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低剂量皮质类固醇激素在非重症新型冠状病毒肺炎中的合理应用:一例报告

Judicious use of low-dosage corticosteroids for non-severe COVID-19: A case report.

作者信息

Zhang Jian, Tian Zigang, Feng Lina, Yang Zhongming, Zou Bo, Li Kun, Zhang Yingliang, Wang Yaguo, Fleming Joy, Cui Wenyu

机构信息

Department of Infectious Diseases, Changchun Infectious Diseases Hospital, Changchun, Jilin, China 130123.

Surgical Department of Tuberculosis, Changchun Infectious Diseases Hospital, Changchun, Jilin, China 130123.

出版信息

Open Med (Wars). 2021 Mar 19;16(1):440-445. doi: 10.1515/med-2021-0250. eCollection 2021.

Abstract

Inflammation-mediated lung injury in severe cases of infection with SARS-CoV-2, the aetiological agent of Coronavirus disease 2019 (COVID-19), can lead to respiratory failure and death, and therapies that block or ameliorate lung injury-associated inflammatory "cytokine storms" and progression to acute respiratory distress syndrome (ARDS) are urgently needed. Therapeutic use of corticosteroids for this purpose has been controversial because of conflicting reports on their efficacy and immunosuppressive behaviour. The WHO has strongly recommended treating critical COVID-19 patients with systemic corticosteroid therapy, but recommends against corticosteroid therapy in non-severe COVID-19 disease because of a lack of strong evidence on its efficacy. This retrospective case report describing the successful treatment of a non-severe COVID-19 case in Changchun, China, by judicious administration of corticosteroids using a personalized therapeutic approach was recorded to strengthen the evidence base showing how corticosteroid use in non-severe COVID-19 cases can be safe and efficacious. Alongside supportive care and lopinavir/ritonavir antiviral drugs, a low dosage of methylprednisolone was administered over a short period to attenuate lung inflammation. Regular chest CT scans guided dosage reduction in response to lesion absorption and improved lung condition. Judicious use of corticosteroids safely attenuated disease progression and facilitated rapid and complete recovery.

摘要

新型冠状病毒肺炎(COVID-19)的病原体严重急性呼吸综合征冠状病毒2型(SARS-CoV-2)感染引发的炎症介导的肺损伤可导致呼吸衰竭和死亡,因此迫切需要能够阻断或改善与肺损伤相关的炎症“细胞因子风暴”以及预防发展为急性呼吸窘迫综合征(ARDS)的治疗方法。由于关于皮质类固醇疗效和免疫抑制行为的报道相互矛盾,其用于此目的的治疗用途一直存在争议。世界卫生组织强烈建议对重症COVID-19患者采用全身皮质类固醇治疗,但由于缺乏其疗效的确凿证据,不建议对非重症COVID-19疾病患者使用皮质类固醇治疗。本回顾性病例报告记录了在中国长春通过采用个性化治疗方法明智地使用皮质类固醇成功治疗一例非重症COVID-19病例的过程,以加强证据基础,证明在非重症COVID-19病例中使用皮质类固醇如何能够安全有效。除了支持性护理和洛匹那韦/利托那韦抗病毒药物外,短期内给予低剂量甲泼尼龙以减轻肺部炎症。定期胸部CT扫描根据病变吸收情况和肺部状况改善指导减少剂量。明智地使用皮质类固醇安全地减缓了疾病进展,并促进了快速完全康复。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/12c2/7985569/4535b98dc6dc/j_med-2021-0250-fig001.jpg

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