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COVID-19 的发病机制、预后因素和治疗策略:紧急建议。

COVID-19 pathogenesis, prognostic factors, and treatment strategy: Urgent recommendations.

机构信息

Department of Medscience, Translational Research Center for Medical Innovation, Foundation for Biomedical Research and Innovation, Kobe, Japan.

出版信息

J Med Virol. 2021 May;93(5):2694-2704. doi: 10.1002/jmv.26754. Epub 2021 Jan 11.

Abstract

The pandemic of novel coronavirus disease (COVID-19) is not yet close to being over, more than 8 months after the first cases, but researchers are making great progress in fighting the disease. We have conducted a brief review of the geographic differences in the prevalence of COVID-19, the updated pathological findings, prognostic factors, and treatments for disease prevention and improvement of prognosis. Although hydroxychloroquine and tocilizumab have been recommended by some researchers, many clinical trials have failed to confirm any beneficial effect of these and other drugs on COVID-19, in terms of improved clinical status or reduced patient mortality. Currently, glucocorticoid is the only drug that reduces the mortality of COVID-19 in a randomized controlled trial; however, it is still necessary to establish the optimal timing of administration. It is also urgent to set up an international or national cohort to address the risk factors associated with infection, the natural history of COVID-19, including the disease type, surrogate markers for critically ill, long-term sequelae, and reinfection after exposure, identify responders to glucocorticoid, and establish optimal treatment strategies for disease control.

摘要

新型冠状病毒病(COVID-19)大流行尚未结束,距离首例病例已超过 8 个月,但研究人员在抗击该疾病方面取得了重大进展。我们简要回顾了 COVID-19 的地域流行差异、更新的病理发现、预后因素以及疾病预防和改善预后的治疗方法。尽管一些研究人员推荐使用羟氯喹和托珠单抗,但许多临床试验未能证实这些药物和其他药物对 COVID-19 的临床状况改善或降低患者死亡率有任何有益作用。目前,糖皮质激素是唯一在随机对照试验中降低 COVID-19 死亡率的药物;然而,仍有必要确定给药的最佳时机。建立一个国际或国家队列以解决与感染相关的风险因素、COVID-19 的自然史,包括疾病类型、危重症替代标志物、暴露后的长期后遗症和再感染、识别糖皮质激素的应答者以及建立疾病控制的最佳治疗策略也迫在眉睫。

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