.56±41.4 mg/L). Lymphocyte and CD4+ T cell counts in severe patients reached to normal level since day 3. Similar improving trends were observed for PaO2/FiO2 (severe: 209.3±111.7, 313.4±146, 423.3±140.8; critical: 119.9±52.7, 201.8±86.64, 190.5±51.99) and sequential organ failure assessment score (severe: 2.83±1.72, 1.33±1.63, 0.67±1.03; critical: 6.67±2.34, 4.17±2.32, 3.83±2.56). Better improving effect was observed in severe than critical patients after HDIVC.

CONCLUSIONS

HDIVC might be beneficial in aspects of inflammatory response, immune and organ function for aggravation of COVID-19 patients. Further clinical trials are in warrant.

TRIAL REGISTRATION

This trial has been retrospectively registered in Chinese Clinical Trail Registry (ChiCTR2000032716) on May 8, 2020. http://www.chictr.org.cn/showproj.aspx?proj=53389.

摘要

背景

2019 年冠状病毒病（COVID-19）是一项全球性的公共卫生事件，目前尚无特定的治疗药物。我们旨在确定高剂量静脉内维生素 C（HDIVC）对 COVID-19 重症患者是否有效。

方法

回顾性滚动了 2020 年 1 月 22 日至 4 月 11 日期间在上海公共卫生临床中心收治的 COVID-19 患者。纳入的患者为确诊为严重或危重症 COVID-19 肺炎的患者，在病情恶化后 24 小时内接受 HDIVC。将 HDIVC 后 3-5 天（第 3 天）和 7-10 天（第 7 天）的主要临床结局与 HDIVC 前（第 0 天）进行比较。

结果

共纳入 12 例患者，其中 6 例为严重（平均年龄 56 岁；四分位距 [IQR]，32-65 岁，3 名男性）和 6 例为危重症（平均年龄 63 岁；IQR，60-82 岁，4 名男性）。维生素 C 的剂量[中位数（IQR），mg/kg（体重）/天]分别为严重患者的[162.7（71.1-328.6）]和危重症患者的[178.6（133.3-350.6）]。通过广义估计方程（GEE）模型，发现 C 反应蛋白（CRP）从第 0 天到第 3 天和第 7 天显著下降（严重患者：59.01±37.9、12.36±22.12、8.95±20.4；危重症患者：92.5±41.21、33.9±30.2、59.56±41.4 mg/L）。严重患者的淋巴细胞和 CD4+T 细胞计数从第 3 天开始恢复正常水平。同样的改善趋势也观察到了 PaO2/FiO2（严重患者：209.3±111.7、313.4±146、423.3±140.8；危重症患者：119.9±52.7、201.8±86.64、190.5±51.99）和序贯器官衰竭评估评分（严重患者：2.83±1.72、1.33±1.63、0.67±1.03；危重症患者：6.67±2.34、4.17±2.32、3.83±2.56）。HDIVC 后严重患者的改善效果优于危重症患者。