Department of Infectious Diseases, Zhongshan Hospital Fudan University, Shanghai, China.
Department of Infectious Diseases, Shanghai Public Health Clinical Center, China.
Biosci Trends. 2021 Jan 23;14(6):408-414. doi: 10.5582/bst.2020.03340. Epub 2020 Dec 18.
The aim of this study is to assess the efficacy of multiple treatments, especially hydroxychloroquine, used in different disease stages of coronavirus disease 2019 (COVID-19). All consecutive patients with COVID-19 admitted to Shanghai Public Health Clinical Center (Shanghai, China) between January 20, 2020, and April 30, 2020, were enrolled, and their clinical data were retrospectively collected. Binary logistic regression was used to screen the factors associated with disease aggravation, and multivariable analyses with the Cox proportional hazards model were used to estimate the effects of prognostic factors on the improvement time and PCR conversion days in throat swabs and stool swabs. A total of 616 patients, including 50 (8.11%) severe and 18 (2.92%) critical patients, were enrolled in our retrospective cohort study. The early use of hydroxychloroquine was a protective factor associated with disease aggravation (95% CI: 0.040-0.575, p = 0.006). Clinical improvement by 20 days was significantly different between patients with hydroxychloroquine used early and those with hydroxychloroquine not used (p = 0.016, 95% CI: 1.052-1.647). The median time to clinical improvement was 6 days in the hydroxychloroquine used early group, compared with 9 days in the without hydroxychloroquine used group and 8 days in the with hydroxychloroquine not used early group (p < 0.001). Hydroxychloroquine used early was associated with earlier PCR conversion in both throat swabs (HR = 1.558, p = 0.001) and stool swabs (HR = 1.400, p = 0.028). The use of hydroxychloroquine at an early stage is a potential therapeutic strategy for treating patients before irreversible severe respiratory complications occur. The early use of hydroxychloroquine decreased the improvement time and the duration of COVID-19 detection in throat and stool swabs.
本研究旨在评估多种治疗方法，尤其是羟氯喹，在新冠肺炎（COVID-19）不同疾病阶段的疗效。2020 年 1 月 20 日至 4 月 30 日期间，连续收治于上海公共卫生临床中心（上海）的所有 COVID-19 患者均被纳入研究，并回顾性收集其临床资料。采用二项逻辑回归筛选疾病加重相关因素，采用多变量 COX 比例风险模型分析估计预后因素对改善时间及咽拭子和粪便拭子 PCR 转换天数的影响。本回顾性队列研究共纳入 616 例患者，其中重症 50 例（8.11%），危重症 18 例（2.92%）。早期使用羟氯喹是疾病加重的保护因素（95%CI：0.040-0.575，p=0.006）。与未使用羟氯喹的患者相比，早期使用羟氯喹的患者 20 天临床改善的差异有统计学意义（p=0.016，95%CI：1.052-1.647）。早期使用羟氯喹组的中位临床改善时间为 6 天，而未使用羟氯喹组和未早期使用羟氯喹组的中位改善时间分别为 9 天和 8 天（p<0.001）。早期使用羟氯喹与咽拭子（HR=1.558，p=0.001）和粪便拭子（HR=1.400，p=0.028）的 PCR 转换时间更早有关。早期使用羟氯喹是一种有潜力的治疗策略，可用于治疗在不可逆严重呼吸并发症发生前的患者。早期使用羟氯喹可缩短 COVID-19 患者的改善时间和咽拭子及粪便拭子的检测持续时间。
